1
  CMS RIF REPORT FOR RECORD: DMERC_CLM_REC,  STATUS: PROD, VERSION: 21006
  PRINTED: 10/19/2021,  USER: F43D,  DATA SOURCE: CA REPOSITORY ON DB2T


       NAME                   LENGTH   BEG  END                                         CONTENTS
  -------------------------------------------------------------------------------------------------------------------------------
  ***  DMERC Claim Record (NCH)
                               VAR      1  18927    REC

                                                    STANDARD ALIAS : DMERC_CLM_REC
                                                    SYSTEM   ALIAS : UTLDMERL

                                                    LIMITATIONS :

                                                      REFER TO :
                                                       CHOICES_DEMO_LIM
                                                       PMT_AMT_EXCEDG_CHRG_AMT_LIM

  1.   DMERC Claim Fixed Group
                              1058      1   1058    GRP


  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).

                                                    NOTE3:  Effective with Version 'J', 3 new code values have
                                                    been added to include a type code for the Medicare
                                                    Advantage claims (IME/GME, no-pay and paid as FFS).
                                                    During the Version 'J' conversion, these type codes were
                                                    populated throughout history. With Version 'J', these claims
                                                    are also being stored in NMUD.  Prior to Version 'J' they
                                                    were only in the NCH.  No history was converted in NMUD.

                                                    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 62 (Medicare Advantage IME/GME
                                                    CLAIMS - 10/1/05 - FORWARD)
                                                    WHERE THE FOLLOWING CONDITIONS ARE MET:
                                                    1.   CLM_MCO_PD_SW = '0'
                                                    2.   CLM_RLT_COND_CD = '04' & '69'
                                                    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 63 (HMO NO-PAY CLAIMS)
                                                    WHERE THE FOLLOWING CONDITIONS ARE MET:
                                                    CLAIMS PROCESSED ON OR AFTER 10/6/08
                                                    1.   CLM_THRU_DT ON OR AFTER 10/1/06
                                                    2.   CLM_MCO_PD_SW = '1'
                                                    3.   CLM_RLT_COND_CD = '04'
                                                    4.   MCO_CNTRCT_NUM
                                                    MCO_OPTN_CD = 'A', 'B' OR 'C'
                                                    CLM_FROM_DT & CLM_THRU_DT ARE WITHIN THE
                                                    MCO_PRD_EFCTV_DT & MCO_PRD_TRMNTN_DT
                                                    ENROLLMENT PERIODS
                                                    5.   ZERO REIMBURSEMENT (CLM_PMT_AMT)

                                                    SET CLM_TYPE_CD TO 63 (HMO NO-PAY CLAIMS)
                                                    WHERE THE FOLLOWING CONDITIONS ARE MET:
                                                    CLAIMS PROCESSED PRIOR to 10/6/08
                                                    1.   MCO_CNTRCT_NUM
                                                    MCO_OPTN_CD = 'A', 'B' OR 'C'
                                                    CLM_FROM_DT & CLM_THRU_DT ARE WITHIN THE
                                                    MCO_PRD_EFCTV_DT & MCO_PRD_TRMNTN_DT
                                                    ENROLLMENT PERIODS
                                                    2.   ZERO REIMBURSEMENT (CLM_PMT_AMT)

                                                    SET CLM_TYPE_CD TO 64 (HMO CLAIMS PAID AS FFS)
                                                    WHERE THE FOLLOWING CONDITIONS ARE MET:
                                                    CLAIMS PROCESSED PRIOR to 10/6/08
                                                    1.   MCO_CNTRCT_NUM
                                                    MCO_OPTN_CD = '1', '2' OR '4'
                                                    CLM_FROM_DT & CLM_THRU_DT ARE WITHIN THE
                                                    MCO_PRD_EFCTV_DT & MCO_PRD_TRMNTN_DT
                                                    ENROLLMENT PERIODS


                                                    SET CLM_TYPE_CD TO 64 (HMO CLAIMS PAID AS FFS)
                                                    WHERE THE FOLLOWING CONDITIONS ARE MET:
                                                    CLAIMS PROCESSED on or after 10/6/08
                                                    1.   CLM_RLT_COND_CD = '04'
                                                    2.   MCO_CNTRCT_NUM
                                                    MCO_OPTN_CD = '1', '2' OR '4'
                                                    CLM_FROM_DT & CLM_THRU_DT ARE WITHIN THE
                                                    MCO_PRD_EFCTV_DT & MCO_PRD_TRMNTN_DT
                                                    ENROLLMENT PERIODS

                                                    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

                                                    LIMITATIONS :

                                                      REFER TO :
                                                       NCH_CLM_TYPE_CD_LIM

                                                    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 :

                                                      REFER TO :
                                                       CLM_ACNT_NUM_LIM

  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
                                                    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.

                                                    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_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         : NCH

                                                    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
                                38     74    111    CHAR

                                                    DB2      ALIAS : FILLER
                                                    STANDARD 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

                                                    LIMITATIONS :

                                                      REFER TO :
                                                       NCH_DAILY_PROC_DT_LIM

                                                    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 2 Group
                               911    134   1044    GRP


  29.  FILLER
                                 5    134    138    CHAR

                                                    DB2      ALIAS : FILLER
                                                    STANDARD 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

                                                    CODE TABLE     : CARR_CLM_ENTRY_TB

  31.  FILLER
                                 1    140    140    CHAR

                                                    DB2      ALIAS : FILLER
                                                    STANDARD 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

                                                    CODE TABLE     : NCH_CLM_BIC_MDFY_TB

  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
                                                    STANDARD ALIAS : CARR_CLM_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
                                 8    178    185    CHAR

                                                    DB2      ALIAS : FILLER
                                                    STANDARD 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         : EDB

  43.  Beneficiary Sex Identification Code
                                 1    199    199    CHAR

                                                    The sex of a beneficiary.

                                                    COMMON   ALIAS : SEX_CD
                                                    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.

                                                    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
                                                    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).

                                                    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 Group
                                 8    220    227    GRP


                                                    Effective with Version 'J', the group used to identify
                                                    the principal diagnosis code.
                                                    This group contains the principal diagnosis code
                                                    and the principal diagnosis version code.

                                                    STANDARD ALIAS : CLM_PRNCPAL_DGNS_GRP

  52.  Claim Principal Diagnosis Version Code
                                 1    220    220    CHAR

                                                    Effective with Version 'J', the code used to indicate
                                                    if the diagnosis is ICD-9 or ICD-10.

                                                    NOTE:  With 5010, the diagnosis and procedure codes
                                                    have been expanded to accommodate ICD-10, even though
                                                    ICD-10 is not scheduled for implementation until 10/2013.

                                                    DB2      ALIAS : UNDEFINED
                                                    SAS      ALIAS : PDVRSNCD
                                                    STANDARD ALIAS : CLM_PRNCPAL_DGNS_VRSN_CD

                                                    LENGTH         : 1

                                                    CODE TABLE     : CLM_DGNS_VRSN_TB

  53.  Claim Principal Diagnosis Code
                                 7    221    227    CHAR

                                                    The 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.

                                                    NOTE1: Effective with Version 'J', this field has been
                                                    expanded from 5 bytes to 7 bytes to accommodate
                                                    the future implementation of ICD-10.

                                                    DB2      ALIAS : PRNCPAL_DGNS_CD
                                                    SAS      ALIAS : PDGNS_CD
                                                    STANDARD ALIAS : CLM_PRNCPAL_DGNS_CD

                                                    LENGTH         : 7

                                                    SOURCE         : CWF

                                                    EDIT RULES :
                                                          ICD-9-CM

  54.  FILLER
                                 1    228    228    CHAR

                                                    DB2      ALIAS : FILLER
                                                    STANDARD ALIAS : FILLER

                                                    LENGTH         : 1

  55.  Carrier Claim Payment Denial Code
                                 2    229    230    CHAR

                                                    The code on a noninstitutional claim indicating to
                                                    whom payment was made or if the claim was denied.

                                                    NOTE1:  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.

                                                    NOTE2:  Effective with Version 'J', the field has been
                                                    expanded on the NCH record to 2 bytes,  With this
                                                    expansion, the NCH will no longer use the character
                                                    values to represent the official two byte values sent in
                                                    by CWF since 4/2002.  During the Version J conversion,
                                                    all character values were converted to the two byte
                                                    values throughout history..

                                                    DB2      ALIAS : CARR_PMT_DNL_CD
                                                    SAS      ALIAS : PMTDNLCD
                                                    STANDARD ALIAS : CARR_CLM_PMT_DNL_CD

                                                    LENGTH         : 2

                                                    COMMENTS :
                                                    Prior to Version H this field was named:
                                                    CWFB_CLM_PMT_DNL_CD.

                                                    CODE TABLE     : CARR_CLM_PMT_DNL_TB

  56.  Claim Excepted/Nonexcepted Medical Treatment Code
                                 1    231    231    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

                                                    CODE TABLE     : CLM_EXCPTD_NEXCPTD_TRTMT_TB

  57.  Claim Payment Amount
                                 6    232    237    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.
                                                    After 7/5/2011, the payment amount could also include
                                                    a payment adjustment given to hospitals to account for
                                                    the higher costs per discharge for "low-income hospitals".
                                                    After 10/1/2012, the payment amount could also include
                                                    adjustments for value based purchasing, readmissions,
                                                    and Model 1, Bundled Payments for Care Improvement. After
                                                    10/1/2014, the payment amount could also include the
                                                    uncompensated care payment (UCP).

                                                    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 noninstitutmonal (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 :

                                                      REFER TO :
                                                       PMT_AMT_EXCEDG_CHRG_AMT_LIM

                                                    EDIT RULES :
                                                          $$$$$$$$$CC

  58.  Carrier Claim Primary Payer Paid Amount
                                 6    238    243    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

  59.  FILLER
                                 1    244    244    CHAR

                                                    DB2      ALIAS : FILLER
                                                    STANDARD ALIAS : FILLER

                                                    LENGTH         : 1

  60.  DMERC Claim Ordering Physician UPIN Number
                                 6    245    250    CHAR

                                                    Effective with Version G, the unique physician
                                                    identification number (UPIN) of the physician
                                                    ordering the Part B services/DMEPOS item.

                                                    DB2      ALIAS : ORDRG_PHYSN_UPIN
                                                    SAS      ALIAS : ORD_UPIN
                                                    STANDARD ALIAS : DMERC_CLM_ORDRG_PHYSN_UPIN_NUM
                                                    TITLE    ALIAS : ORDRG_UPIN

                                                    LENGTH         : 6

                                                    COMMENTS :
                                                    Prior to Version H this field was named:
                                                    CWFB_CLM_ORDRG_PHYSN_UPIN_NUM.

                                                    SOURCE         : CWF

  61.  DMERC Claim Ordering Physician NPI Number
                                10    251    260    CHAR

                                                    The National Provider Identifier (NPI) assigned
                                                    to the physician ordering the Part B/DMEPOS
                                                    line item.

                                                    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, NPIs,
                                                    OSCAR provider numbers, etc.) on the standard
                                                    HIPAA claim transactions.  (During the NPI
                                                    transition phase (4/3/06 - 5/23/07) the capa-
                                                    bility was there for the NCH to receive NPIs
                                                    along with an existing legacy number.

                                                    NOTE1:  CMS has determined that dual provider
                                                    identifiers (legacy numbers and NPIs) must be
                                                    available 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. Effective May 2007, no NEW UPINs
                                                    (legacy number) will be generated for NEW physi-
                                                    cians (Part B and Outpatient claims) so there will
                                                    only be NPIs sent in to the NCH for those physicians.

                                                    COMMON   ALIAS : ORDERING_PHYSICIAN_NPI
                                                    DB2      ALIAS : ORDRG_PHYSN_NPI
                                                    SAS      ALIAS : ORD_NPI
                                                    STANDARD ALIAS : DMERC_CLM_ORDRG_PHYSN_NPI_NUM
                                                    TITLE    ALIAS : ORDRG_NPI

                                                    LENGTH         : 10

                                                    SOURCE         : CWF

  62.  Carrier Claim Provider Assignment Indicator Switch
                                 1    261    261    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

                                                    CODE TABLE     : CARR_CLM_PRVDR_ASGNMT_IND_TB

  63.  NCH Claim Provider Payment Amount
                                 6    262    267    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

  64.  NCH Claim Beneficiary Payment Amount
                                 6    268    273    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

  65.  Carrier Claim Beneficiary Paid Amount
                                 6    274    279    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

  66.  NCH Carrier Claim Submitted Charge Amount
                                 6    280    285    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

  67.  NCH Carrier Claim Allowed Charge Amount
                                 6    286    291    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

  68.  Carrier Claim Cash Deductible Applied Amount
                                 6    292    297    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

  69.  Carrier Claim HCPCS Year Code
                                 1    298    298    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

  70.  Carrier Claim MCO Override Indicator Code
                                 1    299    299    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

  71.  Carrier Claim Hospice Override Indicator Code
                                 1    300    300    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

  72.  Claim Business Segment Identifier Code
                                 4    301    304    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

  73.  Claim Clinical Trial Number
                                 8    305    312    CHAR

                                                    Effective September 1, 2008 with the implementation
                                                    of CR#3, the number used to identify all items
                                                    and services provided to a beneficiary during their
                                                    participation in a clinical trial.

                                                    NOTE:
                                                    CMS is requesting the clinical trial number be
                                                    voluntarily reported.  The number is assigned by
                                                    the National Library of Medicine (NLM) Clinical
                                                    Trials Data Bank when a new study is registered.

                                                    DB2      ALIAS : CLM_CLNCL_TRIL_NUM
                                                    SAS      ALIAS : CTRILNUM
                                                    STANDARD ALIAS : CLM_CLNCL_TRIL_NUM

                                                    LENGTH         : 8

  74.  Recovery Audit Contractor (RAC) Adjustment Indicator Code
                                 1    313    313    CHAR

                                                    Effective January 5, 2009 with the implementation of
                                                    CR#4, the code used to identify a Recovery Audit
                                                    Contractor (RAC) requested adjustment.  This occurs
                                                    as a result of post-payment review activities done by
                                                    the RAC.

                                                    DB2      ALIAS : RAC_ADJSTMT_CD
                                                    SAS      ALIAS : RACINDCD
                                                    STANDARD ALIAS : CLM_RAC_ADJSTMT_IND_CD

                                                    LENGTH         : 1

                                                    CODE TABLE     : CLM_RAC_ADJSTMT_TB

  75.  Claim Paperwork (PWK) Code
                                 2    314    315    CHAR

                                                    Effective with CR#6, the code used to indicate a provider
                                                    has submitted an electronic claim that requires
                                                    additional documentation.

                                                    DB2      ALIAS : CLM_PWK_CD
                                                    STANDARD ALIAS : CLM_PWK_CD

                                                    LENGTH         : 2

                                                    CODE TABLE     : CLM_PWK_TB

  76.  Claim Care Improvement Model 1 Code
                                 2    316    317    CHAR

                                                    Effective with CR#7, the code used to identify that
                                                    the care improvement model 1 is being used for
                                                    bundling payments.  The valid value for care
                                                    improvement model 1 is '61'.

                                                    DB2      ALIAS : CARE_MODEL_1_CD
                                                    SAS      ALIAS : CMODEL1
                                                    STANDARD ALIAS : CLM_CARE_IMPRVMT_MODEL_1_CD

                                                    LENGTH         : 2

                                                    CODE TABLE     : CLM_CARE_IMPRVMT_MODEL_TB

  77.  Claim Care Improvement Model 2 Code
                                 2    318    319    CHAR

                                                    Effective with CR#7, the code used to identify that
                                                    the care improvement model 2 is being used for
                                                    bundling payments.  The valid value for care
                                                    improvement model 2 is '62'.

                                                    DB2      ALIAS : CARE_MODEL_2_CD
                                                    SAS      ALIAS : CMODEL2
                                                    STANDARD ALIAS : CLM_CARE_IMPRVMT_MODEL_2_CD

                                                    LENGTH         : 2

                                                    CODE TABLE     : CLM_CARE_IMPRVMT_MODEL_TB

  78.  Claim Care Improvement Model 3 Code
                                 2    320    321    CHAR

                                                    Effective with CR#7, the code used to identify that
                                                    the care improvement model 3 is being used for
                                                    bundling payments.  The valid value for care
                                                    improvement model 3 is '63'.

                                                    DB2      ALIAS : CARE_MODEL_3_CD
                                                    SAS      ALIAS : CMODEL3
                                                    STANDARD ALIAS : CLM_CARE_IMPRVMT_MODEL_3_CD

                                                    LENGTH         : 2

                                                    CODE TABLE     : CLM_CARE_IMPRVMT_MODEL_TB

  79.  Claim Care Improvement Model 4 Code
                                 2    322    323    CHAR

                                                    Effective with CR#7, the code used to identify that
                                                    the care improvement model 4 is being used for
                                                    bundling payments.  The valid value for care
                                                    improvement model 4 is '64'.

                                                    DB2      ALIAS : CARE_MODEL_4_CD
                                                    SAS      ALIAS : CMODEL4
                                                    STANDARD ALIAS : CLM_CARE_IMPRVMT_MODEL_4_CD

                                                    LENGTH         : 2

                                                    CODE TABLE     : CLM_CARE_IMPRVMT_MODEL_TB

  80.  Claim Fraud Prevention System (FPS) Model Number
                                 2    324    325    CHAR

                                                    Effective with Version 'K', this field identifies an
                                                    FPS analytic model that identifies claims that may
                                                    be high risk for fraud based on specific information.

                                                    DB2      ALIAS : CLM_FPS_MODEL_NUM
                                                    SAS      ALIAS : FPSMODEL
                                                    STANDARD ALIAS : CLM-FPS-MODEL-NUM

                                                    LENGTH         : 2

                                                    COMMENTS :
                                                    Valid Values:   0 - 9, A -Z

  81.  Claim FPS Reason Code
                                 3    326    328    CHAR

                                                    Effective with Version 'K', this field identifies the
                                                    reason codes used to explain why a claim was not
                                                    paid or how the claim was paid.  These codes also
                                                    show the reason for any claim financial adjustment
                                                    such as denial, reductions or increases in payment.

                                                    DB2      ALIAS : CLM_FPS_RSN_CD
                                                    SAS      ALIAS : FPSRSN
                                                    STANDARD ALIAS : CLM_FPS_RSN_CD

                                                    LENGTH         : 3

                                                    CODE TABLE     : CLM_ADJ_RSN_TB

  82.  Claim FPS Remarks Code
                                 5    329    333    CHAR

                                                    Effective with Version 'K', the codes used to
                                                    convey information about remittance processing or
                                                    to provide a supplemental explanation for an
                                                    adjustment already described by a
                                                    Claim Adjustment Reason Code.

                                                    DB2      ALIAS : CLM_FPS_RMRK_CD
                                                    SAS      ALIAS : FPSRMRK
                                                    STANDARD ALIAS : CLM_FPS_RMRK_CD

                                                    LENGTH         : 5

                                                    CODE TABLE     : CLM_RMTNC_ADVC_TB

  83.  Claim FPS MSN 1 Code
                                 5    334    338    CHAR

                                                    Effective with Version 'K', the field used to
                                                    identify the Medicare Secondary Notice Code.

                                                    DB2      ALIAS : CLM_FPS_MSN_1_CD
                                                    SAS      ALIAS : FPSMSN1
                                                    STANDARD ALIAS : CLM-FPS-MSN-1-CD

                                                    LENGTH         : 5

                                                    CODE TABLE     : CLM_FPS_MSN_CD_TB

  84.  Claim FPS MSN 2 Code
                                 5    339    343    CHAR

                                                    Effective with Version 'K', the field used to
                                                    identify the Medicare Secondary Notice Code.

                                                    DB2      ALIAS : CLM_FPS_MSN_2_CD
                                                    SAS      ALIAS : FPSMSN2
                                                    STANDARD ALIAS : CLM-FPS-MSN-2-CD

                                                    LENGTH         : 5

                                                    CODE TABLE     : CLM_FPS_MSN_CD_TB

  85.  Claim Mass Adjustment Indicator Code
                                 1    344    344    CHAR

                                                    Effective with Version 'K', the field used to
                                                    identify if the adjustment claim is part of a mass
                                                    adjustment project.

                                                    DB2      ALIAS : MASS_ADJSTMT_CD
                                                    SAS      ALIAS : MADJSTMT
                                                    STANDARD ALIAS : CLM_MASS_ADJSTMT_IND_CD

                                                    LENGTH         : 1

                                                    CODE TABLE     : CLM_MASS_ADJSTMT_IND_CD_TB

  86.  DMERC Claim National Mail Order (NMO) Competitive Bidding Area (CBA) Indicator Code
                                 5    345    349    CHAR

                                                    Effective with CR#8, the field used to identify when
                                                    a beneficiary does not reside in a competitive
                                                    bidding area (CBA) and at least one line on the
                                                    claim is subject to National Mail Order (NMO) pro-
                                                    gram.

                                                    DB2      ALIAS : DMERC_NMO_CBA_CD
                                                    SAS      ALIAS : NMOIND
                                                    STANDARD ALIAS : DMERC_CLM_NMO_CBA_CD

                                                    LENGTH         : 5

                                                    CODE TABLE     : DMERC_CLM_NMO_CBA_IND_TB

  87.  Claim Paper Provider Code
                                 2    350    351    CHAR

                                                    Effective with CR#8, the code used to identify the
                                                    provider type that submitted the paper claim.

                                                    NOTE:  This data element will not be implemented in
                                                    CWF until the January 2014 release, which means you
                                                    will not begin to see data in this field in the NCH
                                                    until the January implementation.  We are adding
                                                    this field with the NCH CR#8 October release because
                                                    we will not be doing a January 2014 release.

                                                    DB2      ALIAS : CLM_PAPER_PRVDR_CD
                                                    SAS      ALIAS : PPRVDR
                                                    STANDARD ALIAS : CLM_PAPER_PRVDR_CD

                                                    LENGTH         : 2

                                                    CODE TABLE     : CLM_PAPER_PRVDR_TB

  88.  Claim Residual Payment Indicator Code
                                 1    352    352    CHAR

                                                    Effective with CR#11, this field is used by CWF claims processing
                                                    for the purpose of bypassing its normal MSP editing that would
                                                    otherwise apply for ongoing responsibility for medicals (ORM) or
                                                    worker's compensation Medicare Set-Aside Arrangements (WCMSA).
                                                    Normally, CWF does not allow a secondary payment on MSP involving
                                                    ORM or WCMSA, so the residual payment indicator will be used to
                                                    allow CWF to make an exception to its normal routine.

                                                    DB2      ALIAS : CLM_RSDL_PMT_CD
                                                    SAS      ALIAS : RSDLPMT
                                                    STANDARD ALIAS : CLM_RSDL_PMT_IND_CD

                                                    LENGTH         : 1

                                                    SOURCE         : CWF

                                                    CODE TABLE     : RSDL_PMT_IND_TB

  89.  Claim Accountable Care Organization (ACO) Identification Number
                                10    353    362    CHAR

                                                    Effective with CR#12, this field identifies the unique identifi-
                                                    cation number assigned to the Accountable Care Organization (ACO).

                                                    DB2      ALIAS : CLM_ACO_ID_NUM
                                                    SAS      ALIAS : ACOIDNUM
                                                    STANDARD ALIAS : CLM_ACO_ID_NUM

                                                    LENGTH         : 10

                                                    COMMENTS :
                                                    (CMS CR9468) - CWF July 2016 Release

  90.  Medicare Beneficiary Identification (MBI) Number
                                11    363    373    CHAR

                                                    Effective with CR#12, this field represents the Medicare beneficiary
                                                    identification number. This field is being added due to the removal
                                                    of the Social Security Number from the Medicare card (SSNRI project).
                                                    The MBI will replace the HICN on the Medicare card.  CMS will
                                                    continue to use the HICN within internal systems.

                                                    NOTE:  We will not see MBI's on the claims until October 2017
                                                    (start of the transition period).

                                                    DB2      ALIAS : MBI_ID
                                                    SAS      ALIAS : MBIID
                                                    STANDARD ALIAS : MBI_ID

                                                    LENGTH         : 11

                                                    COMMENTS :
                                                    SSNRI Project
                                                    CWF October 2017 Release

  91.  Claim Beneficiary Identifier Type Code
                                 1    374    374    CHAR

                                                    Effective with CR#12, this field identifies whether the claim was
                                                    submitted by the provider, during the transition period, with a
                                                    HICN or MBI.

                                                    NOTE:  This field will not be populated with data until the start
                                                    of the transition period (October 2017).

                                                    DB2      ALIAS : BENE_ID_TYPE_CD
                                                    SAS      ALIAS : BENEIDCD
                                                    STANDARD ALIAS : CLM_BENE_ID_TYPE_CD

                                                    LENGTH         : 1

                                                    COMMENTS :
                                                    (SSNRI Project)
                                                    CWF October 2017 Release

                                                    CODE TABLE     : CLM_BENE_ID_TYPE_TB

  92.  FILLER
                               670    375   1044    CHAR

                                                    DB2      ALIAS : H_FILLER_7

                                                    LENGTH         : 670

  93.  DMERC NCH Edit Code Count
                                 2   1045   1046    NUM

                                                    The count of the number of edit codes
                                                    annotated to the DMERC claim during
                                                    HCFA's CWFMQA process.  The purpose of
                                                    this count is to indicate how many claim
                                                    edit trailers are present.
                                                    Prior to Version H this field was named:
                                                    CLM_EDIT_CD_CNT.

                                                    DB2      ALIAS : EDIT_TRLR_CNT
                                                    SAS      ALIAS : DEDCNT
                                                    STANDARD ALIAS : DMERC_NCH_EDIT_CD_CNT

                                                    LENGTH         : 2    SIGNED : N

                                                    COMMENTS :
                                                    Prior to Version H this field was named:
                                                    CLM_EDIT_CD_CNT.

                                                    SOURCE         : NCH

  94.  DMERC NCH Patch Code Count
                                 2   1047   1048    NUM

                                                    Effective with Version H, the count of the
                                                    number of HCFA patch codes annotated to the
                                                    DMERC 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 : DMERC_PATCH_CD_CNT
                                                    SAS      ALIAS : DPATCNT
                                                    STANDARD ALIAS : DMERC_NCH_PATCH_CD_I_CNT

                                                    LENGTH         : 2    SIGNED : N

                                                    SOURCE         : NCH

  95.  DMERC MCO Period Count
                                 1   1049   1049    NUM

                                                    Effective with Version H, the count of the
                                                    number of Managed Care Organization (MCO)
                                                    periods reported on a DMERC 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 : DMERC_MCO_PRD_CNT
                                                    SAS      ALIAS : DMCOCNT
                                                    STANDARD ALIAS : DMERC_MCO_PRD_CNT

                                                    LENGTH         : 1    SIGNED : N

                                                    SOURCE         : NCH

                                                    EDIT RULES :
                                                          RANGE: 0 TO 2

  96.  DMERC Claim Demonstration ID Count
                                 1   1050   1050    NUM

                                                    Effective with Version H, the count of the number
                                                    of claim demonstration IDs reported on an
                                                    DMERC 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 : DDEMCNT
                                                    STANDARD ALIAS : DMERC_CLM_DEMO_ID_CNT

                                                    LENGTH         : 1    SIGNED : N

                                                    SOURCE         : NCH

                                                    EDIT RULES :
                                                          RANGE: 0 TO 5

  97.  DMERC Claim Diagnosis Code Count
                                 2   1051   1052    NUM

                                                    The count of the number of diagnosis codes (both
                                                    principal and secondary) reported on a DMERC claim.
                                                    The purpose of this count is to indicate how
                                                    many claim diagnosis code trailers are present.

                                                    NOTE:  Effective with Version 'J', the count of the
                                                    number of diagnosis code trailers was expanded
                                                    from 8 to 12.

                                                    DB2      ALIAS : DGNS_TRLR_CNT
                                                    SAS      ALIAS : DDGNCNT
                                                    STANDARD ALIAS : DMERC_CLM_DGNS_CD_J_CNT

                                                    LENGTH         : 2    SIGNED : N

                                                    COMMENTS :
                                                    Prior to Version H this field was named:
                                                    CLM_DGNS_CD_CNT.

                                                    SOURCE         : NCH

                                                    EDIT RULES :
                                                          RANGE: 0 TO 12

  98.  DMERC Claim Line Count
                                 2   1053   1054    NUM

                                                    The count of the number of line items reported
                                                    on the DMERC claim.  The purpose of this count
                                                    is to indicate how many line item trailers are
                                                    present.

                                                    DB2      ALIAS : LINE_ITM_TRLR_CNT
                                                    SAS      ALIAS : DLINECNT
                                                    STANDARD ALIAS : DMERC_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

  99.  FILLER
                                 4   1055   1058    CHAR

                                                    DB2      ALIAS : FILLER
                                                    STANDARD ALIAS : FILLER

                                                    LENGTH         : 4

  100. DMERC Claim Variable Group
                               VAR   1059  18927    GRP


  101. NCH Edit Group
                                65   1059   1123    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 : DMERC_NCH_EDIT_CD_CNT

  102. NCH Edit Trailer Indicator Code
                                 1   1059   1059    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      ALIAS : EDIT_TRLR_IND_CD
                                                    SAS      ALIAS : EDITIND
                                                    STANDARD ALIAS : NCH_EDIT_TRLR_IND_CD

                                                    LENGTH         : 1

                                                    SOURCE         : NCH QA Process

                                                    CODE TABLE     : NCH_EDIT_TRLR_IND_TB

  103. NCH Edit Code
                                 4   1060   1063    CHAR

                                                    The code annotated to the claim indicating
                                                    the CWFMQA editing results so users will
                                                    be aware of data deficiencies.

                                                    NOTE:  Prior to Version H only the highest
                                                    priority code was stored.  Beginning 11/98
                                                    up to 13 edit codes may be present.

                                                    COMMON   ALIAS : QA_ERROR_CODE
                                                    DB2      ALIAS : NCH_EDIT_CD
                                                    SAS      ALIAS : EDIT_CD
                                                    STANDARD ALIAS : NCH_EDIT_CD
                                                    TITLE    ALIAS : QA_ERROR_CD

                                                    LENGTH         : 4

                                                    SOURCE         : NCH QA EDIT PROCESS

                                                    CODE TABLE     : NCH_EDIT_TB

  104. NCH Patch Group
                               330   1124   1453    GRP


                                                    STANDARD ALIAS : NCH_PATCH_GRP

                                                    OCCURS MIN: 0 OCCURS MAX: 30

                                                       DEPENDING ON : DMERC_NCH_PATCH_CD_I_CNT

  105. NCH Patch Trailer Indicator Code
                                 1   1124   1124    CHAR

                                                    Effective with Version H, the code indicating
                                                    the presence of an NCH patch trailer.

                                                    NOTE:  During the Version H conversion this field
                                                    was populated throughout history (back to service
                                                    year 1991).

                                                    DB2      ALIAS : PATCH_TRLR_IND_CD
                                                    SAS      ALIAS : PATCHIND
                                                    STANDARD ALIAS : NCH_PATCH_TRLR_IND_CD

                                                    LENGTH         : 1

                                                    SOURCE         : NCH

                                                    CODE TABLE     : NCH_PATCH_TRLR_IND_TB

  106. NCH Patch Code
                                 2   1125   1126    CHAR

                                                    Effective with Version H, the code annotated
                                                    to the claim indicating a patch was applied
                                                    to the record during an NCH Nearline record
                                                    conversion and/or during current processing.

                                                    NOTE:  Prior to Version H this field was located
                                                    in the third and fourth occurrence of the
                                                    CLM_EDIT_CD.

                                                    DB2      ALIAS : NCH_PATCH_CD
                                                    SAS      ALIAS : PATCHCD
                                                    STANDARD ALIAS : NCH_PATCH_CD
                                                    TITLE    ALIAS : NCH_PATCH

                                                    LENGTH         : 2

                                                    SOURCE         : NCH

                                                    CODE TABLE     : NCH_PATCH_TB

  107. NCH Patch Applied Date
                                 8   1127   1134    NUM

                                                    Effective with Version H, the date the NCH patch
                                                    was applied to the claim.


                                                    DB2      ALIAS : NCH_PATCH_APPLY_DT
                                                    SAS      ALIAS : PATCHDT
                                                    STANDARD ALIAS : NCH_PATCH_APPLY_DT
                                                    TITLE    ALIAS : NCH_PATCH_DT

                                                    LENGTH         : 8    SIGNED : N

                                                    SOURCE         : NCH

                                                    EDIT RULES :
                                                          YYYYMMDD

  108. MCO Period Group
                                74   1454   1527    GRP


                                                    The number of managed care organization (MCO)
                                                    period data trailers present is determined by
                                                    the claim MCO period trailer count.  This field
                                                    reflects the two most current MCO periods in the
                                                    CWF beneficiary history record.  It may have no
                                                    connection to the services on the claim.

                                                    STANDARD ALIAS : MCO_PRD_GRP

                                                    OCCURS MIN: 0 OCCURS MAX: 2

                                                       DEPENDING ON : DMERC_MCO_PRD_CNT

  109. NCH MCO Trailer Indicator Code
                                 1   1454   1454    CHAR

                                                    Effective with Version H, the code indicating
                                                    the presence of a Managed Care Organization (MCO)
                                                    trailer.

                                                    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_TRLR_IND_CD
                                                    SAS      ALIAS : MCOIND
                                                    STANDARD ALIAS : NCH_MCO_TRLR_IND_CD
                                                    TITLE    ALIAS : MCO_INDICATOR

                                                    LENGTH         : 1

                                                    SOURCE         : NCH QA Process

                                                    CODE TABLE     : NCH_MCO_TRLR_IND_TB

  110. MCO Contract Number
                                 5   1455   1459    CHAR

                                                    Effective with Version H, this field represents
                                                    the plan contract number of the Managed Care
                                                    Organization (MCO).

                                                    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_CNTRCT_NUM
                                                    SAS      ALIAS : MCONUM
                                                    STANDARD ALIAS : MCO_CNTRCT_NUM
                                                    TITLE    ALIAS : MCO_NUM

                                                    LENGTH         : 5

                                                    SOURCE         : CWF

  111. MCO Option Code
                                 1   1460   1460    CHAR

                                                    Effective with Version H, the code indicating
                                                    Managed Care Organization (MCO) lock-in
                                                    enrollment status of 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
                                                    spaces in this field.

                                                    DB2      ALIAS : MCO_OPTN_CD
                                                    SAS      ALIAS : MCOOPTN
                                                    STANDARD ALIAS : MCO_OPTN_CD
                                                    TITLE    ALIAS : MCO_OPTION_CD

                                                    LENGTH         : 1

                                                    SOURCE         : CWF

                                                    CODE TABLE     : MCO_OPTN_TB

  112. MCO Period Effective Date
                                 8   1461   1468    NUM

                                                    Effective with Version H, the date the bene-
                                                    ficiary's enrollment in the Managed Care
                                                    Organization (MCO) became effective.

                                                    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 : MCO_PRD_EFCTV_DT
                                                    SAS      ALIAS : MCOEFFDT
                                                    STANDARD ALIAS : MCO_PRD_EFCTV_DT
                                                    TITLE    ALIAS : MCO_PERIOD_EFF_DT

                                                    LENGTH         : 8    SIGNED : N

                                                    SOURCE         : CWF

                                                    EDIT RULES :
                                                          YYYYMMDD

  113. MCO Period Termination Date
                                 8   1469   1476    NUM

                                                    Effective with Version H, the date the bene-
                                                    ficiary's enrollment in the Managed Care
                                                    Organization (MCO) was terminated.

                                                    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 : MCO_PRD_TRMNTN_DT
                                                    SAS      ALIAS : MCOTRMDT
                                                    STANDARD ALIAS : MCO_PRD_TRMNTN_DT
                                                    TITLE    ALIAS : MCO_PERIOD_TERM_DT

                                                    LENGTH         : 8    SIGNED : N

                                                    SOURCE         : CWF

                                                    EDIT RULES :
                                                          YYYYMMDD

  114. MCO Health PLANID Number
                                14   1477   1490    CHAR

                                                    A placeholder field (effective with Version H)
                                                    for storing the Health PlanID associated with
                                                    the Managed Care Organization (MCO).  Prior to
                                                    Version 'I' this field was named:
                                                    MCO_PAYERID_NUM.

                                                    DB2      ALIAS : MCO_PLANID_NUM
                                                    SAS      ALIAS : MCOPLNID
                                                    STANDARD ALIAS : MCO_HLTH_PLANID_NUM
                                                    TITLE    ALIAS : MCO_PLANID

                                                    LENGTH         : 14

                                                    COMMENTS :
                                                    Prior to Version I this field was named:
                                                    MCO_PAYERID_NUM.

                                                    SOURCE         : CWF

  115. Claim Demonstration Identification Group
                                90   1528   1617    GRP


                                                    The number of demonstration identification
                                                    trailers present is determined by the claim
                                                    demonstration identification trailer count.

                                                    STANDARD ALIAS : CLM_DEMO_ID_GRP

                                                    OCCURS MIN: 0 OCCURS MAX: 5

                                                       DEPENDING ON : DMERC_CLM_DEMO_ID_CNT

  116. NCH Demonstration Trailer Indicator Code
                                 1   1528   1528    CHAR

                                                    Effective with Version H, the code indicating
                                                    the presence of a demo trailer.

                                                    NOTE:  During the Version H conversion this field
                                                    was populated throughout history (back to service
                                                    year 1991).

                                                    DB2      ALIAS : NCH_DEMO_TRLR_IND_
                                                    SAS      ALIAS : DEMOIND
                                                    STANDARD ALIAS : NCH_DEMO_TRLR_IND_CD
                                                    TITLE    ALIAS : DEMO_INDICATOR

                                                    LENGTH         : 1

                                                    SOURCE         : NCH

                                                    CODE TABLE     : NCH_DEMO_TRLR_IND_TB

  117. Claim Demonstration Identification Number
                                 2   1529   1530    CHAR

                                                    Effective with Version H, the number assigned
                                                    to identify a demo.  This field is also used to
                                                    denote special processing (a.k.a. Special Processing
                                                    Number, SPN).

                                                    NOTE: Prior to Version H, Demo ID was stored in the
                                                    redefined Claim Edit Group, 4th occurrence, positions
                                                    3 and 4.   During the H conversion, this field was
                                                    populated with data throughout history (as
                                                    appropriate either by moving ID on Version G or by
                                                    deriving from specific demo criteria).

                                                    DB2      ALIAS : CLM_DEMO_ID_NUM
                                                    SAS      ALIAS : DEMONUM
                                                    STANDARD ALIAS : CLM_DEMO_ID_NUM
                                                    TITLE    ALIAS : DEMO_ID

                                                    LENGTH         : 2

                                                    SOURCE         : CWF

                                                    CODE TABLE     : CLM_DEMO_ID_TB

  118. Claim Demonstration Information Text
                                15   1531   1545    CHAR

                                                    Effective with Version H, the text field that
                                                    contains related demo information.  For example,
                                                    a claim involving a CHOICES demo id '05' would
                                                    contain the MCO plan contract number in the first
                                                    five positions of this text field.

                                                    NOTE: During the Version H conversion this
                                                    field was populated with data throughout
                                                    history.

                                                    DB2      ALIAS : CLM_DEMO_INFO_TXT
                                                    SAS      ALIAS : DEMOTXT
                                                    STANDARD ALIAS : CLM_DEMO_INFO_TXT
                                                    TITLE    ALIAS : DEMO_INFO

                                                    LENGTH         : 15

                                                    DERIVATIONS :
                                                    DERIVATION RULES:
                                                    Demo ID = 01 (RUGS) -- the text field will contain
                                                    a 2, 3 or 4 to denote the RUGS phase.  If RUGS phase
                                                    is blank or not one of the above the text field
                                                    will reflect 'INVALID'.  NOTE:  In Version 'G', RUGS
                                                    phase was stored in redefined Claim Edit Group,
                                                    3rd occurrence, 4th position.

                                                    Demo ID = 02 (Home Health demo) -- the text field
                                                    will contain PROV#.  When demo number not equal to
                                                    02 then text will reflect 'INVALID'.

                                                    Demo ID = 03 (Telemedicine demo) -- text field will
                                                    contain the HCPCS code.  If the required HCPCS is
                                                    not shown then the text field will reflect
                                                    'INVALID'.

                                                    Demo ID = 04 (UMWA) -- text field will contain
                                                    W0 denoting that condition code W0 was present.
                                                    If condition code W0 not present then the text
                                                    field will reflect 'INVALID'.

                                                    Demo ID = 05 (CHOICES) -- the text field will con-
                                                    tain the CHOICES plan number, if both of the follow-
                                                    ing conditions are met: (1) CHOICES plan number
                                                    present and PPS or Inpatient claim shows that 1st
                                                    3 positions of provider number as '210' and the
                                                    admission date is within HMO effective/termination
                                                    date; or non-PPS claim and the from date is within
                                                    HMO effective/termination date and (2) CHOICES
                                                    plan number matches the HMO plan number.  If
                                                    either condition is not met the text field will
                                                    reflect 'INVALID CHOICES PLAN NUMBER'.  When
                                                    CHOICES plan number not present, text will re-
                                                    flect 'INVALID'.

                                                    NOTE:  In Version 'G', a valid CHOICES plan ID is
                                                    stored as alpha character in redefined Claim
                                                    Edit Group, 4th occurrence, 2nd position.  If
                                                    invalid, CHOICES indicator 'ZZ' displayed.

                                                    Demo ID = 15 (ESRD Managed Care) -- text field
                                                    will contain the ESRD/MCO plan number.  If ESRD/
                                                    MCO plan number not present the field will
                                                    reflect 'INVALID'.

                                                    Demo ID = 38 (Physician Encounter Claims) --
                                                    text field will contain the MCO plan number.
                                                    When MCO plan number not present the field will
                                                    reflect 'INVALID'.


                                                    SOURCE         : CWF

                                                    LIMITATIONS :

                                                      REFER TO :
                                                       CHOICES_DEMO_LIM

  119. Carrier Claim Diagnosis Group
                               108   1618   1725    GRP


                                                    The number of claim diagnosis trailers is determined by
                                                    the carrier claim diagnosis code count.

                                                    STANDARD ALIAS : CARR_CLM_DGNS_GRP

                                                    OCCURS MIN: 0 OCCURS MAX: 12

                                                       DEPENDING ON : DMERC_CLM_DGNS_CD_J_CNT

  120. NCH Diagnosis Trailer Indicator Code
                                 1   1618   1618    CHAR

                                                    Effective with Version H, the code indicating
                                                    the presence of a diagnosis trailer.

                                                    NOTE:  During the Version H conversion this field
                                                    was populated throughout history (back to service
                                                    year 1991).

                                                    DB2      ALIAS : DGNS_TRLR_IND_CD
                                                    SAS      ALIAS : DGNSIND
                                                    STANDARD ALIAS : NCH_DGNS_TRLR_IND_CD

                                                    LENGTH         : 1

                                                    SOURCE         : NCH

                                                    CODE TABLE     : NCH_DGNS_TRLR_IND_TB

  121. Claim Diagnosis Version Code
                                 1   1619   1619    CHAR

                                                    Effective with Version 'J', the code used to indicate if the
                                                    diagnosis code is ICD-9 or ICD-10.

                                                    NOTE:  With 5010, the diagnosis and procedure codes have been
                                                    expanded to accommodate ICD-10, even though ICD-10 is not
                                                    scheduled for implementation until 10/2014.

                                                    DB2      ALIAS : CLM_DGNS_VRSN_CD
                                                    SAS      ALIAS : DVRSNCD
                                                    STANDARD ALIAS : CLM_DGNS_VRSN_CD

                                                    LENGTH         : 1

                                                    CODE TABLE     : CLM_DGNS_VRSN_TB

  122. Claim Diagnosis Code
                                 7   1620   1626    CHAR

                                                    The diagnosis code identifying the
                                                    beneficiary's principal or other diagnosis
                                                    (including E code).

                                                    NOTE:
                                                    Prior to Version H, the principal diagnosis
                                                    code was not stored with the 'OTHER' diagnosis
                                                    codes.  During the Version H conversion the
                                                    CLM_PRNCPAL_DGNS_CD was added as the first
                                                    occurrence.

                                                    NOTE1: Effective with Version 'J', this field has been
                                                    expanded from 5 bytes to 7 bytes to accommodate the
                                                    future implementation of ICD-10.

                                                    NOTE2:  Effective with Version 'J', the diagnosis E
                                                    codes are stored in a separate trailer (CLM_DGNS_E_GRP).

                                                    DB2      ALIAS : CLM_DGNS_CD
                                                    SAS      ALIAS : DGNS_CD
                                                    STANDARD ALIAS : CLM_DGNS_CD

                                                    LENGTH         : 7

                                                    EDIT RULES :
                                                          ICD-9-CM

  123. DMERC Line Group
                             17199   1726  18924    GRP


                                                    OCCURS MIN: 0 OCCURS MAX: 13

                                                       DEPENDING ON : DMERC_CLM_LINE_CNT

  124. NCH Line Item Trailer Indicator Code
                                 1   1726   1726    CHAR

                                                    Effective with Version H, the code indicating
                                                    the presence of a line item trailer on the non-
                                                    institutional claim.

                                                    NOTE:  During the Version H conversion this field
                                                    was populated throughout history (back to service
                                                    year 1991).

                                                    DB2      ALIAS : LINE_TRLR_IND_CD
                                                    SAS      ALIAS : LINEIND
                                                    STANDARD ALIAS : NCH_LINE_TRLR_IND_CD

                                                    LENGTH         : 1

                                                    SOURCE         : NCH

                                                    CODE TABLE     : NCH_LINE_TRLR_IND_TB

  125. DMERC Line Supplier Provider Number
                                10   1727   1736    CHAR

                                                    Effective with Version 'G', billing number assigned
                                                    tothe supplier of the Part B service/DMEPOS by
                                                    the National Supplier Clearinghouse, as reported
                                                    on the line item for the DMERC claim.

                                                    DB2      ALIAS : SUPLR_PRVDR_NUM
                                                    SAS      ALIAS : SUPLRNUM
                                                    STANDARD ALIAS : DMERC_LINE_SUPLR_PRVDR_NUM
                                                    TITLE    ALIAS : SUPLR_NUM

                                                    LENGTH         : 10

                                                    COMMENTS :
                                                    Prior to Version H this field was named:
                                                    CWFB_SUPLR_PRVDR_NUM.

                                                    SOURCE         : CWF

  126. DMERC Line Item Supplier NPI Number
                                10   1737   1746    CHAR

                                                    The National Provider Identifier (NPI) assigned
                                                    to the supplier of the Part B service/DMEPOS
                                                    line item.

                                                    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 capa-
                                                    bility 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
                                                    identifiers (legacy numbers and NPIs) must be
                                                    available 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.  Effective May 2007, no NEW
                                                    UPINs will be generated for NEW physicians
                                                    (Part B and Outpatient claims) so there will
                                                    only be NPIs sent in to the NCH for those phy-
                                                    sicians.

                                                    COMMON   ALIAS : SUPPLIER_NPI
                                                    DB2      ALIAS : SUPLR_NPI_NUM
                                                    SAS      ALIAS : SUP_NPI
                                                    STANDARD ALIAS : DMERC_LINE_SUPLR_NPI_NUM
                                                    TITLE    ALIAS : SUPLR_NPI

                                                    LENGTH         : 10

                                                    SOURCE         : CWF

  127. DMERC Line Pricing State Code
                                 2   1747   1748    CHAR

                                                    Prior to Version H this field was named:
                                                    CWFB_DME_PRCNG_STATE_CD.

                                                    DB2      ALIAS : DMERC_PRCNG_STATE
                                                    SAS      ALIAS : PRCNG_ST
                                                    STANDARD ALIAS : DMERC_LINE_PRCNG_STATE_CD
                                                    TITLE    ALIAS : DMERC_PRCNG_STATE_CD

                                                    LENGTH         : 2

                                                    COMMENTS :
                                                    Prior to Version H this field was named:
                                                    CWFB_DME_PRCNG_STATE_CD.

                                                    SOURCE         : CWF/NCH

                                                    CODE TABLE     : GEO_STATE_TB

  128. DMERC Line Pricing Zip Code
                                 9   1749   1757    CHAR

                                                    The zip code used to identify where the supply/item was
                                                    rendered. The pricing state code and the pricing zip
                                                    code will be used in pricing DMEPOS claims.

                                                    NOTE: Due to a change in the CWF release schedule, we
                                                    will not see data in this field until April 2010.

                                                    DB2      ALIAS : DMERC_PRCNG_ZIP_CD
                                                    SAS      ALIAS : PRCNGZIP
                                                    STANDARD ALIAS : DMERC_LINE_PRCNG_ZIP_CD

                                                    LENGTH         : 9

                                                    LANGUAGE   : C

  129. DMERC Line Beneficiary Mailing State Code
                                 2   1758   1759    CHAR

                                                    The state code used to identify the beneficiary's mailing
                                                    address.  This state code may be the same as the pricing
                                                    state code, but it could be different(e.g. representative
                                                    payee, temporary address, etc.).

                                                    NOTE1: The pricing state code (existing field) will contain
                                                    the state code where the supply/item was rendered.  The
                                                    mailing state code (new field) will represent where the
                                                    beneficiary's MSN is sent.

                                                    NOTE2: NOTE: Due to a change in the CWF release schedule, we
                                                    will not see data in this field until April 2010.

                                                    DB2      ALIAS : DMERC_MLG_STATE_CD
                                                    SAS      ALIAS : MLGSTATE
                                                    STANDARD ALIAS : DMERC_LINE_BENE_MLG_STATE_CD

                                                    LENGTH         : 2

                                                    LANGUAGE   : C

  130. DMERC Line Provider State Code
                                 2   1760   1761    CHAR

                                                    Prior to Version H this field was named:
                                                    CWFB_DME_PRVDR_STATE_CD.

                                                    DB2      ALIAS : DMERC_PRVDR_STATE
                                                    SAS      ALIAS : PRVSTATE
                                                    STANDARD ALIAS : DMERC_LINE_PRVDR_STATE_CD
                                                    TITLE    ALIAS : DMERC_PRVDR_STATE_CD

                                                    LENGTH         : 2

                                                    COMMENTS :
                                                    Prior to Version H this field was named:
                                                    CWFB_DME_PRVDR_STATE_CD.

                                                    SOURCE         : CWF/NCH

                                                    CODE TABLE     : GEO_STATE_TB

  131. DMERC Line Supplier Type Code
                                 1   1762   1762    CHAR

                                                    Prior to Version H this field on the DMERC claim
                                                    was named:  CWFB_PRVDR_TYPE_CD.

                                                    DB2      ALIAS : SUPLR_TYPE_CD
                                                    SAS      ALIAS : SUP_TYPE
                                                    STANDARD ALIAS : DMERC_LINE_SUPLR_TYPE_CD
                                                    TITLE    ALIAS : SUPLR_TYPE

                                                    LENGTH         : 1

                                                    COMMENTS :
                                                    Prior to Version H this field on the DMERC claim
                                                    was named:  CWFB_PRVDR_TYPE_CD.

                                                    SOURCE         : CWF

                                                    CODE TABLE     : DMERC_LINE_SUPLR_TYPE_TB

  132. Line Provider Tax Number
                                10   1763   1772    CHAR

                                                    Social security number or employee
                                                    identification number of physician/supplier
                                                    used to identify to whom payment is made for
                                                    the line item service on the noninstitutional
                                                    claim.
                                                    Note: The first 9 positions contain the Social
                                                    Security/Tax Number and the 10th position contains
                                                    the provider type code.

                                                    DB2      ALIAS : LINE_PRVDR_TAX_NUM
                                                    SAS      ALIAS : TAX_NUM
                                                    STANDARD ALIAS : LINE_PRVDR_TAX_NUM
                                                    TITLE    ALIAS : PRVDR_TAX_NUM

                                                    LENGTH         : 10

                                                    COMMENTS :
                                                    Prior to Version H this field was named:
                                                    CWFB_PRVDR_TAX_NUM.

                                                    SOURCE         : CWF

  133. Line HCFA Provider Specialty Code
                                 2   1773   1774    CHAR

                                                    CMS specialty code used for pricing the
                                                    line item service on the noninstitutional
                                                    claim.

                                                    DB2      ALIAS : HCFA_SPCLTY_CD
                                                    SAS      ALIAS : HCFASPCL
                                                    STANDARD ALIAS : LINE_HCFA_PRVDR_SPCLTY_CD
                                                    TITLE    ALIAS : HCFA_PRVDR_SPCLTY

                                                    LENGTH         : 2

                                                    COMMENTS :
                                                    Prior to Version H this field was named:
                                                    CWFB_HCFA_PRVDR_SPCLTY_CD.

                                                    SOURCE         : CWF

                                                    CODE TABLE     : CMS_PRVDR_SPCLTY_TB

  134. Line Provider Participating Indicator Code
                                 1   1775   1775    CHAR

                                                    Code indicating whether or not a provider is
                                                    participating or accepting assignment for this
                                                    line item service on the noninstitutional claim.

                                                    DB2      ALIAS : PRVDR_PRTCPTG_CD
                                                    SAS      ALIAS : PRTCPTG
                                                    STANDARD ALIAS : LINE_PRVDR_PRTCPTG_IND_CD
                                                    TITLE    ALIAS : PRVDR_PRTCPTG_IND

                                                    LENGTH         : 1

                                                    COMMENTS :
                                                    Prior to Version H this field was named:
                                                    CWFB_PRVDR_PRTCPTG_IND_CD.

                                                    SOURCE         : CWF

                                                    CODE TABLE     : LINE_PRVDR_PRTCPTG_IND_TB

  135. Line Service Count
                                 6   1776   1781    PACK

                                                    The count of the total number of services
                                                    processed for the line item on the non-institutional
                                                    claim.

                                                    DB2      ALIAS : SRVC_CNT
                                                    SAS      ALIAS : SRVC_CNT
                                                    STANDARD ALIAS : LINE_SRVC_CNT

                                                    LENGTH         : 7.3    SIGNED : Y

                                                    COMMENTS :
                                                    Prior to Version H this field was named:
                                                    CWFB_SRVC_CNT.

                                                    Prior to Version 'J', this field was S9(3)
                                                      Length: 7.3

                                                    SOURCE         : CWF

  136. Line HCFA Type Service Code
                                 1   1782   1782    CHAR

                                                    Code indicating the type of service, as defined
                                                    in the CMS Medicare Carrier Manual, for this
                                                    line item on the non-institutional claim.

                                                    DB2      ALIAS : HCFA_TYPE_SRVC_CD
                                                    SAS      ALIAS : TYPSRVCB
                                                    STANDARD ALIAS : LINE_HCFA_TYPE_SRVC_CD
                                                    TITLE    ALIAS : HCFA_TYPE_SRVC

                                                    LENGTH         : 1

                                                    COMMENTS :
                                                    Prior to Version H this field was named:
                                                    CWFB_HCFA_TYPE_SRVC_CD.

                                                    SOURCE         : CWF

                                                    EDIT RULES :
                                                          The only type of service codes applicable to DMERC
                                                          claims are: 1, 9, A, E, G, H, J, K, L, M, P,
                                                          R, and S.

                                                    CODE TABLE     : CMS_TYPE_SRVC_TB

  137. Line Place of Service Code
                                 2   1783   1784    CHAR

                                                    The code indicating the place of service, as
                                                    defined in the Medicare Carrier Manual, for
                                                    this line item on the noninstitutional claim.

                                                    COMMON   ALIAS : POS
                                                    DB2      ALIAS : LINE_PLC_SRVC_CD
                                                    SAS      ALIAS : PLCSRVC
                                                    STANDARD ALIAS : LINE_PLC_SRVC_CD
                                                    TITLE    ALIAS : PLC_SRVC

                                                    LENGTH         : 2

                                                    COMMENTS :
                                                    Prior to Version H this field was named:
                                                    CWFB_PLC_SRVC_CD.

                                                    SOURCE         : CWF

                                                    CODE TABLE     : LINE_PLC_SRVC_TB

  138. Line First Expense Date
                                 8   1785   1792    NUM

                                                    Beginning date (1st expense) for this line item
                                                    service on the noninstitutional
                                                    claim.

                                                    DB2      ALIAS : LINE_1ST_EXPNS_DT
                                                    SAS      ALIAS : EXPNSDT1
                                                    STANDARD ALIAS : LINE_1ST_EXPNS_DT
                                                    TITLE    ALIAS : 1ST_EXPNS_DT

                                                    LENGTH         : 8    SIGNED : N

                                                    COMMENTS :
                                                    Prior to Version H this field was named:
                                                    CWFB_1ST_EXPNS_DT.

                                                    SOURCE         : CWF

                                                    EDIT RULES :
                                                          YYYYMMDD

  139. Line Last Expense Date
                                 8   1793   1800    NUM

                                                    The ending date (last expense) for the line
                                                    item service on the noninstitutional claim.

                                                    DB2      ALIAS : LINE_LAST_EXPNS_DT
                                                    SAS      ALIAS : EXPNSDT2
                                                    STANDARD ALIAS : LINE_LAST_EXPNS_DT
                                                    TITLE    ALIAS : LAST_EXPNS_DT

                                                    LENGTH         : 8    SIGNED : N

                                                    COMMENTS :
                                                    Prior to Version H this field was named:
                                                    CWFB_LAST_EXPNS_DT.

                                                    SOURCE         : CWF

                                                    EDIT RULES :
                                                          YYYYMMDD

  140. Line HCPCS Code
                                 5   1801   1805    CHAR

                                                    The Health Care Common Procedure Coding
                                                    System (HCPCS) is a collection of codes that
                                                    represent procedures, supplies, products and
                                                    services which may be provided to Medicare
                                                    beneficiaries and to individuals enrolled in
                                                    private health insurance programs.  The codes
                                                    are divided into three levels, or groups as
                                                    described below:


                                                    DB2      ALIAS : LINE_HCPCS_CD
                                                    SAS      ALIAS : HCPCS_CD
                                                    STANDARD ALIAS : LINE_HCPCS_CD
                                                    TITLE    ALIAS : HCPCS_CD

                                                    LENGTH         : 5

                                                    COMMENTS :
                                                    Prior to Version H this line item field was
                                                    named: HCPCS_CD.  With Version H, a prefix
                                                    was added to denote the location of this field
                                                    on each claim type (institutional: REV_CNTR and
                                                    noninstitutional: LINE).

                                                    Level I
                                                    Codes and descriptors copyrighted by the American
                                                    Medical Association's Current Procedural
                                                    Terminology, Fourth Edition (CPT-4).  These are
                                                    5 position numeric codes representing physician
                                                    and nonphysician services.

                                                    **** Note: ****
                                                    CPT-4 codes including both long and short
                                                    descriptions shall be used in accordance with the
                                                    CMS/AMA agreement.  Any other use violates the
                                                    AMA copyright.

                                                    Level II
                                                    Includes codes and descriptors copyrighted by
                                                    the American Dental Association's Current Dental
                                                    Terminology, Fifth Edition (CDT-5).  These are
                                                    5 position alpha-numeric codes comprising
                                                    the D series.  All other level II codes and
                                                    descriptors are approved and maintained jointly
                                                    by the alpha-numeric editorial panel (consisting
                                                    of CMS, the Health Insurance Association of
                                                    America, and the Blue Cross and Blue Shield
                                                    Association).  These are 5 position alpha-
                                                    numeric codes representing primarily items and
                                                    nonphysician services that are not
                                                    represented in the level I codes.

                                                    Level III
                                                    Codes and descriptors developed by Medicare
                                                    carriers for use at the local (carrier) level.
                                                    These are 5 position alpha-numeric codes in the
                                                    W, X, Y or Z series representing physician
                                                    and nonphysician services that are not
                                                    represented in the level I or level II codes.


  141. Line HCPCS Initial Modifier Code
                                 2   1806   1807    CHAR

                                                    A first modifier to the HCPCS procedure code
                                                    to enable a more specific procedure
                                                    identification for the line item service
                                                    on the noninstitutional claim.


                                                    DB2      ALIAS : UNDEFINED
                                                    SAS      ALIAS : MDFR_CD1
                                                    STANDARD ALIAS : LINE_HCPCS_INITL_MDFR_CD
                                                    TITLE    ALIAS : INITIAL_MODIFIER

                                                    LENGTH         : 2

                                                    COMMENTS :
                                                    Prior to Version H this field was named:
                                                    HCPCS_INITL_MDFR_CD.  With Version H, a prefix
                                                    was added to denote the location of this field
                                                    on each claim type (institutional: REV_CNTR and
                                                    noninstitutional: LINE).

                                                    SOURCE         : CWF

                                                    EDIT RULES :
                                                          CARRIER INFORMATION FILE

  142. Line HCPCS Second Modifier Code
                                 2   1808   1809    CHAR

                                                    A second modifier to the HCPCS procedure code to
                                                    make it more specific than the first modifier
                                                    code to identify the line item procedures for
                                                    this claim.

                                                    DB2      ALIAS : UNDEFINED
                                                    SAS      ALIAS : MDFR_CD2
                                                    STANDARD ALIAS : LINE_HCPCS_2ND_MDFR_CD
                                                    TITLE    ALIAS : SECOND_MODIFIER

                                                    LENGTH         : 2

                                                    COMMENTS :
                                                    Prior to Version H this field was named:
                                                    HCPCS_2ND_MDFR_CD.  With Version H, a prefix
                                                    was added to denote the location of this field
                                                    on each claim type (institutional: REV_CNTR and
                                                    noninstitutional: LINE).

                                                    SOURCE         : CWF

                                                    EDIT RULES :
                                                          CARRIER INFORMATION FILE

  143. DMERC Line HCPCS Third Modifier Code
                                 2   1810   1811    CHAR

                                                    Prior to Version H this field was named:
                                                    HCPCS_3RD_MDFR_CD.

                                                    DB2      ALIAS : HCPCS_3RD_MDFR_CD
                                                    SAS      ALIAS : MDFR_CD3
                                                    STANDARD ALIAS : DMERC_LINE_HCPCS_3RD_MDFR_CD
                                                    TITLE    ALIAS : HCPCS_3RD_MDFR

                                                    LENGTH         : 2

                                                    COMMENTS :
                                                    Prior to Version H this field was named:
                                                    HCPCS_3RD_MDFR_CD.

                                                    SOURCE         : CWF

  144. DMERC Line HCPCS Fourth Modifier Code
                                 2   1812   1813    CHAR

                                                    Prior to Version H this field was named:
                                                    HCPCS_4TH_MDFR_CD.

                                                    DB2      ALIAS : HCPCS_4TH_MDFR_CD
                                                    SAS      ALIAS : MDFR_CD4
                                                    STANDARD ALIAS : DMERC_LINE_HCPCS_4TH_MDFR_CD
                                                    TITLE    ALIAS : HCPCS_4TH_MDFR

                                                    LENGTH         : 2

                                                    COMMENTS :
                                                    Prior to Version H this field was named:
                                                    HCPCS_4TH_MDFR_CD.

                                                    SOURCE         : CWF

  145. Line NCH BETOS Code
                                 3   1814   1816    CHAR

                                                    Effective with Version H, the Berenson-Eggers
                                                    type of service (BETOS) for the procedure code
                                                    based on generally agreed upon clinically
                                                    meaningful groupings of procedures and services.
                                                    This field is included as a line item on the
                                                    noninstitutional claim.

                                                    NOTE:  During the Version H conversion this field
                                                    was populated with data throughout history (back
                                                    to service year 1991).

                                                    DB2      ALIAS : LINE_NCH_BETOS_CD
                                                    SAS      ALIAS : BETOS
                                                    STANDARD ALIAS : LINE_NCH_BETOS_CD
                                                    TITLE    ALIAS : BETOS

                                                    LENGTH         : 3

                                                    DERIVATIONS :
                                                    DERIVED FROM:
                                                    LINE_HCPCS_CD
                                                    LINE_HCPCS_INITL_MDFR_CD
                                                    LINE_HCPCS_2ND_MDFR_CD
                                                    HCPCS MASTER FILE

                                                    DERIVATION RULES:
                                                    Match the HCPCS on the claim to the HCPCS on
                                                    the HCPCS Master File to obtain the BETOS code.

                                                    SOURCE         : NCH

                                                    CODE TABLE     : BETOS_TB

  146. Line IDE Number
                                 7   1817   1823    CHAR

                                                    Effective with Version H, the exemption number
                                                    assigned by the Food and Drug Administration (FDA)
                                                    to an investigational device after a manufacturer
                                                    has been approved by FDA to conduct a clinical
                                                    trial on that device.   HCFA established a new
                                                    policy of covering certain IDE's which was
                                                    implemented in claims processing on 10/1/96
                                                    (which is NCH weekly process 10/4/96) for service
                                                    dates beginning 10/1/95.

                                                    NOTE:  Prior to Version H a dummy line item was
                                                    created in the last occurrence of line item group
                                                    to store IDE.   The IDE number was housed in two
                                                    fields: HCPCS code and HCPCS initial modifier;
                                                    the second modifier contained the value 'ID'.
                                                    There will be only one distinct IDE number
                                                    reported on the non-institutional claim.  During
                                                    the Version H conversion, the IDE was moved from
                                                    the dummy line item to its own dedicated field
                                                    for each line item (i.e., the IDE was repeated
                                                    on all line items on the claim.)

                                                    DB2      ALIAS : LINE_IDE_NUM
                                                    SAS      ALIAS : LINE_IDE
                                                    STANDARD ALIAS : LINE_IDE_NUM
                                                    TITLE    ALIAS : IDE_NUMBER

                                                    LENGTH         : 7

                                                    SOURCE         : CWF

  147. DMERC Line Not Otherwise Classified HCPCS Code Text
                                14   1824   1837    CHAR

                                                    Prior to Version H this field was named:
                                                    CWFB_DME_ITM_NOC_HCPCS_CD_TXT.

                                                    DB2      ALIAS : NOC_HCPCS_CD_TXT
                                                    SAS      ALIAS : NOC_TXT
                                                    STANDARD ALIAS : DMERC_LINE_NOC_HCPCS_CD_TXT
                                                    TITLE    ALIAS : NOC_HCPCS_TXT

                                                    LENGTH         : 14

                                                    COMMENTS :
                                                    Prior to Version H this field was named:
                                                    CWFB_DME_ITM_NOC_HCPCS_CD_TXT.

                                                    SOURCE         : CWF

  148. Line National Drug Code
                                11   1838   1848    CHAR

                                                    Effective 1/1/94 on the DMERC claim, the National
                                                    Drug Code identifying the oral anti-cancer drugs.
                                                    Effective with Version H, this line item field was
                                                    added as a placeholder on the carrier claim.

                                                    DB2      ALIAS : LINE_NATL_DRUG_CD
                                                    SAS      ALIAS : NDC_CD
                                                    STANDARD ALIAS : LINE_NATL_DRUG_CD
                                                    TITLE    ALIAS : NDC_CD

                                                    LENGTH         : 11

                                                    SOURCE         : CWF

  149. Line NCH Payment Amount
                                 6   1849   1854    PACK

                                                    Amount of payment made from the trust funds (after
                                                    deductible and coinsurance amounts have been
                                                    paid) for the line item service on the non-
                                                    institutional claim.

                                                    COMMON   ALIAS : REIMBURSEMENT
                                                    DB2      ALIAS : LINE_NCH_PMT_AMT
                                                    SAS      ALIAS : LINEPMT
                                                    STANDARD ALIAS : LINE_NCH_PMT_AMT
                                                    TITLE    ALIAS : REIMBURSEMENT

                                                    LENGTH         : 9.2    SIGNED : Y

                                                    COMMENTS :
                                                    Prior to Version H this line item field was named:
                                                    CLM_PMT_AMT and the size of this field was
                                                    S9(7)V99.

                                                    SOURCE         : NCH

                                                    EDIT RULES :
                                                          $$$$$$$$$CC

  150. Line Beneficiary Payment Amount
                                 6   1855   1860    PACK

                                                    Effective with Version H, the payment (reim-
                                                    bursement) made to the beneficiary related
                                                    to the line item service on the noninstitu-
                                                    tional 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 : LINE_BENE_PMT_AMT
                                                    SAS      ALIAS : LBENPMT
                                                    STANDARD ALIAS : LINE_BENE_PMT_AMT
                                                    TITLE    ALIAS : BENE_PMT_AMT

                                                    LENGTH         : 9.2    SIGNED : Y

                                                    SOURCE         : CWF

  151. Line Provider Payment Amount
                                 6   1861   1866    PACK

                                                    Effective with Version H, the payment
                                                    made to the provider for the line item
                                                    service on the noninstitutional 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 : LINE_PRVDR_PMT_AMT
                                                    SAS      ALIAS : LPRVPMT
                                                    STANDARD ALIAS : LINE_PRVDR_PMT_AMT
                                                    TITLE    ALIAS : PRVDR_PMT_AMT

                                                    LENGTH         : 9.2    SIGNED : Y

                                                    SOURCE         : CWF

  152. Line Beneficiary Part B Deductible Amount
                                 6   1867   1872    PACK

                                                    The amount of money for which the
                                                    carrier has determined that the beneficiary
                                                    is liable for the Part B cash deductible
                                                    for the line item service on the noninstitutional
                                                    claim.

                                                    DB2      ALIAS : LINE_DDCTBL_AMT
                                                    SAS      ALIAS : LDEDAMT
                                                    STANDARD ALIAS : LINE_BENE_PTB_DDCTBL_AMT
                                                    TITLE    ALIAS : PTB_DED_AMT

                                                    LENGTH         : 9.2    SIGNED : Y

                                                    COMMENTS :
                                                    Prior to Version H this field was named:
                                                    BENE_PTB_DDCTBL_LBLTY_AMT and the size of the
                                                    field was S9(3)V99.

                                                    SOURCE         : CWF

                                                    EDIT RULES :
                                                          $$$$$$$$$CC

  153. Line Beneficiary Primary Payer Code
                                 1   1873   1873    CHAR

                                                    The code specifying a federal non-Medicare program
                                                    or other source that has primary responsibility
                                                    for the payment of the Medicare beneficiary's
                                                    medical bills relating to the line item service
                                                    on the noninstitutional claim.

                                                    DB2      ALIAS : LINE_PRMRY_PYR_CD
                                                    SAS      ALIAS : LPRPAYCD
                                                    STANDARD ALIAS : LINE_BENE_PRMRY_PYR_CD
                                                    TITLE    ALIAS : PRIMARY_PAYER_CD

                                                    LENGTH         : 1

                                                    COMMENTS :
                                                    Prior to Version H this field was named:
                                                    BENE_PRMRY_PYR_CD.

                                                    SOURCE         : CWF,VA,DOL,SSA

                                                    CODE TABLE     : BENE_PRMRY_PYR_TB

  154. Line Beneficiary Primary Payer Paid Amount
                                 6   1874   1879    PACK

                                                    The amount of a payment made on behalf of a
                                                    Medicare beneficiary by a primary payer other
                                                    than Medicare, that the provider is applying
                                                    to covered Medicare charges for to the line
                                                    ITEM SERVICE ON THE NONINSTITUTIONAL.

                                                    DB2      ALIAS : LINE_PRMRY_PYR_PD
                                                    SAS      ALIAS : LPRPDAMT
                                                    STANDARD ALIAS : LINE_BENE_PRMRY_PYR_PD_AMT
                                                    TITLE    ALIAS : PRMRY_PYR_PD

                                                    LENGTH         : 9.2    SIGNED : Y

                                                    COMMENTS :
                                                    Prior to Version H this field was named:
                                                    BENE_PRMRY_PYR_PMY_AMT and the field size
                                                    was S9(5)V99.

                                                    SOURCE         : CWF

                                                    EDIT RULES :
                                                          $$$$$$$$$CC

  155. Line Coinsurance Amount
                                 6   1880   1885    PACK

                                                    Effective with Version H, the beneficiary
                                                    coinsurance liability amount for this line
                                                    item service on the noninstitutional 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 : LINE_COINSRNC_AMT
                                                    SAS      ALIAS : COINAMT
                                                    STANDARD ALIAS : LINE_COINSRNC_AMT
                                                    TITLE    ALIAS : COINSRNC_AMT

                                                    LENGTH         : 9.2    SIGNED : Y

                                                    SOURCE         : CWF

  156. Line Interest Amount
                                 6   1886   1891    PACK

                                                    Amount of interest to be paid for this line
                                                    item service on the noninstitutional claim.
                                                    **NOTE: This is not included in the line item
                                                    NCH payment (reimbursement) amount.

                                                    DB2      ALIAS : LINE_INTRST_AMT
                                                    SAS      ALIAS : LINT_AMT
                                                    STANDARD ALIAS : LINE_INTRST_AMT
                                                    TITLE    ALIAS : INTRST_AMT

                                                    LENGTH         : 9.2    SIGNED : Y

                                                    COMMENTS :
                                                    Prior to Version H this field was named:
                                                    CWFB_INTRST_AMT and the field size was
                                                    S9(5)V99.

                                                    SOURCE         : CWF

                                                    EDIT RULES :
                                                          $$$$$$$$$CC

  157. Line Primary Payer Allowed Charge Amount
                                 6   1892   1897    PACK

                                                    Effective with Version H, the primary payer
                                                    allowed charge amount for the line item
                                                    service on the noninstitutional 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 : PRMRY_PYR_ALOW_AMT
                                                    SAS      ALIAS : PRPYALOW
                                                    STANDARD ALIAS : LINE_PRMRY_PYR_ALOW_CHRG_AMT
                                                    TITLE    ALIAS : PRMRY_PYR_ALOW_CHRG

                                                    LENGTH         : 9.2    SIGNED : Y

                                                    SOURCE         : CWF

  158. Line 10% Penalty Reduction Amount
                                 6   1898   1903    PACK

                                                    Effective with Version H, the 10% payment
                                                    reduction amount (applicable to a late
                                                    filing claim) for the line item service.
                                                    on the noninstitutional claim.

                                                    DB2      ALIAS : TENPCT_PNLTY_AMT
                                                    SAS      ALIAS : PNLTYAMT
                                                    STANDARD ALIAS : LINE_10PCT_PNLTY_RDCTN_AMT
                                                    TITLE    ALIAS : TENPCT_PNLTY

                                                    LENGTH         : 9.2    SIGNED : Y

                                                    SOURCE         : CWF

  159. Line Submitted Charge Amount
                                 6   1904   1909    PACK

                                                    The amount of submitted charges for the line
                                                    item service on the noninstitutional claim.

                                                    DB2      ALIAS : LINE_SBMT_CHRG_AMT
                                                    SAS      ALIAS : LSBMTCHG
                                                    STANDARD ALIAS : LINE_SBMT_CHRG_AMT
                                                    TITLE    ALIAS : SBMT_CHRG

                                                    LENGTH         : 9.2    SIGNED : Y

                                                    COMMENTS :
                                                    Prior to Version H this field was named:
                                                    CWFB_SBMT_CHRG_AMT and the field size was
                                                    S9(5)V99.

                                                    SOURCE         : CWF

                                                    EDIT RULES :
                                                          $$$$$$$$$CC

  160. Line Allowed Charge Amount
                                 6   1910   1915    PACK

                                                    The amount of allowed charges for the line item
                                                    service on the noninstitutional claim. This
                                                    charge is used to compute pay to providers or
                                                    reimbursement to beneficiaries. **NOTE: The

                                                    Note1: The amount includes beneficiary-paid
                                                    amounts (i.e., deductible and coinsurance).

                                                    Note2: The allowed charge is determined by the
                                                    lower of three charges: prevailing, customary or
                                                    actual.

                                                    DB2      ALIAS : LINE_ALOW_CHRG_AMT
                                                    SAS      ALIAS : LALOWCHG
                                                    STANDARD ALIAS : LINE_ALOW_CHRG_AMT
                                                    TITLE    ALIAS : ALOW_CHRG

                                                    LENGTH         : 9.2    SIGNED : Y

                                                    COMMENTS :
                                                    Prior to Version H this field was named:
                                                    CWFB_ALOW_CHRG_AMT and the field size was
                                                    S9(5)V99.

                                                    SOURCE         : CWF

                                                    EDIT RULES :
                                                          $$$$$$$CC

  161. DMERC Line Screen Savings Amount
                                 6   1916   1921    PACK

                                                    Prior to Version H this field was named:
                                                    CWFB_DME_SCRN_SVGS_AMT and the field size was
                                                    S9(5)V99.

                                                    DB2      ALIAS : LINE_SCRN_SVGS_AMT
                                                    SAS      ALIAS : SCRNSVGS
                                                    STANDARD ALIAS : DMERC_LINE_SCRN_SVGS_AMT
                                                    TITLE    ALIAS : SCRN_SVGS

                                                    LENGTH         : 9.2    SIGNED : Y

                                                    COMMENTS :
                                                    Prior to Version H this field was named:
                                                    CWFB_DME_SCRN_SVGS_AMT and the field size was
                                                    S9(5)V99.

                                                    SOURCE         : CWF

  162. Line DME Purchase Price Amount
                                 6   1922   1927    PACK

                                                    Effective 5/92, the amount representing the
                                                    lower of fee schedule for purchase of new or
                                                    used DME, or actual charge.  In case of rental
                                                    DME, this amount represents the purchase cap;
                                                    rental payments can only be made until the
                                                    cap is met.  This line item field is applicable
                                                    to non-institutional claims involving DME,
                                                    prosthetic, orthotic and supply items,
                                                    immunosuppressive drugs, pen, ESRD and oxygen
                                                    items referred to as DMEPOS.

                                                    DB2      ALIAS : DME_PURC_PRICE_AMT
                                                    SAS      ALIAS : DME_PURC
                                                    STANDARD ALIAS : LINE_DME_PURC_PRICE_AMT
                                                    TITLE    ALIAS : DME_PURC_PRICE

                                                    LENGTH         : 9.2    SIGNED : Y

                                                    COMMENTS :
                                                    Prior to Version H this field was named:
                                                    CWFB_DME_PURC_PRICE_AMT and the field size
                                                    was S9(5)V99.

                                                    SOURCE         : CWF

                                                    EDIT RULES :
                                                          $$$$$$$$$CC

  163. Line Processing Indicator Code
                                 2   1928   1929    CHAR

                                                    The code on a noninstitutional claim indicating to
                                                    whom payment was made or if the claim was denied.

                                                    NOTE1:  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.

                                                    NOTE2:  Effective with Version 'J', the field has been
                                                    expanded on the NCH record to 2 bytes,  With this
                                                    expansion, the NCH will no longer use the character
                                                    values to represent the official two byte values sent in
                                                    by CWF since 4/2002.  During the Version J conversion,
                                                    all character values were converted to the two byte
                                                    values.

                                                    DB2      ALIAS : LINE_PRCSG_IND_CD
                                                    SAS      ALIAS : PRCNGIND
                                                    STANDARD ALIAS : LINE_PRCSG_IND_CD

                                                    LENGTH         : 2

                                                    COMMENTS :
                                                    Prior to Version H this field was named:
                                                    CWFB_PRCSG_IND_CD.

                                                    SOURCE         : CWF

                                                    CODE TABLE     : LINE_PRCSG_IND_TB

  164. Line Payment 80%/100% Code
                                 1   1930   1930    CHAR

                                                    The code indicating that the amount shown in the
                                                    payment field on the noninstitutional line item
                                                    represents either 80% or 100% of the allowed
                                                    charges less any deductible, or 100% limitation
                                                    of liability only.

                                                    COMMON   ALIAS : REIMBURSEMENT_IND
                                                    DB2      ALIAS : LINE_PMT_80_100_CD
                                                    SAS      ALIAS : PMTINDSW
                                                    STANDARD ALIAS : LINE_PMT_80_100_CD
                                                    TITLE    ALIAS : REINBURSEMENT_IND

                                                    LENGTH         : 1

                                                    COMMENTS :
                                                    Prior to Version H this field was named:
                                                    CWFB_PMT_80_100_CD.

                                                    SOURCE         : CWF

                                                    CODE TABLE     : LINE_PMT_80_100_TB

  165. Line Service Deductible Indicator Switch
                                 1   1931   1931    CHAR

                                                    Switch indicating whether or not the line item
                                                    service on the noninstitutional claim is subject
                                                    to a deductible.

                                                    DB2      ALIAS : SRVC_DDCTBL_SW
                                                    SAS      ALIAS : DED_SW
                                                    STANDARD ALIAS : LINE_SRVC_DDCTBL_IND_SW
                                                    TITLE    ALIAS : SRVC_DED_IND

                                                    LENGTH         : 1

                                                    COMMENTS :
                                                    Prior to Version H this field was named:
                                                    CWFB_SRVC_DDCTBL_IND_SW.

                                                    SOURCE         : CWF

                                                    CODE TABLE     : LINE_SRVC_DDCTBL_IND_TB

  166. Line Payment Indicator Code
                                 1   1932   1932    CHAR

                                                    Code that indicates the payment screen used to
                                                    determine the allowed charge for the line item
                                                    service on the noninstitutional claim.

                                                    DB2      ALIAS : LINE_PMT_IND_CD
                                                    SAS      ALIAS : PMTINDCD
                                                    STANDARD ALIAS : LINE_PMT_IND_CD
                                                    TITLE    ALIAS : PMT_IND

                                                    LENGTH         : 1

                                                    COMMENTS :
                                                    Prior to Version H this field was named:
                                                    CWFB_PMT_IND_CD.

                                                    SOURCE         : CWF

  167. DMERC Line Miles/Time/Units/Services Count
                                 6   1933   1938    PACK

                                                    The count of the total units associated with the
                                                    DMERC line item service needing unit reporting,
                                                    including number of services, volume of oxygen
                                                    and drug dose.

                                                    DB2      ALIAS : DMERC_MTUS_CNT
                                                    SAS      ALIAS : DME_UNIT
                                                    STANDARD ALIAS : DMERC_LINE_MTUS_CNT
                                                    TITLE    ALIAS : MTUS_CNT

                                                    LENGTH         : 7.3    SIGNED : Y

                                                    COMMENTS :
                                                    Prior to Version H this field was named:
                                                    CWFB_MTUS_CNT.

                                                    Prior to Version 'J', this field was S9(3)
                                                      Length: 7.3

  168. DMERC Line Miles/Time/Units/Services Indicator Code
                                 1   1939   1939    CHAR

                                                    Prior to Version H this field was named:
                                                    CWFB_DME_MTUS_IND_CD.

                                                    DB2      ALIAS : DMERC_MTUS_IND_CD
                                                    SAS      ALIAS : UNIT_IND
                                                    STANDARD ALIAS : DMERC_LINE_MTUS_IND_CD
                                                    TITLE    ALIAS : MTUS_IND

                                                    LENGTH         : 1

                                                    COMMENTS :
                                                    Prior to Version H this field was named:
                                                    CWFB_DME_MTUS_IND_CD.

                                                    SOURCE         : CWF

                                                    CODE TABLE     : DMERC_LINE_MTUS_IND_TB

  169. Line Diagnosis Code Group
                                 8   1940   1947    GRP


                                                    Effective with Version 'J', the group used to
                                                    identify the diagnosis codes at the line level.
                                                    This group contains the diagnosis code and the
                                                    diagnosis version code.

                                                    STANDARD ALIAS : LINE_DGNS_CD_GRP

  170. Line Diagnosis Version Code
                                 1   1940   1940    CHAR

                                                    Effective with Version 'J', the code used to indicate if the
                                                    diagnosis code is ICD-9 or ICD-10.

                                                    NOTE:  With 5010, the diagnosis and procedure codes have
                                                    been expanded to accomodate ICD-10, even though ICD-10 is
                                                    not scheduled for implementation until 10/2013.

                                                    DB2      ALIAS : UNDEFINED
                                                    SAS      ALIAS : LDVRSNCD
                                                    STANDARD ALIAS : LINE_DGNS_VRSN_CD

                                                    LENGTH         : 1

                                                    CODE TABLE     : LINE_DGNS_VRSN_TB

  171. Line Diagnosis Code
                                 7   1941   1947    CHAR

                                                    The code indicating the diagnosis
                                                    supporting this line item procedure/service
                                                    on the noninstitutional claim.

                                                    DB2      ALIAS : LINE_DGNS_CD
                                                    SAS      ALIAS : LINEDGNS
                                                    STANDARD ALIAS : LINE_DGNS_CD
                                                    TITLE    ALIAS : DGNS_CD

                                                    LENGTH         : 7

                                                    COMMENTS :
                                                    Prior to Version H this field was named:
                                                    CWFB_LINE_DGNS_CD.

                                                    SOURCE         : CWF

  172. Line Additional Claim Documentation Indicator Code
                                 1   1948   1948    CHAR

                                                    Effective 5/92, the code indicating additional
                                                    claim documentation was submitted for this line
                                                    item service on the noninstitutional claim.

                                                    COMMON   ALIAS : DOCUMENT_IND
                                                    DB2      ALIAS : ADDTNL_DCMTN_CD
                                                    SAS      ALIAS : DCMTN_CD
                                                    STANDARD ALIAS : LINE_ADDTNL_CLM_DCMTN_IND_CD
                                                    TITLE    ALIAS : ADDTNL_DCMTN_IND

                                                    LENGTH         : 1

                                                    COMMENTS :
                                                    Prior to Version H this field was named:
                                                    CWFB_ADDTNL_CLM_DCMTN_IND_CD.

                                                    SOURCE         : CWF

                                                    EDIT RULES :
                                                          In any case where more than one value is
                                                          applicable, highest number is shown.

                                                    CODE TABLE     : LINE_ADDTNL_CLM_DCMTN_IND_TB

  173. DMERC Line Screen Suspension Indicator Code
                                 4   1949   1952    CHAR

                                                    Effective with Version G, the code identifying
                                                    the medical review (MR) screen that caused DMERC
                                                    line item to suspend.

                                                    DB2      ALIAS : SCRN_SUSPNSN_CD
                                                    SAS      ALIAS : SUSP_IND
                                                    STANDARD ALIAS : DMERC_LINE_SCRN_SUSPNSN_IND_CD
                                                    TITLE    ALIAS : SCRN_SUSPNSN_IND

                                                    LENGTH         : 4

                                                    SOURCE         : CWF

                                                    CODE TABLE     : DMERC_LINE_SCRN_SUSPNSN_IND_TB

  174. DMERC Line Screen Result Indicator Code
                                 1   1953   1953    CHAR

                                                    Effective with Version G, code indicating the
                                                    outcome of the medical review (MR) unit's evaluation
                                                    of the DMERC line item.

                                                    DB2      ALIAS : SCRN_RSLT_IND_CD
                                                    SAS      ALIAS : RSLT_IND
                                                    STANDARD ALIAS : DMERC_LINE_SCRN_RSLT_IND_CD
                                                    TITLE    ALIAS : SCRN_RSLT_IND

                                                    LENGTH         : 1

                                                    COMMENTS :
                                                    Prior to Version H this field was named:
                                                    CWFB_DME_SCRN_RSLT_IND_CD.

                                                    SOURCE         : CWF

                                                    CODE TABLE     : DMERC_LINE_SCRN_RSLT_IND_TB

  175. DMERC Line Waiver Of Provider Liability Switch
                                 1   1954   1954    CHAR

                                                    Effective with Version G, the switch indicating
                                                    the beneficiary was notified that the item, reported
                                                    as a DMERC line item, may not be considered medically
                                                    necessary and has agreed in writing to pay for
                                                    the item.

                                                    DB2      ALIAS : WVR_PRVDR_LBLTY_SW
                                                    SAS      ALIAS : WAIVERSW
                                                    STANDARD ALIAS : DMERC_LINE_WVR_PRVDR_LBLTY_SW
                                                    TITLE    ALIAS : WAIVER_LBLTY_SW

                                                    LENGTH         : 1

                                                    COMMENTS :
                                                    Prior to Version H this field was named:
                                                    CWFB_DME_WVR_PRVDR_LBLTY_SW.

                                                    SOURCE         : CWF

                                                    CODE TABLE     : YES_NO_TB

  176. DMERC Line Decision Indicator Switch
                                 1   1955   1955    CHAR

                                                    Effective with Version G, the switch identifying
                                                    whether the DMERC claim represents an original
                                                    decision or a reversal of an earlier decision
                                                    on the original claim.

                                                    DB2      ALIAS : DMERC_DCSN_IND_SW
                                                    SAS      ALIAS : DCSN_IND
                                                    STANDARD ALIAS : DMERC_LINE_DCSN_IND_SW
                                                    TITLE    ALIAS : DCSN_IND

                                                    LENGTH         : 1

                                                    COMMENTS :
                                                    Prior to Version H this field was named:
                                                    CWFB_DME_DCSN_IND_SW.

                                                    SOURCE         : CWF

                                                    CODE TABLE     : DMERC_LINE_DCSN_IND_TB

  177. Line Consolidated Billing Indicator Code
                                 1   1956   1956    CHAR

                                                    Effective 1/1/2004 with implementation of NCH/NMUD
                                                    CR#1, this code is reflected on carrier & DMERC claims
                                                    to identify those line item services (i.e. therapy
                                                    and nonroutine supply services) that are subject
                                                    to SNF and Home Health consolidated billing. If the
                                                    line item service was paid by a  carrier prior
                                                    to the submission of the SNF or home health claim
                                                    an adjustment for the carrier or DMERC claim will
                                                    be submitted identifying those services that are
                                                    subject to consolidated billing.

                                                    NOTE1:  Prior to 10/2005 (implementation of NCH/NMUD
                                                    CR#2), this data was stored in position 245 (FILLER)
                                                    of the line item trailer.

                                                    Effective July 2005, this data will no longer be coming
                                                    into the NCH.

                                                    DB2      ALIAS : CNSLDTD_BLG_CD
                                                    SAS      ALIAS : LCNSLDTD
                                                    STANDARD ALIAS : LINE_CNSLDTD_BLG_CD

                                                    LENGTH         : 1

                                                    CODE TABLE     : LINE_CNSLDTD_BLG_TB

  178. Line Duplicate Claim Check Indicator Code
                                 1   1957   1957    CHAR

                                                    Effective 1/1/2004 with the implementation of NCH/NMUD
                                                    CR#1, the code used to identify an item or service that
                                                    appeared to be a duplicate but has been reviewed by a
                                                    carrier and appropriately approved for payment.

                                                    NOTE1:  Prior to 10/2005 (implementation of NCH/NMUD
                                                    CR#2), this data was stored in position 246 (FILLER)
                                                    on the line item trailer.

                                                    DB2      ALIAS : DUP_CLM_CHK_IND_CD
                                                    SAS      ALIAS : DUP_CHK
                                                    STANDARD ALIAS : LINE_DUP_CLM_CHK_IND_CD

                                                    LENGTH         : 1

                                                    SOURCE         : CWF

                                                    CODE TABLE     : LINE_DUP_CLM_CHK_IND_TB

  179. Line Hematocrit/Hemoglobin Test Type Code
                                 2   1958   1959    CHAR

                                                    Effective September 1, 2008 with the implementation
                                                    of CR#3, the code used to identify which reading is
                                                    reflected in the hematocrit/hemoglobin result number
                                                    field on the noninstitutional claim.

                                                    DB2      ALIAS : HCT_HGB_TYPE_CD
                                                    SAS      ALIAS : HTYPECD
                                                    STANDARD ALIAS : LINE_HCT_HGB_TYPE_CD

                                                    LENGTH         : 2

                                                    CODE TABLE     : LINE_HCT_HGB_TYPE_TB

  180. Line Hematocrit/Hemoglobin Result Number
                                 3   1960   1962    CHAR

                                                    Effective September 1, 2008, with the implementation
                                                    of CR#3, the number used to identify the most recent
                                                    hematocrit or hemoglobin reading on the noninstitutional
                                                    claim.

                                                    NOTE:  The hematocrit/hemoglobin test result field is a
                                                    redefined field.  The field is being defined as X(3) and
                                                    redefined as numeric (99V9).  A numeric test on the
                                                    alphanumeric field is needed.  Whenever a user wants to
                                                    use the field they must test the alphanumeric field for
                                                    numerics and if it is numeric then the 99V9 definition
                                                    would be used.  The older data will cause an abend if
                                                    trying to process numeric data with characters.

                                                    DB2      ALIAS : HCT_HGB_RSLT_NUM
                                                    SAS      ALIAS : HRSLTNUM
                                                    STANDARD ALIAS : LINE_HCT_HGB_RSLT_NUM

                                                    LENGTH         : 3

  181. Line Hematocrit/Hemoglobin Result Number -- Redefined
                                 3   1963   1965    NUM

                                                    Effective September 1, 2008, with the implementation
                                                    of CR#3, the number used to identify the most recent
                                                    hematocrit or hemoglobin reading on the noninstitutional
                                                    claim.

                                                    NOTE:  The hematocrit/hemoglobin test result field is a
                                                    redefined field.  The field is being defined as X(3) and
                                                    redefined as numeric (99V9).  A numeric test on the
                                                    alphanumeric field is needed.  Whenever a user wants to
                                                    use the field they must test the alphanumeric field for
                                                    numerics and if it is numeric then the 99V9 definition
                                                    would be used.  The older data will cause an abend if
                                                    trying to process numeric data with characters.

                                                    DB2      ALIAS : HCT_HGB_RSLT_NUM
                                                    SAS      ALIAS : HRLSTNUM
                                                    STANDARD ALIAS : LINE_HCT_HGB_RSLT_NUM_R

                                                    LENGTH         : 2.1    SIGNED : N

                                                    REDEFINE   : LINE_HCT_HGB_RSLT_NUM

  182. Worker's Compensation Indicator Code
                                 1   1966   1966    CHAR

                                                    This indicator is used to determine whether the
                                                    diagnosis codes on the claims are related to the
                                                    diagnosis codes on the MSP auxiliary file in CWF.

                                                    DB2      ALIAS : LINE_WC_IND_CD
                                                    SAS      ALIAS : WCINDCD
                                                    STANDARD ALIAS : LINE_WC_IND_CD

                                                    LENGTH         : 1

                                                    CODE TABLE     : LINE_WC_IND_TB

  183. Line Paperwork (PWK) Code
                                 2   1967   1968    CHAR

                                                    Effective with CR#6, the code used to indicate a provider
                                                    has submitted an electronic claim that requires
                                                    additional documentation.

                                                    DB2      ALIAS : LINE_PWK_CD
                                                    STANDARD ALIAS : LINE_PWK_CD

                                                    LENGTH         : 2

                                                    CODE TABLE     : LINE_PWK_TB

  184. Line Unique Tracking Number
                                14   1969   1982    CHAR

                                                    Effective with CR#7, the number assigned to each Power
                                                    Mobility Device (PMD) prior authorization request.
                                                    Prior to the NCH April release (CR#7), the PMD
                                                    tracking number was stored in the demonstration trailer.
                                                    The tracking number was reflected in the claim by
                                                    demo # '60'.

                                                    Effective with the CWF January release, demo '60' was
                                                    implemented with CR7495 (Implementation of Prior
                                                    Authorization for Power Mobility Devices (PMD) to
                                                    facilitate a three year mandatory prior authori-
                                                    zation process in 7 states.  This initiative was
                                                    designed as a tool to protect the Medicare trust
                                                    fund by deterring fraudulent and abusive billing
                                                    practices, and make the physician or treating
                                                    practitioner more accountable for the items he or
                                                    she orders to prevent improper payments. Under
                                                    this demonstration for a PMD, a physician/treating
                                                    practitioner must submit a request for prior authori-
                                                    zation to support Medicare coverage requirements of
                                                    the PMD item.

                                                    Prior to CR#9, this field was named:
                                                    LINE_PMD_TRKNG_NUM.

                                                    DB2      ALIAS : LINE_UNIQ_TRKNG_NU
                                                    SAS      ALIAS : UNIQNUM
                                                    STANDARD ALIAS : LINE_UNIQ_TRKNG_NUM

                                                    LENGTH         : 14

                                                    COMMENTS :
                                                    (CMS CR7495)

  185. Line Other Applied Indicator 1 Code
                                 2   1983   1984    CHAR

                                                    Effective with Version 'K', the code used to
                                                    identify the reason the claim payment amount
                                                    was adjusted during claims processing.

                                                    Effective with Version L (January 2021 release), this
                                                    field was expanded from 1 byte to 2 bytes.

                                                    DB2      ALIAS : UNDEFINED
                                                    SAS      ALIAS : APLDIND1

                                                    LENGTH         : 2

                                                    CODE TABLE     : LINE_OTHR_APLD_IND_CD_TB

  186. Line Other Applied Indicator 2 Code
                                 2   1985   1986    CHAR

                                                    Effective with Version 'K', the code used to
                                                    identify the reason the claim payment amount
                                                    was adjusted during claims processing.

                                                    Effective with Version L (January 2021 release), this
                                                    field was expanded from 1 byte to 2 bytes.

                                                    DB2      ALIAS : UNDEFINED
                                                    SAS      ALIAS : APLDIND2

                                                    LENGTH         : 2

                                                    SOURCE         : CWF

                                                    CODE TABLE     : LINE_OTHR_APLD_IND_CD_TB

  187. Line Other Applied Indicator 3 Code
                                 2   1987   1988    CHAR

                                                    Effective with Version 'K', the code used to
                                                    identify the reason the claim payment amount
                                                    was adjusted during claims processing.

                                                    Effective with Version L (January 2021 release), this
                                                    field was expanded from 1 byte to 2 bytes.

                                                    DB2      ALIAS : UNDEFINED
                                                    SAS      ALIAS : APLDIND3

                                                    LENGTH         : 2

                                                    SOURCE         : CWF

                                                    CODE TABLE     : LINE_OTHR_APLD_IND_CD_TB

  188. Line Other Applied Indicator 4 Code
                                 2   1989   1990    CHAR

                                                    Effective with Version 'K', the code used to
                                                    identify the reason the claim payment amount
                                                    was adjusted during claims processing.

                                                    Effective with Version L (January 2021 release), this
                                                    field was expanded from 1 byte to 2 bytes.

                                                    DB2      ALIAS : UNDEFINED
                                                    SAS      ALIAS : APLDIND4

                                                    LENGTH         : 2

                                                    SOURCE         : CWF

                                                    CODE TABLE     : LINE_OTHR_APLD_IND_CD_TB

  189. Line Other Applied Indicator 5 Code
                                 2   1991   1992    CHAR

                                                    Effective with Version 'K', the code used to
                                                    identify the reason the claim payment amount
                                                    was adjusted during claims processing.

                                                    Effective with Version L (January 2021 release), this
                                                    field was expanded from 1 byte to 2 bytes.

                                                    DB2      ALIAS : UNDEFINED
                                                    SAS      ALIAS : APLDIND5

                                                    LENGTH         : 2

                                                    SOURCE         : CWF

                                                    CODE TABLE     : LINE_OTHR_APLD_IND_CD_TB

  190. Line Other Applied Indicator 6 Code
                                 2   1993   1994    CHAR

                                                    Effective with Version 'K', the code used to
                                                    identify the reason the claim payment amount
                                                    was adjusted during claims processing.

                                                    Effective with Version L (January 2021 release), this
                                                    field was expanded from 1 byte to 2 bytes.

                                                    DB2      ALIAS : UNDEFINED
                                                    SAS      ALIAS : APLDIND6

                                                    LENGTH         : 2

                                                    SOURCE         : CWF

                                                    CODE TABLE     : LINE_OTHR_APLD_IND_CD_TB

  191. Line Other Applied Indicator 7 Code
                                 2   1995   1996    CHAR

                                                    Effective with Version 'K', the code used to
                                                    identify the reason the claim payment amount
                                                    was adjusted during claims processing.

                                                    Effective with Version L (January 2021 release), this
                                                    field was expanded from 1 byte to 2 bytes.

                                                    DB2      ALIAS : UNDEFINED
                                                    SAS      ALIAS : APLDIND7

                                                    LENGTH         : 2

                                                    SOURCE         : CWF

                                                    CODE TABLE     : LINE_OTHR_APLD_IND_CD_TB

  192. Line Other Applied 1 Amount
                                 6   1997   2002    PACK

                                                    Effective with Version 'K', the field used to
                                                    identify amounts that were used to adjust the
                                                    amount payable when processing the line item.

                                                    DB2      ALIAS : OTHR_APLD_1_AMT
                                                    SAS      ALIAS : APLDAMT1
                                                    STANDARD ALIAS : LINE_OTHR_APLD_1_AMT

                                                    LENGTH         : 9.2    SIGNED : Y

  193. Line Other Applied 2 Amount
                                 6   2003   2008    PACK

                                                    Effective with Version 'K', the field used to
                                                    identify amounts that were used to adjust the
                                                    amount payable when processing the line item.

                                                    DB2      ALIAS : OTHR_APLD_2_AMT
                                                    SAS      ALIAS : APLDAMT2
                                                    STANDARD ALIAS : LINE_OTHR_APLD_2_AMT

                                                    LENGTH         : 9.2    SIGNED : Y

  194. Line Other Applied 3 Amount
                                 6   2009   2014    PACK

                                                    Effective with Version 'K', the field used to
                                                    identify amounts that were used to adjust the
                                                    amount payable when processing the line item.

                                                    DB2      ALIAS : OTHR_APLD_3_AMT
                                                    SAS      ALIAS : APLDAMT3
                                                    STANDARD ALIAS : LINE_OTHR_APLD_3_AMT

                                                    LENGTH         : 9.2    SIGNED : Y

  195. Line Other Applied 4 Amount
                                 6   2015   2020    PACK

                                                    Effective with Version 'K', the field used to
                                                    identify amounts that were used to adjust the
                                                    amount payable when processing the line item.

                                                    DB2      ALIAS : OTHR_APLD_4_AMT
                                                    SAS      ALIAS : APLDAMT4
                                                    STANDARD ALIAS : LINE_OTHR_APLD_4_AMT

                                                    LENGTH         : 9.2    SIGNED : Y

  196. Line Other Applied 5 Amount
                                 6   2021   2026    PACK

                                                    Effective with Version 'K', the field used to
                                                    identify amounts that were used to adjust the
                                                    amount payable when processing the line item.

                                                    DB2      ALIAS : OTHR_APLD_5_AMT
                                                    SAS      ALIAS : APLDAMT5
                                                    STANDARD ALIAS : LINE_OTHR_APLD_5_AMT

                                                    LENGTH         : 9.2    SIGNED : Y

  197. Line Other Applied 6 Amount
                                 6   2027   2032    PACK

                                                    Effective with Version 'K', the field used to
                                                    identify amounts that were used to adjust the
                                                    amount payable when processing the line item.

                                                    DB2      ALIAS : OTHR_APLD_6_AMT
                                                    SAS      ALIAS : APLDAMT6
                                                    STANDARD ALIAS : LINE_OTHR_APLD_6_AMT

                                                    LENGTH         : 9.2    SIGNED : Y

  198. Line Other Applied 7 Amount
                                 6   2033   2038    PACK

                                                    Effective with Version 'K', the field used to
                                                    identify amounts that were used to adjust the
                                                    amount payable when processing the line item.

                                                    DB2      ALIAS : OTHR_APLD_7_AMT
                                                    SAS      ALIAS : APLDAMT7
                                                    STANDARD ALIAS : LINE_OTHR_APLD_7_AMT

                                                    LENGTH         : 9.2    SIGNED : Y

  199. Line FPS Model Number
                                 2   2039   2040    CHAR

                                                    Effective with Version 'K', this field identifies an
                                                    FPS analytic model that identifies claims that may
                                                    be high risk for fraud based on specific information.

                                                    DB2      ALIAS : LINE_FPS_MODEL_NUM
                                                    SAS      ALIAS : LMODEL
                                                    STANDARD ALIAS : LINE-FPS-MODEL-NUM

                                                    LENGTH         : 2

  200. Line FPS Reason Code
                                 3   2041   2043    CHAR

                                                    Effective with Version 'K', this field identifies the
                                                    reason codes used to explain why a claim was not
                                                    paid or how the claim was paid.  These codes also
                                                    show the reason for any claim financial adjustment
                                                    such as denial, reductions or increases in payment.

                                                    DB2      ALIAS : LINE_FPS_RSN_CD
                                                    SAS      ALIAS : LFPSRSN
                                                    STANDARD ALIAS : LINE-FPS-RSN-CD

                                                    LENGTH         : 3

                                                    CODE TABLE     : CLM_ADJ_RSN_TB

  201. Line FPS Remark Code
                                 5   2044   2048    CHAR

                                                    Effective with Version 'K', the codes used to
                                                    convey information about remittance processing or
                                                    to provide a supplemental explanation for an
                                                    adjustment already described by a Claim
                                                    Adjustment Reason Code.

                                                    DB2      ALIAS : LINE_FPS_RMRK_CD
                                                    SAS      ALIAS : LFPSRMRK
                                                    STANDARD ALIAS : LINE-FPS-RMRK-CD

                                                    LENGTH         : 5

                                                    CODE TABLE     : CLM_RMTNC_ADVC_TB

  202. Line FPS MSN 1 Code
                                 5   2049   2053    CHAR

                                                    Effective with Version 'K', the field used
                                                    to identify the Medicare Secondary Notice Code.

                                                    DB2      ALIAS : LINE_FPS_MSN_1_CD
                                                    SAS      ALIAS : LFPSMSN1
                                                    STANDARD ALIAS : LINE-FPS-MSN-1-CD

                                                    LENGTH         : 5

                                                    CODE TABLE     : CLM_FPS_MSN_CD_TB

  203. Line FPS MSN 2 Code
                                 5   2054   2058    CHAR

                                                    Effective with Version 'K', the field used to
                                                    identify the Medicare Secondary Notice Code.

                                                    DB2      ALIAS : LINE_FPS_MSN_2_CD
                                                    SAS      ALIAS : LFPSMSN2
                                                    STANDARD ALIAS : LINE-FPS-MSN-2-CD

                                                    LENGTH         : 5

                                                    CODE TABLE     : CLM_FPS_MSN_CD_TB

  204. DMERC Line Competitive Bidding Area (CBA) Code
                                 5   2059   2063    CHAR

                                                    Effective with CR#8, the code used to identify the
                                                    Competitive Bidding Area (CBA).

                                                    DB2      ALIAS : DMERC_LINE_CBA_CD
                                                    SAS      ALIAS : CBACD
                                                    STANDARD ALIAS : DMERC_LINE_CBA_CD

                                                    LENGTH         : 5

                                                    CODE TABLE     : DMERC_LINE_CBA_TB

  205. DMERC Line Competitive Bidding Area (CBA) Date
                                 8   2064   2071    NUM

                                                    Effective with CR#8, the date used to identify the
                                                    start date for a particular round of competitive
                                                    bidding used to determine the eligibility for
                                                    contract or grandfathering suppliers.

                                                    DB2      ALIAS : DMERC_LINE_CBA_DT
                                                    SAS      ALIAS : CBADATE
                                                    STANDARD ALIAS : DMERC_LINE_CBA_DT

                                                    LENGTH         : 8    SIGNED : N

  206. Line Prior Authorization Indicator Code
                                 4   2072   2075    CHAR

                                                    Effective with CR#9 (October 2014 release), the indicator assigned
                                                    by CMS for each prior authorization program to define the applicable
                                                    line of business (i.e. Part A, Part B, DME, Home Health and Hospice).

                                                    DB2      ALIAS : LINE_AUTHRZTN_CD
                                                    SAS      ALIAS : LPRIOR
                                                    STANDARD ALIAS : LINE_PRIOR_AUTHRZTN_IND_CD

                                                    LENGTH         : 4

                                                    CODE TABLE     : LINE_PRIOR_AUTHRZTN_TB

  207. Line Representative Payee (RP) Indicator Code
                                 1   2076   2076    CHAR

                                                    Effective with CR#11, this field will be used to designate by-
                                                    passing of the prior authorization processing for claims with a
                                                    representative payee when an 'R' is present in the field.

                                                    NOTE:  Data will not start coming in until April 2016.  This field
                                                    was added to the January 2016 release because our workload (FA fix)
                                                    will not allow us to implement another CR in April.

                                                    DB2      ALIAS : LINE_RP_IND_CD
                                                    SAS      ALIAS : LRPIND
                                                    STANDARD ALIAS : LINE_RP_IND_CD

                                                    LENGTH         : 1

                                                    SOURCE         : CWF

                                                    CODE TABLE     : RP_IND_TB

  208. Line Residual Payment Indicator Code
                                 1   2077   2077    CHAR

                                                    Effective with CR#11, this field is used by CWF claims processing
                                                    for the purpose of bypassing its normal MSP editing that would
                                                    otherwise apply for ongoing responsibility for medicals (ORM) or
                                                    worker's compensation Medicare Set-Aside Arrangements (WCMSA).
                                                    Normally, CWF does not allow a secondary payment on MSP involving
                                                    ORM or WCMSA, so the residual payment indicator will be used to
                                                    allow CWF to make an exception to its normal routine.

                                                    DB2      ALIAS : LINE_RSDL_PMT_CD
                                                    SAS      ALIAS : LRSDLPMT
                                                    STANDARD ALIAS : LINE_RSDL_PMT_IND_CD

                                                    LENGTH         : 1

                                                    SOURCE         : CWF

                                                    CODE TABLE     : RSDL_PMT_IND_TB

  209. Line Foreign Address Indicator
                                 2   2078   2079    CHAR

                                                    Effective with CR#12, this field is used to identify
                                                    claims for expatriate beneficiaries (beneificiary whose
                                                    permanent address is outside the U.S.) who purchased
                                                    DMEPOS items that were furnished in the United States.

                                                    DB2      ALIAS : FRGN_ADR_IND_CD
                                                    SAS      ALIAS : FRGNADR
                                                    STANDARD ALIAS : DMERC_LINE_FRGN_ADR_IND_CD

                                                    LENGTH         : 2

                                                    COMMENTS :
                                                    (CMS CR9468) - CWF July 2016 Release

                                                    CODE TABLE     : DMERC_LINE_FRGN_ADR_IND_TB

  210. DMERC Line Railroad Board Exclusion Indicator Switch
                                 1   2080   2080    CHAR

                                                    Effective with CR#14 (April 2019 release), this field informs the
                                                    Shared System Maintainer (SSM) and Common Working File (CWF) if
                                                    the Railroad Board (RRB) beneficiary claim should either be in-
                                                    cluded or excluded from Prior Authorization (PA) processing.

                                                    For example, if the field is valued "Y", and it is an RRB bene-
                                                    ficiary claim, it will be excluded from PA processing.

                                                    DB2      ALIAS : UNDEFINED
                                                    SAS      ALIAS : DLEXCLSN

                                                    LENGTH         : 1

                                                    CODE TABLE     : DMERC_LINE_RRB_EXCLSN_IND_TB

  211. Line Voluntary Service Indicator Code
                                 1   2081   2081    CHAR

                                                    Effective with Version L (January 2021 release), this line level
                                                    field will be used to identify if the service (Procedure Code)
                                                    was voluntary or required.

                                                    NOTE:
                                                    Data will not start coming in for this field until the July
                                                    release (July 6, 2021)

                                                    Valid values:
                                                    V = A Voluntary procedure code
                                                    Blank = A Required procedure code

                                                    DB2      ALIAS : UNDEFINED
                                                    SAS      ALIAS : LVLNTRY
                                                    STANDARD ALIAS : LINE_VLNTRY_SRVC_IND_CD

                                                    LENGTH         : 1

                                                    SOURCE         : CWF

                                                    CODE TABLE     : LINE_VLNTRY_SRVC_IND_TB

  212.
                               970   2082   3051    CHAR

                                                    DB2      ALIAS : H_FILLER_9

                                                    LENGTH         : 970

  213. End of Record Code
                                 3  18925  18927    CHAR

                                                    Effective with Version 'I', the code used
                                                    to identify the end of a record/segment or
                                                    the end of the claim.

                                                    DB2      ALIAS : END_REC_CD
                                                    SAS      ALIAS : EOR
                                                    STANDARD ALIAS : END_REC_CD
                                                    TITLE    ALIAS : END_OF_REC

                                                    LENGTH         : 3

                                                    COMMENTS :
                                                    Prior to Version I this field was named:
                                                    END_REC_CNSTNT.

                                                    SOURCE         : NCH

                                                    CODE TABLE     : END_REC_TB



                                                     QUERY: RIFQQ11, RIFQQ21 ON DB2T
                                                    ***********END OF MAIN REPORT FOR RECORD: DMERC_CLM_REC***********


1
  TABLE OF CODES APPENDIX FOR RECORD: DMERC_CLM_REC,  STATUS: PROD, VERSION: 21006
  PRINTED: 10/19/2021,  USER: F43D,  DATA SOURCE: CA REPOSITORY ON DB2T


 BENE_CWF_LOC_TB                         Beneficiary Common Working File Location Table

       B = Mid-Atlantic
       C = Southwest
       D = Northeast
       E = Great Lakes
       F = Great Western
       G = Keystone
       H = Southeast
       I = South
       J = Pacific



 BENE_IDENT_TB                           Beneficiary Identification Code (BIC) Table

       Social Security Administration:

       A  = Primary claimant
       B  = Aged wife, age 62 or over (1st
            claimant)
       B1 = Aged husband, age 62 or over (1st
            claimant)
       B2 = Young wife, with a child in her care
            (1st claimant)
       B3 = Aged wife (2nd claimant)
       B4 = Aged husband (2nd claimant)
       B5 = Young wife (2nd claimant)
       B6 = Divorced wife, age 62 or over (1st
            claimant)
       B7 = Young wife (3rd claimant)
       B8 = Aged wife (3rd claimant)
       B9 = Divorced wife (2nd claimant)
       BA = Aged wife (4th claimant)
       BD = Aged wife (5th claimant)
       BG = Aged husband (3rd claimant)
       BH = Aged husband (4th claimant)
       BJ = Aged husband (5th claimant)
       BK = Young wife (4th claimant)
       BL = Young wife (5th claimant)
       BN = Divorced wife (3rd claimant)
       BP = Divorced wife (4th claimant)
       BQ = Divorced wife (5th claimant)
       BR = Divorced husband (1st claimant)
       BT = Divorced husband (2nd claimant)
       BW = Young husband (2nd claimant)
       BY = Young husband (1st claimant)
       C1-C9,CA-CZ = Child (includes minor, student
                     or disabled child)
       D  = Aged widow, 60 or over (1st claimant)
       D1 = Aged widower, age 60 or over (1st
            claimant)
       D2 = Aged widow (2nd claimant)
       D3 = Aged widower (2nd claimant)
       D4 = Widow (remarried after attainment of
            age 60) (1st claimant)
       D5 = Widower (remarried after attainment of
            age 60) (1st claimant)
       D6 = Surviving divorced wife, age 60 or over
            (1st claimant)
       D7 = Surviving divorced wife (2nd claimant)
       D8 = Aged widow (3rd claimant)
       D9 = Remarried widow (2nd claimant)
       DA = Remarried widow (3rd claimant)
       DD = Aged widow (4th claimant)
       DG = Aged widow (5th claimant)
       DH = Aged widower (3rd claimant)
       DJ = Aged widower (4th claimant)
       DK = Aged widower (5th claimant)
       DL = Remarried widow (4th claimant)
       DM = Surviving divorced husband (2nd
            claimant)
       DN = Remarried widow (5th claimant)
       DP = Remarried widower (2nd claimant)
       DQ = Remarried widower (3rd claimant)
       DR = Remarried widower (4th claimant)
       DS = Surviving divorced husband (3rd
            claimant)
       DT = Remarried widower (5th claimant)
       DV = Surviving divorced wife (3rd claimant)
       DW = Surviving divorced wife (4th claimant)
       DX = Surviving divorced husband (4th
            claimant)
       DY = Surviving divorced wife (5th claimant)
       DZ = Surviving divorced husband (5th
            claimant)
       E  = Mother (widow) (1st claimant)
       E1 = Surviving divorced mother (1st
            claimant)
       E2 = Mother (widow) (2nd claimant)
       E3 = Surviving divorced mother (2nd
            claimant)
       E4 = Father (widower) (1st claimant)
       E5 = Surviving divorced father (widower)
            (1st claimant)
       E6 = Father (widower) (2nd claimant)
       E7 = Mother (widow) (3rd claimant)
       E8 = Mother (widow) (4th claimant)
       E9 = Surviving divorced father (widower)
            (2nd claimant)
       EA = Mother (widow) (5th claimant)
       EB = Surviving divorced mother (3rd
            claimant)
       EC = Surviving divorced mother (4th
            claimant)
       ED = Surviving divorced mother (5th
            claimant
       EF = Father (widower) (3rd claimant)
       EG = Father (widower) (4th claimant)
       EH = Father (widower) (5th claimant)
       EJ = Surviving divorced father (3rd
            claimant)
       EK = Surviving divorced father (4th
            claimant)
       EM = Surviving divorced father (5th
            claimant)
       F1 = Father
       F2 = Mother
       F3 = Stepfather
       F4 = Stepmother
       F5 = Adopting father
       F6 = Adopting mother
       F7 = Second alleged father
       F8 = Second alleged mother
       J1 = Primary prouty entitled to HIB
            (less than 3 Q.C.) (general fund)
       J2 = Primary prouty entitled to HIB
            (over 2 Q.C.) (RSI trust fund)
       J3 = Primary prouty not entitled to HIB
            (less than 3 Q.C.) (general fund)
       J4 = Primary prouty not entitled to HIB
            (over 2 Q.C.) (RSI trust fund)
       K1 = Prouty wife entitled to HIB (less than
            3 Q.C.) (general fund) (1st claimant)
       K2 = Prouty wife entitled to HIB (over 2
            Q.C.) (RSI trust fund) (1st claimant)
       K3 = Prouty wife not entitled to HIB (less
            than 3 Q.C.) (general fund) (1st
            claimant)
       K4 = Prouty wife not entitled to HIB (over
            2 Q.C.) (RSI trust fund) (1st
            claimant)
       K5 = Prouty wife entitled to HIB (less than
            3 Q.C.) (general fund) (2nd claimant)
       K6 = Prouty wife entitled to HIB (over 2
            Q.C.) (RSI trust fund) (2nd claimant)
       K7 = Prouty wife not entitled to HIB (less
            than 3 Q.C.) (general fund) (2nd
            claimant)
       K8 = Prouty wife not entitled to HIB (over
            2 Q.C.) (RSI trust fund) (2nd
            claimant)
       K9 = Prouty wife entitled to HIB (less than
            3 Q.C.) (general fund) (3rd claimant)
       KA = Prouty wife entitled to HIB (over 2
            Q.C.) (RSI trust fund) (3rd claimant)
       KB = Prouty wife not entitled to HIB (less
            than 3 Q.C.) (general fund) (3rd
            claimant)
       KC = Prouty wife not entitled to HIB (over
            2 Q.C.) (RSI trust fund) (3rd
            claimant)
       KD = Prouty wife entitled to HIB (less than
            3 Q.C.) (general fund) (4th claimant)
       KE = Prouty wife entitled to HIB (over 2 Q.C
            (4th claimant)
       KF = Prouty wife not entitled to HIB (less
            than 3 Q.C.)(4th claimant)
       KG = Prouty wife not entitled to HIB (over
            2 Q.C.)(4th claimant)
       KH = Prouty wife entitled to HIB (less than
            3 Q.C.)(5th claimant)
       KJ = Prouty wife entitled to HIB (over 2
            Q.C.) (5th claimant)
       KL = Prouty wife not entitled to HIB (less
            than 3 Q.C.)(5th claimant)
       KM = Prouty wife not entitled to HIB (over
            2 Q.C.) (5th claimant)
       M  = Uninsured-not qualified for deemed HIB
       M1 = Uninsured-qualified but refused HIB
       T  = Uninsured-entitled to HIB under deemed
            or renal provisions
       TA = MQGE (primary claimant)
       TB = MQGE aged spouse (first claimant)
       TC = MQGE disabled adult child (first claimant)
       TD = MQGE aged widow(er) (first claimant)
       TE = MQGE young widow(er) (first claimant)
       TF = MQGE parent (male)
       TG = MQGE aged spouse (second claimant)
       TH = MQGE aged spouse (third claimant)
       TJ = MQGE aged spouse (fourth claimant)
       TK = MQGE aged spouse (fifth claimant)
       TL = MQGE aged widow(er) (second claimant)
       TM = MQGE aged widow(er) (third claimant)
       TN = MQGE aged widow(er) (fourth claimant)
       TP = MQGE aged widow(er) (fifth claimant)
       TQ = MQGE parent (female)
       TR = MQGE young widow(er) (second claimant)
       TS = MQGE young widow(er) (third claimant)
       TT = MQGE young widow(er) (fourth claimant)
       TU = MQGE young widow(er) (fifth claimant)
       TV = MQGE disabled widow(er) fifth claimant
       TW = MQGE disabled widow(er) first claimant
       TX = MQGE disabled widow(er) second claimant
       TY = MQGE disabled widow(er) third claimant
       TZ = MQGE disabled widow(er) fourth claimant
       T2-T9 = Disabled child (second to ninth
               claimant)
       W  = Disabled widow, age 50 or over (1st
            claimant)
       W1 = Disabled widower, age 50 or over (1st
            claimant)
       W2 = Disabled widow (2nd claimant)
       W3 = Disabled widower (2nd claimant)
       W4 = Disabled widow (3rd claimant)
       W5 = Disabled widower (3rd claimant)
       W6 = Disabled surviving divorced wife (1st
            claimant)
       W7 = Disabled surviving divorced wife (2nd
            claimant)
       W8 = Disabled surviving divorced wife (3rd
            claimant)
       W9 = Disabled widow (4th claimant)
       WB = Disabled widower (4th claimant)
       WC = Disabled surviving divorced wife (4th
            claimant)
       WF = Disabled widow (5th claimant)
       WG = Disabled widower (5th claimant)
       WJ = Disabled surviving divorced wife (5th
            claimant)
       WR = Disabled surviving divorced husband
            (1st claimant)
       WT = Disabled surviving divorced husband
            (2nd claimant)

       Railroad Retirement Board:

          NOTE:
          Employee:  a Medicare beneficiary who is
                     still working or a worker who
                     died before retirement
          Annuitant: a person who retired under the
                     railroad retirement act on or
                     after 03/01/37
          Pensioner: a person who retired prior to
                     03/01/37 and was included in the
                     railroad retirement act

       10 = Retirement - employee or annuitant
       80 = RR pensioner (age or disability)
       14 = Spouse of RR employee or annuitant
            (husband or wife)
       84 = Spouse of RR pensioner
       43 = Child of RR employee
       13 = Child of RR annuitant
       17 = Disabled adult child of RR annuitant
       46 = Widow/widower of RR employee
       16 = Widow/widower of RR annuitant
       86 = Widow/widower of RR pensioner
       43 = Widow of employee with a child in her care
       13 = Widow of annuitant with a child in her care
       83 = Widow of pensioner with a child in her care
       45 = Parent of employee
       15 = Parent of annuitant
       85 = Parent of pensioner
       11 = Survivor joint annuitant
            (reduced benefits taken to insure benefits
            for surviving spouse)



 BENE_MDCR_STUS_TB                       CWF Beneficiary Medicare Status Table

       10 = Aged without ESRD
       11 = Aged with ESRD
       20 = Disabled without ESRD
       21 = Disabled with ESRD
       31 = ESRD only



 BENE_PRMRY_PYR_TB                       Beneficiary Primary Payer Table

       A = Working aged bene/spouse with employer
           group health plan (EGHP)
       B = End stage renal disease (ESRD) beneficiary
           in the 18 month coordination period with
           an employer group health plan
       C = Conditional payment by Medicare; future
           reimbursement expected
       D = Automobile no-fault (eff. 4/97; Prior
           to 3/94, also included any liability
           insurance)
       E = Workers' compensation
       F = Public Health Service or other federal
           agency (other than Dept. of Veterans
           Affairs)
       G = Working disabled bene (under age 65
           with LGHP)
       H = Black Lung
       I = Dept. of Veterans Affairs
       J = Any liability insurance
           (eff. 3/94 - 3/97)
       L = Any liability insurance (eff. 4/97)
           (eff. 12/90 for carrier claims and 10/93
           for FI claims; obsoleted for all claim
           types 7/1/96)

       M = Override code:  EGHP services involved
           (eff. 12/90 for carrier claims and 10/93
           for FI claims; obsoleted for all claim
           types 7/1/96)

       N = Override code:  non-EGHP services involved
           (eff. 12/90 for carrier claims and 10/93
           for FI claims; obsoleted for all claim
           types 7/1/96)

       BLANK = Medicare is primary payer (not sure
               of effective date: in use 1/91, if
               not earlier)

                    ***Prior to 12/90***

       Y = Other secondary payer investigation
           shows Medicare as primary payer
       Z = Medicare is primary payer

       NOTE:  Values C, M, N, Y, Z and BLANK
              indicate Medicare is primary payer.
              (values Z and Y were used prior to
              12/90.  BLANK was suppose to be
              effective after 12/90, but may have
              been used prior to that date.)



 BENE_RACE_TB                            Beneficiary Race Table

       0 = Unknown
       1 = White
       2 = Black
       3 = Other
       4 = Asian
       5 = Hispanic
       6 = North American Native



 BENE_SEX_IDENT_TB                       Beneficiary Sex Identification Table

       1 = Male
       2 = Female
       0 = Unknown



 BETOS_TB                                BETOS Table

       M1A = Office visits - new
       M1B = Office visits - established
       M2A = Hospital visit - initial
       M2B = Hospital visit - subsequent
       M2C = Hospital visit - critical care
       M3  = Emergency room visit
       M4A = Home visit
       M4B = Nursing home visit
       M5A = Specialist - pathology
       M5B = Specialist - psychiatry
       M5C = Specialist - opthamology
       M5D = Specialist - other
       M6  = Consultations
       P0  = Anesthesia
       P1A = Major procedure - breast
       P1B = Major procedure - colectomy
       P1C = Major procedure - cholecystectomy
       P1D = Major procedure - turp
       P1E = Major procedure - hysterectomy
       P1F = Major procedure - explor/decompr/excisdisc
       P1G = Major procedure - Other
       P2A = Major procedure, cardiovascular-CABG
       P2B = Major procedure, cardiovascular-Aneurysm repair
       P2C = Major Procedure, cardiovascular-Thromboendarterectomy
       P2D = Major procedure, cardiovascualr-Coronary angioplasty (PTCA)
       P2E = Major procedure, cardiovascular-Pacemaker insertion
       P2F = Major procedure, cardiovascular-Other
       P3A = Major procedure, orthopedic - Hip fracture repair
       P3B = Major procedure, orthopedic - Hip replacement
       P3C = Major procedure, orthopedic - Knee replacement
       P3D = Major procedure, orthopedic - other
       P4A = Eye procedure - corneal transplant
       P4B = Eye procedure - cataract removal/lens insertion
       P4C = Eye procedure - retinal detachment
       P4D = Eye procedure - treatment of retinal lesions
       P4E = Eye procedure - other
       P5A = Ambulatory procedures - skin
       P5B = Ambulatory procedures - musculoskeletal
       P5C = Ambulatory procedures - inguinal hernia repair
       P5D = Ambulatory procedures - lithotripsy
       P5E = Ambulatory procedures - other
       P6A = Minor procedures - skin
       P6B = Minor procedures - musculoskeletal
       P6C = Minor procedures - other (Medicare fee schedule)
       P6D = Minor procedures - other (non-Medicare fee schedule)
       P7A = Oncology - radiation therapy
       P7B = Oncology - other
       P8A = Endoscopy - arthroscopy
       P8B = Endoscopy - upper gastrointestinal
       P8C = Endoscopy - sigmoidoscopy
       P8D = Endoscopy - colonoscopy
       P8E = Endoscopy - cystoscopy
       P8F = Endoscopy - bronchoscopy
       P8G = Endoscopy - laparoscopic cholecystectomy
       P8H = Endoscopy - laryngoscopy
       P8I = Endoscopy - other
       P9A = Dialysis services (medicare fee schedule)
       P9B = Dialysis services (non-medicare fee schedule)
       I1A = Standard imaging - chest
       I1B = Standard imaging - musculoskeletal
       I1C = Standard imaging - breast
       I1D = Standard imaging - contrast gastrointestinal
       I1E = Standard imaging - nuclear medicine
       I1F = Standard imaging - other
       I2A = Advanced imaging - CAT/CT/CTA: brain/head/neck
       I2B = Advanced imaging - CAT/CT/CTA: other
       I2C = Advanced imaging - MRI/MRA: brain/head/neck
       I2D = Advanced imaging - MRI/MRA: other
       I3A = Echography/ultrasonography - eye
       I3B = Echography/ultrasonography - abdomen/pelvis
       I3C = Echography/ultrasonography - heart
       I3D = Echography/ultrasonography - carotid arteries
       I3E = Echography/ultrasonography - prostate, transrectal
       I3F = Echography/ultrasonography - other
       I4A = Imaging/procedure - heart including cardiac
                                  catheterization
       I4B = Imaging/procedure - other
       T1A = Lab tests - routine venipuncture (non Medicare
                         fee schedule)
       T1B = Lab tests - automated general profiles
       T1C = Lab tests - urinalysis
       T1D = Lab tests - blood counts
       T1E = Lab tests - glucose
       T1F = Lab tests - bacterial cultures
       T1G = Lab tests - other (Medicare fee schedule)
       T1H = Lab tests - other (non-Medicare fee schedule)
       T2A = Other tests - electrocardiograms
       T2B = Other tests - cardiovascular stress tests
       T2C = Other tests - EKG monitoring
       T2D = Other tests - other
       D1A = Medical/surgical supplies
       D1B = Hospital beds
       D1C = Oxygen and supplies
       D1D = Wheelchairs
       D1E = Other DME
       D1F = Prosthetic/Orthotic devices
       D1G = Drugs Administered through DME
       O1A = Ambulance
       O1B = Chiropractic
       O1C = Enteral and parenteral
       O1D = Chemotherapy
       O1E = Other drugs
       O1F = Hearing and speech services
       O1G = Immunizations/Vaccinations
       Y1  = Other - Medicare fee schedule
       Y2  = Other - non-Medicare fee schedule
       Z1  = Local codes
       Z2  = Undefined codes



 CARR_CLM_ENTRY_TB                       Carrier Claim Entry Table

       1 = Original debit; void of original debit
           (If CLM_DISP_CD = 3, code 1 means
           voided original debit)
       3 = Full credit
       5 = Replacement debit
       9 = Accrete bill history only (internal;
           effective 2/22/91)



 CARR_CLM_HOSPC_OVRRD_IND_TB             Carrier Claim Hospice Override Indicator Table

      0 = No Investigation
      1 = Hospice investigation shown not applicable
          to this claim.



 CARR_CLM_MCO_OVRRD_IND_TB               Carrier Claim MCO Override Indicator Table

      0 = No Investigation
      1 = MCO Investigation does not apply to this
          claim.



 CARR_CLM_PMT_DNL_TB                     Carrier Claim Payment Denial Table

      Valid values effective 1/2011 (2-byte values are
      replacing the character values)
       0 = Denied
       1 = Physician/supplier
       2 = Beneficiary
       3 = Both physician/supplier and beneficiary
       4 = Hospital (hospital based physicians)
       5 = Both hospital and beneficiary
       6 = Group practice prepayment plan
       7 = Other entries (e.g. Employer, union)
       8 = Federally funded
       9 = PA service
       A = Allowed
       B = Benefits Exhausted
       C = Non-convered Care
       D = Denied due to demonstration involvement
           (eff. 5/97)
       E = MSP Cost Avoided - First Claim Development
       F = MSP Cost Avoided - Trauma Code Development
       G = Secondary Claims Investigation
       H = Self Reports
       J = 411.25
       K = Insurer Voluntary Reporting
       L = Clinical Lab Improvement Amendment (CLIA)
       M = Multiple submittal (i.e. duplicate line item)
       N = Medical Necessity
       O = Other
       P = Physician ownership denial (eff 3/92)
       Q = MSP Cost Avoided - Employer Voluntary Reporting
       R = Reprocessed adjustment based on subsequent
           reprocessing of claim
       S = Secondary Payer
       T = MSP cost avoided - IEQ contractor
           (eff. 7/96)
       U = MSP cost avoided - HMO rate cell
           adjustment (eff. 7/96)
       V = MSP cost avoided - litigation
           settlement (eff. 7/96)
       X = MSP cost avoided - generic
       Y = MSP cost avoided - IRS/SSA data
           match project
       Z = Zero payment, allowed test
       00= MSP cost avoided - COB Contractor
       12= MSP cost avoided - BC/BS Voluntary Agreements
       13= MSP cost avoided - Office of Personnel Management
       14= MSP cost avoided - Workman's Compensation (WC) Datamatch
       15= MSP cost avoided - Workman's Compensation Insurer Voluntary
           Data Sharing Agreements (WC VDSA) (eff. 4/2006)
       16= MSP cost avoided - Liability Insurer VDSA (eff.4/2006)
       17= MSP cost avoided - No-Fault Insurer VDSA  (eff.4/2006)
       18= MSP cost avoided - Pharmacy Benefit Manager Data Sharing
           Agreement (eff.4/2006)
       19 = MSP cost avoided - Worker's Compensation Medicare Set-Aside
            Arrangement (eff. 4/2006)
       21= MSP cost avoided - MIR Group Health Plan (eff.1/2009)
       22= MSP cost avoided - MIR non-Group Health Plan (eff.1/2009)
       25= MSP cost avoided - Recovery Audit Contractor - California
           (eff.10/2005)
       26= MSP cost avoided - Recovery Audit Contractor - Florida
           (eff.10/2005)
       39 = MSP Cost Avoided - GHP Recovery
       41 = MSP Cost Avoided - NGHP Non-ORM
       42 = MSP Cost Avoided - NGHP ORM Recovery
       43 = MSP Cost Avoided - COBC/Medicare Part C/Medicare Advantage
       NOTE: Effective 4/1/02, the Carrier claim payment denial
       code was expanded to a 2-byte field.  The NCH instituted
       a crosswalk from the 2-byte code to a 1-byte character
       code. Below are the character codes (found in NCH &
       NMUD). At some point, NMUD will carry the 2-byte code
       but NCH will continue to have the 1-byte character
       code.

       ! = MSP cost avoided - COB Contractor ('00' 2-byte code)
       @ = MSP cost avoided - BC/BS Voluntary Agreements
           ('12' 2-byte code)
       # = MSP cost avoided - Office of Personnel Management
           ('13' 2-byte code)
       $ = MSP cost avoided - Workman's Compensation (WC) Datamatch
           ('14' 2-byte code)
       * = MSP cost avoided - Workman's Compensation Insurer
           Voluntary Data Sharing Agreements (WC VDSA)
           ('15' 2-byte code) (eff. 4/2006)
       ( = MSP cost avoided - Liability Insurer VDSA
           ('16' 2-byte code) (eff. 4/2006)
       ) = MSP cost avoided - No-Fault Insurer VDSA
           ('17' 2-byte code) (eff. 4/2006)
       + = MSP cost avoided - Pharmacy Benefit Manager Data
           Sharing Agreement ('18' 2 -byte code) (eff. 4/2006)
       < = MSP cost avoided - MIR Group Health Plan
           ('21' 2-byte code) (eff. 1/2009)
       > = MSP cost avoided - MIR non-Group Health Plan
           ('22' 2-byte code) (eff. 1/2009)
       % = MSP cost avoided - Recovery Audit Contractor -
           - California ('25' 2-byte code) (eff. 10/2005)
       & = MSP cost avoided - Recovery Audit Contractor -
           Florida ('26' 2-byte code) (eff. 10/2005)



 CARR_CLM_PRVDR_ASGNMT_IND_TB            Carrier Claim Provider Assignment Code Table

      A = Assigned claim
      N = Non-assigned claim



 CARR_NUM_TB                             Carrier Number/MAC Table

       00510 = Alabama - CAHABA (eff. 1983; term. 05/2009)
               (replaced by MAC #10102 -- see below)
       00511 = Georgia - CAHABA (eff. 1998; term. 06/2009)
               (replaced by MAC #10202 -- see below)
       00512 = Mississippi - CAHABA (eff. 2000)
       00520 = Arkansas BC/BS (eff. 1983)
       00521 = New Mexico - Arkansas BC/BS (eff. 1998; term. 02/2008)
               (replaced by MAC #04202 -- see below)
       00522 = Oklahoma - Arkansas BC/BS (eff. 1998; term. 02/2008)
               (replaced by MAC #04302 -- see below)
       00523 = Missouri East - Arkansas BC/BS (eff. 1999; term. 02/2008)
               (replaced by MAC #05392 -- see below)
       00524 = Rhode Island - Arkansas BC/BS (eff. 2004; term. 01/2009)
               (replaced by MAC #14402 -- see below)
       00528 = Louisiana - Arkansas BS (eff. 1984)
       00542 = California BS (eff. 1983; term. 05/2009)
       00550 = Colorado BS (eff. 1983; term. 11/1994)
       00570 = Delaware - Pennsylvania BS (eff. 1983;
                 term. 07/1997)
       00580 = District of Columbia - Pennsylvania BS
               (eff. 1983; term. 08/1997)
       00590 = Florida - First Coast (eff. 1983; term. 01/2009)
               (replaced by MAC #09102 -- see below)
       00591 = Connecticut - First Coast (eff. 2000; term. 07/2008)
               (replaced by MAC #13102 -- see below)
       00621 = Illinois BS - HCSC (eff. 1983; term. 08/1997)
       00623 = Michigan - Illinois Blue Shield (eff. 1995;
               term. 08/1997)
       00630 = Indiana - Administar (eff. 1983) (term. 08/19/2012)
               (replaced by MAC #08102 -- see below)
       00635 = DMERC-B - Administar (eff. 1993; term. 06/2006)
               (replaced by MAC #17003 -- see below)
       00640 = Iowa - Wellmark, Inc. (eff. 1983; term. 11/1996)
       00645 = Nebraska - Iowa BS (eff. 1985; term. 11/1994)
       00650 = Kansas BCBS (eff. 1983) (term. 02/2008)
               (replaced by MAC #05202 -- see below)
       00651 = Missouri - Kansas BCBS (eff. 1983; term. 02/2008)
               (replaced by MAC #05202 -- see below)
       00655 = Nebraska - Kansas BC/BS (eff. 1988; term. 02/2008)
               (replaced by MAC #05402 -- see below)
       00660 = Kentucky - Administar (eff. 1983; term. 04/2011)
       00662 = PFDC (Floyd Epps) (terminated)
       00663 = FQHC Pilot Demo (CAFM - Ayers-Ramsey)
               (term. 11/2011)
       00690 = Maryland BS (terminated)
       00691 = CAREFIRST - CWF (terminated)

       00700 = Massachusetts BS (eff. 1983; term. 11/1996)
       00710 = Michigan BS (eff. 1983; term. 09/2000)
       00720 = Minnesota BS (eff. 1983; term. 09/2000)
       00740 = Western Missouri - Kansas BS (eff. 1983;
               term. 06/1997)
               (replaced by MAC #05302 -- see below)
       00751 = Montana BC/BS (eff. 1983; term. 11/2006)
               (replaced by MAC # 03202 -- see below)
       00770 = New Hampshire/Vermont Physician Services
               (eff. 1983; term. 12/1988)
       00780 = New Hampshire - Massachusetts BS
               (eff. 1985; term. 04/1997)
       00781 = Vermont - Massachusetts BS
               (eff. 1985; term. 06/1997)

       00801 = New York - Healthnow (eff. 1983; term. 08/2008)
               (replaced by MAC #13282 -- see below)
       00803 = New York - Empire BS (eff. 1983; term. 07/2008)
               (replaced by MAC #13202 -- see below)
       00804 = New York - Rochester BS (term. 02/1999)
               (replaced by MAC # 12402 -- see below)
       00805 = New Jersey - Empire BS (eff. 3/99; term. 11/2008)
               (replaced by MAC # 12402 -- see below)
       00811 = DMERC (A) - Healthnow (eff. 2000; term. 06/2006)
               (replaced by MAC #16003 -- see below)
       00820 = North Dakota - Noridian (eff. 1983; term. 11/2006)
               (replaced by MAC #03302 -- see below)
       00823 = Utah - Noridian (eff. 12/1/2005; term. 11/2006)
               (replaced by MAC #03502 -- see below)
       00824 = Colorado - Noridian (eff. 1995; term. 02/2008)
               (term. 2008)
               (replaced by MAC #04102 -- see below)
       00825 = Wyoming - Noridian (eff. 1990; term. 11/2006)
               (replaced by MAC #03602 -- see below)
       00826 = Iowa - Noridian (eff. 1999; term. 01/2008)
               (replaced by MAC #05102 -- see below)
       00831 = Alaska - Noridian (eff. 1998)
       00832 = Arizona -  Noridian (eff. 1998; term. 11/2006)
               (replaced by MAC # 03102 -- see below)
       00833 = Hawaii - Noridian (eff. 1998; term. 07/2008)
               (replaced by MAC # 01202 -- see below)
       00834 = Nevada - Noridian (eff. 1998; term. 07/2008)
               (replaced by MAC # 01302 -- see below)
       00835 = Oregon - Noridian (eff. 1998)
       00836 = Washington - Noridian (eff. 1998)
       00860 = New Jersey - Pennsylvania BS (eff. 1988;
               term. 02/1998)
       00865 = Pennsylvania - Highmark (eff. 1983; term. 12/2008)
               (replaced by MAC # 12502 -- see below)
       00870 = Rhode Island BS (eff. 1983; term. 02/1999)
       00880 = South Carolina - Palmetto (eff. 1983; term. 06/2011)
       00881 = South Carolina BS-P&E (terminated)
       00882 = RRB - South Carolina PGBA (eff. 2000)
       00883 = Ohio - Palmetto (eff. 2002; term. 06/2011)
       00884 = West Virginia - Palmetto (eff. 2002; term. 06/2011)
       00885 = DMERC C - Palmetto (eff. 1993; term. 05/2006)
               (replaced by MAC #18003 -- see below)
       00888 = PLAMETTO DRUGS (terminated)
       00889 = South Dakota - Noridian (eff. 4/1/2006; term. 11/2006)
               (replaced by MAC # 03402 -- see below)

       00900 = Texas - Trailblazer (eff. 1983; term. 06/2008)
               (replaced by MAC # 04402 -- see below)
       00901 = Maryland - Trailblazer (eff. 1995; term. 07/2008)
               (replaced by MAC # 12302 -- see below)
       00902 = Delaware - Trailblazer (eff. 1998; term. 07/2008)
               (replaced by MAC # 12102 -- see below)
       00903 = District of Columbia - Trailblazer (eff. 1998;
               term. 07/2008)
               (replaced by MAC # 12202 -- see below)
       00904 = Virginia - Trailblazer (eff. 2000; term. 03/2011)
               (replaced by MAC # 11302 -- see below)
       00910 = Utah  BS (eff. 1983; term. 09/2006)
       00930 = Washington BS (Washington Phy. Ser.) (term. 07/1998)
       0093Q = Washington-Whatcom County BS (term. 10/1998)
       0093R = Washington-Yakima County BS (term. 09/2000)
       00931 = Washington-Lewis County BS
       00932 = Washington BS
       00934 = Washington-Chelan County BS
       00935 = Washington-Kisap County BS (term. 12/1994)
       00936 = Washington-Spokane County BS
       0093B = Washington-Clallam County BS (terminated)
       0093C = Washington-Clark County BS (terminated)
       0093D = Washington-Columbia County BS (terminated)
       0093E = Washington-CO WLITZ County BS (terminated)
       0093F = Washington-Grays Harbor County BS (terminated)
       0093G = Washington-Jefferson County BS (terminated)
       0093H = Washington-Kittitas County BS (terminated)
       0093I = Washington-Lewis County BS (terminated)
       0093J = Washington-Pacific County BS (terminated)
       0093K = Washington-Tacoma BS (terminated)
       0093L = Washington-Skagit County BS (terminated)
       0093M = Washington-Snohomish County BS (terminated)
       0093N = Washington-Thurston County BS (terminated)
       0093P = Washington-Walla Walla County BS (term. 11/2000)

       00950 = Wisconsin - Milwaukee Surgical (term. 07/1997)
       00951 = Wisconsin - Wisconsin Phy Svc (eff. 1983)
       00952 = Illinois - Wisconsin Phy Svc (eff. 1999)
       00953 = Michigan - Wisconsin Phy Svc (eff. 1999)
               (term. 07/15/2012)
               (replaced by MAC #08202 -- see below)
       00954 = Minnesota - Wisconsin Phy Svc (eff. 2000)
       00960 = WPS Part D GAP (CAFM)(Truffer)
               (eff. 01/2010)
       00973 = Puerto Rico - Triple S, Inc. (eff. 1983;
               term. 02/2009)
               (replaced by MAC # 09302 -- see below)
       00974 = Virgin Islands - Triple S, Inc. (term. 02/2009)
       01020 = Alaska - AETNA (eff. 1983; term. 07/1997)
       01030 = Arizona - AETNA (eff. 1983; term. 07/1997)
       01040 = Georgia - AETNA (eff. 1988; term. 07/1997)
       01070 = Connecticut - AETNA (term. 07/1997)
       01120 = Hawaii - AETNA (eff. 1983; term. 1997)
       01290 = Nevada - AETNA (eff. 1983; term. 10/1994)
       01360 = New Mexico - AETNA (eff. 1986; term. 07/1998)
       01370 = Oklahoma - AETNA (eff. 1983; term. 02/1996)
       01380 = Oregon - AETNA (eff. 1983; term. 09/2000)
       01390 = Washington - AETNA (eff. 1994; term. 09/2000)
       02050 = California - TOLIC (eff. 1983; term. 09/1991)
       02051 = OCCIDENTAL - P&E (eff. 1983; term. 12/1998)
       02831 = WEST.CONSORT.OCCIDENTAL-ALASKA (term. 07/2002)
       02832 = WEST.CONSORT.OCCIDENTAL-ALASKA (term. 07/2002)
       02833 = WEST.CONSORT.OCCIDENTAL-ALASKA
       02834 = WEST.CONSORT.OCCIDENTAL-ALASKA (term. 11-1988)
       02835 = WEST.CONSORT.OCCIDENTAL-ALASKA
       02836 = WEST.CONSORT.OCCIDENTAL-ALASKA (term. 12-1988)

       03070 = Connecticut General Life Insurance Co.
               (eff. 1983; term. 04/1997)

       04110 = GEORGIA - JOHN HANCOCK (term. 04/1997)
       04220 = MASSACHUSETTS - JOHN HANCOCK (term. 04/1997)

       05130 = Idaho - CIGNA (eff. 1983)
       05320 = New Mexico - Equitable Insurance
               (eff. 1983; term. 1985)
       05330 = NEW YORK - Equitable
       05440 = Tennessee - CIGNA (eff. 1983; term. 08/2009)
               (replaced by MAC #10302 - see below)
       05530 = Wyoming - Equitable Insurance (eff. 1983)
               (term. 1989)
       05535 = North Carolina - CIGNA (eff. 1988)
       05655 = DMERC-D Alaska - CIGNA (eff. 1993; term. 09/2006)
               (replaced by MAC #19003 -- see below)
       06140 = ILLINOIS - CONTINENTAL CASUALTY (term. 11/2008)

       07180 = Kentucky - Metropolitan (term. 11/2000)
       07330 = New York - Metropolitan (term. 08/1994)
       08190 = Louisiana - Pan American

       09200 = Maine-Union Mutual (terminated)

       10070 = RRB-United Healthcare (term. 02/2004)
       10071 = RRB-United Healthcare (terminated)
       10072 = RRB-United Healthcare (terminated)
       10073 = RRB-United Healthcare (terminated)
       10074 = RRB-United Healthcare (term. 09/2000)
       10075 = RRB-United Healthcare (terminated)
       10076 = RRB-United Healthcare (terminated)
       10230 = Connecticut - Metra Health (eff. 1986)
               (terminated)
       10240 = Minnesota - Metra Health (eff. 1983)
               (term. 08/1994)
       10250 = Mississippi - Metra Health (eff. 1983)
               (term. 09/2000)
       10490 = Virginia - Metra Health (eff. 1983)
               (term. 05/1997)
       10555 = DMERC A - United Healthcare
               (eff. 1993) (term. 12/1993)
       11260 = General American Life of Missouri
               (eff. 1983; term. 1998)
       14330 = New York - GHI (eff. 1983; term. 07/2008)
               (replaced by MAC #13292 -- see below)
       16360 = Ohio - Nationwide Insurance Co. (eff. 1983)
               (term. 2002)
       16510 = West Virginia - Nationwide Insurance Co.
               (eff. 1983) (term. 2002)
       21200 = Maine - Massachusetts BS
               (eff. 1983) (term. 1998)
       25370 = Okalhoma Dept of Public Welfare (terminated)
       31140 = N. California - National Heritage Ins.
               (eff. 1997; term. 08/2008)
               (replaced by MAC #01102 -- see below)
       31142 = Maine - National Heritage Ins.
               (eff. 1998; term. 05-2009)
               (replaced with MAC # 14102 - see below)
       31143 = Massachusetts - National Heritage Ins.
               (eff. 1998; term. 05-2009)
               (replaced with MAC # 14202 - see below)
       31144 = New Hampshire - National Heritage Ins.
               (eff. 1998; term. 05-2009)
               (replaced with MAC # 14302 - see below)
       31145 = Vermont - National Heritage Ins.
               (eff. 1998; term. 05-2009)
       31146 = So. California - NHIC (eff. 2000; term. 08/2008)
       41260 = Missouri-General American (terminated)

       80884 = Contractor ID for Physician Risk Adjust-
               ment Data (data not sent through CWF;
               but through Palmetto)

       88001 = Retiree Drugs Subsidy Program (terminated)
       88002 = Retiree Drugs Subsidy Program (ViPS) (CAFM)
               (terminated)

       ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
          Medicare Administrative Contractors (MACs)

       JURISDICTION 1 -- Part B MACs

       01002 = J1 Roll-up
       01102 = California (eff. 9/1/08)
               (replaces carrier #00832)
       01192 = Palmetto GBA J1 (S CA) (eff. 09/01/2008)
       01202 = Hawaiia (eff. 8/1/08)
               (replaces carrier #00833)
       01302 = Nevada (eff. 8/1/08)
               (replaces carrier #00834)

       02002 = JF Roll-up (2/3)
       02102 = Alaska - Noridian Admin Svcs (eff. 02/01/2012)
       02202 = Idaho - Noridian Admin Svcs (eff. 02/01/2012)
       02302 = Oregon - Noridian Admin Svcs (eff. 02/01/2012)
       02402 = Washington - Noridian Admin Svcs (eff. 02/01/2012)

       JURISDICTION 3 -- Part B MACs

       03002 = JF Roll-up (2/3) (orig. J3)
       03102 = Arizona (eff. 12/1/06)
               (replaces carrier #00832)
       03202 = Montana (eff. 12/1/06)
               (replaces carrier #00751)
       03302 = N. Dakota (eff. 12/1/06)
               (replaces carrier #00820)
       03402 = S. Dakota (eff. 12/1/06)
               (replaces carrier #00889)
       03502 = Utah (eff. 12/1/06)
               (replaces carrier #00823)
       03602 = Wyoming (eff. 12/1/06)
               (replaces carrier #00825)

       JURISDICTION 4 -- Part B MACs

       04002 = J4 Roll-up
       04102 = Colorado (eff. 03/01/2008)
               (replaces carrier #00550)
               (terminated)
       04202 = New Mexico (eff. 03/01/2008)
               (replaces carrier #00521)
       04302 = Oklahoma (eff. 03/01/2008)
               (replaces carrier #00522)
       04402 = Texas (eff. 06/01/2008)
               (replaces carrier #00900)

       JH Roll-up (4/7)
       04112 = Colorado - Novitas Solutions JH
               (eff. 11/17/2012)
       04212 = New Mexico - Novitas Solutions JH
               (eff. 11/17/2012)
       04312 = Oklahoma - Novitas Solutions JH
               (eff. 11/17/2012)
       04412 = Texas - Novitas Solutions JH
               (eff. 11/17/2012)

       JURISDICTION 5 -- Part B MACs

       05002 = J5 Roll-up
       05102 = Iowa (eff.2/1/08)
               (replaces carrier #00826)
       05202 = Kansas (eff. 3/1/08)
               (replaces carrier #00650)
       05302 = W. Missouri (eff. 3/1/08)
               (replaces carrier #00651 or 00740)
       05392 = E. Missouri (eff. 6/1/08)
               (replaces carrier #00523)
       05402 = Nebraska (eff. 3/1/08)
               (replaces carrier #00655)

       06002 = J6 Roll-up
       06102 = Illinois
       06202 = Minnesota
       06302 = Wisconsin

       07002 = JH Roll-up (4/7)
       07102 = Arkansas - Novitas Solutions JH
               (eff. 08/11/2012) (CR7812)
       07202 = Louisiana - Novitas Solutions JH
               (eff. 08/11/2012)
       07302 = Mississipppi - Novitas Solutions JH
               (eff. 10/20/2012)

       JURISDICTION 8 -- Part B MACs

       08002 =  J8 Roll-up
       08102 = Indiana (eff.8/20/2012)
               (replaces carrier #00630)
       08202 = Michigan (eff.7/16/2012)
               (replaces carrier #00953)

       JURISDICTION 9 -- Part B MACs

       09002 = J9 Roll-up
       09102 = Florida - First Coast (eff. 02/2009)
               (replaces carrier #00590)
       09202 = Puerto Rico - First Coast (eff.03/2009)
               (replaces carrier #00973)
       09302 = Virgin Island - First Coast (eff.03/2009)
               (replaces carrier #00974)

       JURISDICTION 10 -- Part B MACs

       10002 = J10 Roll-up
       10102 = Alabama (eff.5/4/09)
               (replaces carrier #00510)
       10202 = Georgia (eff.8/3/09)
               (replaces carrier #00511)
       10302 = Tennessee (eff.9/1/09)
               (replaces carrier #05440)

       COB Contractor Numbers in CWF

       11100 = MSP/COB Contr. 6000 COB Contractor
       11101 = MSP/COB Contr. 6010 Initial Enrollment Questionaire (IEQ)
       11102 = MSP/COB Contr. 6020 IRS/SSA/CMS/Data Match.
       11103 = MSP/COB Contr. 6030 HMO Rate Call
       11104 = MSP/COB Contr. 6040 Litigation Settlement
       11105 = MSP/COB Contr. 6050 Employer Voluntary Reporting
       11106 = MSP/COB Contr. 6060 Insurer Voluntary Reporting
       11107 = MSP/COB Contr. 6070 First Claim Development
       11108 = MSP/COB Contr. 6080 Trauma Code Development
       11109 = MSP/COB Contr. 6090 Secondary Claims Investigation
       11110 = MSP/COB Contr. 7000 Self Reports
       11111 = MSP/COB Contr. 7010 411.25
       11112 = MSP/COB Contr. 7012 BCBS Voluntary Agreements
       11113 = MSP/COB Contr. 7013 OPM Data Match (OPM)
       11114 = MSP/COB Contr. 7014 State Workers' Compensation
       11115 = MSP/COB Contr. 7015 WC Insurer Vol Data Sharing Agreement
       11116 = MSP/COB Contr. 7016 Liabilty Ins Vol Data Sharing Agreement
       11117 = MSP/COB Contr. 7017 Vol Data Sharing Agreement (No...
       11118 = MSP/COB Contr. 7018 Pharmacy Benefit Manager Data
       11119 = MSP/COB Contr. 7019 Workers' Compensation Medicare ...
       11120 = MSP/COB Contr. 7020 To be determined
       11121 = MSP/COB Contr. 7021 MIR Group Health Plan
       11122 = MSP/COB Contr. 7022 MIR non-Group Health Plan
       11123 = MSP/COB Contr. 7023 To be determined
       11124 = MSP/COB Contr. 7024 To be determined
       11125 = MSP/COB Contr. 7025 Recovery Audit Contractor - California
       11126 = MSP/COB Contr. 7026 Recovery Audit Contractor - Florida
       11127 = MSP/COB Contr. 7027 To be determined
       11139 = MSP/COB Contr. 7039 Group Health PlanRecovery
               (eff. 01/01/2013)  (CR7906)
       11140 = MSP/COB Contr.
       11141 = MSP/COB Contr. 7041 Non-Group Health Plan Non-ORM
               (eff. 01/01/2013)  (CR7906)
             = MSP/COB Contr. 7041 COB/MSPRC
               (redefined (description) via CR7906)
       11142 = MSP/COB Contr. 7042 Non-Group Health Plan Recovery
               (eff. 01/01/2013)  (CR7906)
       11143 = MSP/COB Contr. 7043 COBC/Medicare Part C/Medicare Advantage
       11144 = MSP/COB Contr. 7044 To be determined
       11199 = MSP/COB Contr. 7099 To be determined


       JURISDICTION 11 -- Part B MACs

       11002 = J11 Roll-up
       11202 = South Carolina -
               Palmetto Gov. Benefits Admin. (PGBA)
       11302 = Virginia (eff.3/19/2011)
               Palmetto Gov. Benefits Admin. (PGBA)
               (replaces carrier #00904)
       11402 = West Virginia (eff.6/18/2011)
               Palmetto Gov. Benefits Admin. (PGBA)
       11502 = North Carolina (eff.5/28/2011)
               Palmetto Gov. Benefits Admin. (PGBA)

       JURISDICTION 12 -- Part B MACs

       12002 = J12 Roll-up
       12102 = Delaware (eff. 7/11/2008)
               (replaces carrier # 00902)
       12202 = District of Columbia (eff. 7/11/2008)
               (replaces carrier # 00903)
       NOTE:   Includes Montgomery & Prince Georges
               Counties in Maryland and Fairfax
               Counties and the City of Alexandria, VA
       12302 = Maryland (eff. 7/11/2008)
               (replaces carrier # 00901)
       12402 = New Jersey (eff. 11/14/2008)
               (replaces carrier # 00805)
       12502 = Pennsylvania (eff. 12/12/2008)
               (replaces carrier # 00865)

       JURISDICTION 13 -- Part B MACs

       13002 = J13 Roll-up
       13102 = Connecticut (eff. 8/1/2008)
               (replaces carrier # 00591)
       13202 = E. New York (eff. 7/18/2008)
               (replaces carrier # 00803)
       13282 = W. New York (eff. 9/1/2008)
               (replaces carrier # 00801)
       13292 = New York (Queens) (eff. 7/18/2008)
               (replaces carrier # 14330)

       JURISDICTION 14 -- Part B MACs

       14002 = J14 Roll-up
       14102 = Maine (eff. 6/1/2009)
               (replaces carrier # 31142)
       14202 = Massachusetts (eff. 6/1/2009)
               (replaces carrier # 31143)
       14302 = N. Hampshire (eff. 6/1/2009)
               (replaces carrier # 31144)
       14402 = Rhode Island (eff. 5/1/2009)
               (replaces carrier # 00524)
       14502 = Vermont (eff. 6/1/2009)
               (replaces carrier # 31145)

       15002 = J15 Roll-up
       15102 = Kentucky (eff. 4/30/2011)
               CGS Government Sservices
       15202 = Ohio (eff. 06/15/2011)
               CGS Government Sservices

       Durable Medical Equipment (DME) MACs

       16003 = National Heritage Insurance Company (NHIC) (A)
               (eff. 7/1/06)
               (replaces carrier #00811)
       17003 = Administar Federal, Inc. (B)
               (eff. 7/1/06)
               (replaces carrier # 00635)
       18003 = Connecticut General (CIGNA) (C)
               (eff. 06/2006)
               (replaces carrier #00885)
       19003 = Noridan Mutual Ins. Co (D)
               (eff. 10/1/06)
               (replaces carrier #05655)

       33333 = MSP/COB Contr, 4000 Litigation Settlement
       44410 = STC Testing
       55555 = MSP/COB Contr, 3000 HMO Rate Cell Adjustment
       66001 = Noridian Competitive Acquisition Program
       66666 = MSP/COB Contr.
       77001 = Program Safeguard Contractor (PSC)
               (Mike Lopatin)
       77002 = Program Safeguard Contractor (PSC)
       77003 = Program Safeguard Contractor (PSC)
       77004 = Program Safeguard Contractor (PSC)
       77005 = Program Safeguard Contractor (PSC)
       77006 = Program Safeguard Contractor (PSC)
       77007 = Program Safeguard Contractor (PSC)
       77008 = Program Safeguard Contractor (PSC)
       77009 = Program Safeguard Contractor (PSC)
       77010 = Program Safeguard Contractor (PSC)
       77011 = Program Safeguard Contractor (PSC)
       77012 = Program Safeguard Contractor (PSC)

       77013 = Zone Program Integrity Contractor (ZPICs)
               (Tara Ross)
       77014 = Zone Program Integrity Contractor (ZPICs)
       77015 = Zone Program Integrity Contractor (ZPICs)
       77016 = Zone Program Integrity Contractor (ZPICs)
       77017 = Zone Program Integrity Contractor (ZPICs)
       77018 = Zone Program Integrity Contractor (ZPICs)
       77019 = Zone Program Integrity Contractor (ZPICs)
       77020 = Zone Program Integrity Contractor (ZPICs)
       77021 = Zone Program Integrity Contractor (ZPICs)
       77022 = Zone Program Integrity Contractor (ZPICs)
       77023 = Zone Program Integrity Contractor (ZPICs)
       77024 = Zone Program Integrity Contractor (ZPICs)
       77025 = Zone Program Integrity Contractor (ZPICs)
       77026 = Zone Program Integrity Contractor (ZPICs)
       77027 = Zone Program Integrity Contractor (ZPICs)
       77028 = Zone Program Integrity Contractor (ZPICs)

       77777 = MSP/COB Contr. 1000 IRS/SSA/HCFA Data Match

       78001 = Medicare Drug Integrity Contractor (MEDIC)
               (Tara Ross)
       78002 = MEDIC Contractor
       78003 = MEDIC Contractor
       78004 = MEDIC Contractor
       78005 = MEDIC Contractor
       78006 = MEDIC Contractor
       78007 = MEDIC Contractor
       78008 = MEDIC Contractor
       78009 = MEDIC Contractor
       78010 = MEDIC Contractor
       78011 = MEDIC Contractor
       78012 = MEDIC Contractor
       78013 = MEDIC Contractor
       78014 = MEDIC Contractor
       78015 = MEDIC Contractor

       79001 = MSP Recovery Contractor
       88888 = MSP/COB Contr. 5000 Voluntary Agreements

       99999 = MSP/COB Contr. 2000 Initial Questionaire

       Note: (CA) - 31140 & 31146
             (MO) - 00523 & 00651
             (NY) - 801 & 803 & 14330

       Alaska-Oregon Aetna-Total (term. 09/2000)
       Arizona-Nevada Aetna-Total (term. 09/2000)
       Highmark-Total (term. 09/2000)
       MASSACHUSETTS BS-Total (term. 09/2000)
       MASSACHUSETTS BS TRI-STATE-Total (term. 09/2000)
       New Mexico-Oklahoma-Total (terminated)
       West.Consort.Occidental-Total (term. 09/2000)




 CLM_ADJ_RSN_TB                          Claim Adjustment Reason Code

      1   = Deductible Amount
            Start: 01/01/1995
      2   = Coinsurance Amount
            Start: 01/01/1995
      3   = Co-payment Amount
            Start: 01/01/1995
      4   = The procedure code is inconsistent with the
            modifier used or a required modifier is
            missing. Note: Refer to the 835 Healthcare
            Policy Identification Segment (loop 2110
            Service Payment Information REF), if
            present.
            Start: 01/01/1995
      5   = The procedure code/bill type is
            inconsistent with the place of service.
            Note: Refer to the 835 Healthcare Policy
            Identification Segment (loop 2110 Service
            Payment Information REF), if present.
            Start: 01/01/1995
      6   = The procedure/revenue code is inconsistent
            with the patient's age. Note: Refer to the
            835 Healthcare Policy Identification
            Segment (loop 2110 Service Payment
            Information REF), if present.
            Start: 01/01/1995
      7   = The procedure/revenue code is inconsistent
            with the patient's gender. Note: Refer to
            the 835 Healthcare Policy Identification
            Segment (loop 2110 Service Payment
            Information REF), if present.
            Start: 01/01/1995
      8   = The procedure code is inconsistent with the
            provider type/specialty (taxonomy). Note:
            Refer to the 835 Healthcare Policy
            Identification Segment (loop 2110 Service
            Payment Information REF), if present.
            Start: 01/01/1995
      9   = The diagnosis is inconsistent with the
            patient's age. Note: Refer to the 835
            Healthcare Policy Identification Segment
            (loop 2110 Service Payment Information REF),
            if present.
            Start: 01/01/1995
      10  = The diagnosis is inconsistent with the
            patient's gender. Note: Refer to the 835
            Healthcare Policy Identification Segment
            (loop 2110 Service Payment Information REF),
            if present.
            Start: 01/01/1995
      11  = The diagnosis is inconsistent with the
            procedure. Note: Refer to the 835
            Healthcare Policy Identification Segment
            (loop 2110 Service Payment Information REF),
            if present.
            Start: 01/01/1995
            Last Modified: 09/20/2009
      12  = The diagnosis is inconsistent with the
            provider type. Note: Refer to the 835
            Healthcare Policy Identification Segment
            (loop 2110 Service Payment Information REF),
            if present.
            Start: 01/01/1995
      13  = The date of death precedes the date of
            service.
            Start: 01/01/1995
      14  = The date of birth follows the date of
            service.
            Start: 01/01/1995
      15  = The authorization number is missing,
            invalid, or does not apply to the billed
            services or provider.
            Start: 01/01/1995
      16  = Claim/service lacks information which is
            needed for adjudication. At least one
            Remark Code must be provided (may be
            comprised of either the NCPDP Reject
            Reason Code, or Remittance Advice Remark
            Code that is not an ALERT.)
            Start: 01/01/1995
      17  = Requested information was not provided or
            was insufficient/incomplete. At least one
            Remark Code must be provided (may be
            comprised of either the Remittance Advice
            Remark Code or NCPDP Reject Reason Code.)
            Start: 01/01/1995
            Stop: 07/01/2009
      18  = Duplicate claim/service. This change
            effective 1/1/2013: Exact duplicate claim/
            service (Use only with Group Code OA)
            Start: 01/01/1995
      19  = This is a work-related injury/illness and
            thus the liability of the Worker's
            Compensation Carrier.
            Start: 01/01/1995
      20  = This injury/illness is covered by the
            liability carrier.
            Start: 01/01/1995
      21  = This injury/illness is the liability of
            the no-fault carrier.
            Start: 01/01/1995
      22  = This care may be covered by another payer
            per coordination of benefits.
            Start: 01/01/1995
      23  = The impact of prior payer(s) adjudication
            including payments and/or adjustments.
            (Use only with Group Code OA)
            Start: 01/01/1995
      24  = Charges are covered under a capitation
            agreement/managed care plan.
            Start: 01/01/1995
      25  = Payment denied. Your Stop loss deductible
            has not been met.
            Start: 01/01/1995
            Stop: 04/01/2008
      26  = Expenses incurred prior to coverage.
            Start: 01/01/1995
      27  = Expenses incurred after coverage terminated
            Start: 01/01/1995
      28  = Coverage not in effect at the time the
            service was provided.
            Start: 01/01/1995
            Stop: 10/16/2003
            Notes: Redundant to codes 26&27.
      29  = The time limit for filing has expired.
            Start: 01/01/1995
      30  = Payment adjusted because the patient has
            not met the required eligibility, spend
            down, waiting, or residency requirements.
            Start: 01/01/1995
            Stop: 02/01/2006
      31  = Patient cannot be identified as our insured
            Start: 01/01/1995
      32  = Our records indicate that this dependent is
            not an eligible dependent as defined.
            Start: 01/01/1995
      33  = Insured has no dependent coverage.
            Start: 01/01/1995
      34  = Insured has no coverage for newborns.
            Start: 01/01/1995
      35  = Lifetime benefit maximum has been reached.
            Start: 01/01/1995
      36  = Balance does not exceed co-payment amount.
            Start: 01/01/1995
            Stop: 10/16/2003
      37  = Balance does not exceed deductible.
            Start: 01/01/1995
            Stop: 10/16/2003
      38  = Services not provided or authorized by
            designated (network/primary care) providers.
            Start: 01/01/1995
            Stop: 01/01/2013
      39  = Services denied at the time authorization/
            pre-certification was requested.
            Start: 01/01/1995
      40  = Charges do not meet qualifications for
            emergent/urgent care. Note: Refer to the
            835 Healthcare Policy Identification
            Segment (loop 2110 Service Payment
            Information REF), if present.
            Start: 01/01/1995
      41  = Discount agreed to in Preferred Provider
            contract.
            Start: 01/01/1995
            Stop: 10/16/2003
      42  = Charges exceed our fee schedule or maximum
            allowable amount. (Use CARC 45)
            Start: 01/01/1995
            Stop: 06/01/2007
      43  = Gramm-Rudman reduction.
            Start: 01/01/1995
            Stop: 07/01/2006
      44  = Prompt-pay discount.
            Start: 01/01/1995
      45  = Charge exceeds fee schedule/maximum
            allowable or contracted/legislated fee
            arrangement. (Use Group Codes PR or CO
            depending upon liability). This change
            effective 7/1/2013: Charge exceeds fee
            schedule/maximum allowable or contracted/
            legislated fee arrangement. (Use only with
            Group Codes PR or CO depending upon
            liability)
            Start: 01/01/1995
      46  = This (these) service(s) is (are) not
            covered.
            Start: 01/01/1995
            Stop: 10/16/2003
            Notes: Use code 96.
      47  = This (these) diagnosis(es) is (are) not
            covered, missing, or are invalid.
            Start: 01/01/1995
            Stop: 02/01/2006
      48  = This (these) procedure(s) is (are) not
            covered.
            Start: 01/01/1995
            Stop: 10/16/2003
            Notes: Use code 96.
      49  = These are non-covered services because this
            is a routine exam or screening procedure
            done in conjunction with a routine exam.
            Note: Refer to the 835 Healthcare Policy
            Identification Segment (loop 2110 Service
            Payment Information REF), if present.
            Start: 01/01/1995
      50  = These are non-covered services because this
            is not deemed a 'medical necessity' by the
            payer. Note: Refer to the 835 Healthcare
            Policy Identification Segment (loop 2110
            Service Payment Information REF), if
            present.
            Start: 01/01/1995
      51  = These are non-covered services because this
            is a pre-existing condition. Note: Refer to
            the 835 Healthcare Policy Identification
            Segment (loop 2110 Service Payment
            Information REF), if present.
            Start: 01/01/1995
      52  = The referring/prescribing/rendering
            provider is not eligible to refer/prescribe
            /order/perform the service billed.
            Start: 01/01/1995
            Stop: 02/01/2006
      53  = Services by an immediate relative or a
            member of the same household are not
            covered.
            Start: 01/01/1995
      54  = Multiple physicians/assistants are not
            covered in this case. Note: Refer to the
            835 Healthcare Policy Identification
            Segment (loop 2110 Service Payment
            Information REF), if present.
            Start: 01/01/1995
      55  = Procedure/treatment is deemed experimental/
            investigational by the payer. Note: Refer
            to the 835 Healthcare Policy Identification
            Segment (loop 2110 Service Payment
            Information REF), if present.
            Start: 01/01/1995
      56  = Procedure/treatment has not been deemed
            'proven to be effective' by the payer.
            Note: Refer to the 835 Healthcare Policy
            Identification Segment (loop 2110 Service
            Payment Information REF), if present.
            Start: 01/01/1995
      57  = Payment denied/reduced because the payer
            deems the information submitted does not
            support this level of service, this many
            services, this length of service, this
            dosage, or this day's supply.
            Start: 01/01/1995
            Stop: 06/30/2007
            Notes: Split into codes 150, 151, 152, 153
            and 154.
      58  = Treatment was deemed by the payer to have
            been rendered in an inappropriate or
            invalid place of service. Note: Refer to
            the 835 Healthcare Policy Identification
            Segment (loop 2110 Service Payment
            Information REF), if present.
            Start: 01/01/1995
      59  = Processed based on multiple or concurrent
            procedure rules. (For example multiple
            surgery or diagnostic imaging, concurrent
            anesthesia.) Note: Refer to the 835
            Healthcare Policy Identification Segment
            (loop 2110 Service Payment Information REF),
            if present.
            Start: 01/01/1995
      60  = Charges for outpatient services are not
            covered when performed within a period of
            time prior to or after inpatient services.
            Start: 01/01/1995
      61  = Penalty for failure to obtain second
            surgical opinion. Note: Refer to the 835
            Healthcare Policy Identification Segment
            (loop 2110 Service Payment Information REF),
            if present.
            Start: 01/01/1995
      62  = Payment denied/reduced for absence of,
            or exceeded, pre-certification/
            authorization.
            Start: 01/01/1995
            Stop: 04/01/2007
      63  = Correction to a prior claim.
            Start: 01/01/1995
            Stop: 10/16/2003
      64  = Denial reversed per Medical Review.
            Start: 01/01/1995
            Stop: 10/16/2003
      65  = Procedure code was incorrect. This payment
            reflects the correct code.
            Start: 01/01/1995
            Stop: 10/16/2003
      66  = Blood Deductible.
            Start: 01/01/1995
      67  = Lifetime reserve days. (Handled in QTY,
            QTY01=LA)
            Start: 01/01/1995
            Stop: 10/16/2003
      68  = DRG weight. (Handled in CLP12)
            Start: 01/01/1995
            Stop: 10/16/2003
      69  = Day outlier amount.
            Start: 01/01/1995
      70  = Cost outlier - Adjustment to compensate for
            additional costs.
            Start: 01/01/1995
      71  = Primary Payer amount.
            Start: 01/01/1995
            Stop: 06/30/2000
            Notes: Use code 23.
      72  = Coinsurance day. (Handled in QTY, QTY01=CD)
            Start: 01/01/1995
            Stop: 10/16/2003
      73  = Administrative days.
            Start: 01/01/1995
            Stop: 10/16/2003
      74  = Indirect Medical Education Adjustment.
            Start: 01/01/1995
      75  = Direct Medical Education Adjustment.
            Start: 01/01/1995
      76  = Disproportionate Share Adjustment.
            Start: 01/01/1995
      77  = Covered days. (Handled in QTY, QTY01=CA)
            Start: 01/01/1995
            Stop: 10/16/2003
      78  = Non-Covered days/Room charge adjustment.
            Start: 01/01/1995
      79  = Cost Report days. (Handled in MIA15)
            Start: 01/01/1995
            Stop: 10/16/2003
      80  = Outlier days. (Handled in QTY, QTY01=OU)
            Start: 01/01/1995
            Stop: 10/16/2003
      81  = Discharges.
            Start: 01/01/1995
            Stop: 10/16/2003
      82  = PIP days.
            Start: 01/01/1995
            Stop: 10/16/2003
      83  = Total visits.
            Start: 01/01/1995
            Stop: 10/16/2003
      84  = Capital Adjustment. (Handled in MIA)
            Start: 01/01/1995
            Stop: 10/16/2003
      85  = Patient Interest Adjustment (Use Only Group
            code PR)
            Start: 01/01/1995
            Notes: Only use when the payment of
            interest is the responsibility of the
            patient.
      86  = Statutory Adjustment.
            Start: 01/01/1995
            Stop: 10/16/2003
            Notes: Duplicative of code 45.
      87  = Transfer amount.
            Start: 01/01/1995
            Stop: 01/01/2012
      88  = Adjustment amount represents collection
            against receivable created in prior
            overpayment.
            Start: 01/01/1995
            Stop: 06/30/2007
      89  = Professional fees removed from charges.
            Start: 01/01/1995
      90  = Ingredient cost adjustment. Note: To be
            used for pharmaceuticals only.
            Start: 01/01/1995
      91  = Dispensing fee adjustment.
            Start: 01/01/1995
      92  = Claim Paid in full.
            Start: 01/01/1995
            Stop: 10/16/2003
      93  = No Claim level Adjustments.
            Start: 01/01/1995
            Stop: 10/16/2003
            Notes: As of 004010, CAS at the claim level
            is optional.
      94  = Processed in Excess of charges.
            Start: 01/01/1995
      95  = Plan procedures not followed.
            Start: 01/01/1995
      96  = Non-covered charge(s). At least one Remark
            Code must be provided (may be comprised of
            either the NCPDP Reject Reason Code, or
            Remittance Advice Remark Code that is not
            an ALERT.) Note: Refer to the 835
            Healthcare Policy Identification Segment
            (loop 2110 Service Payment Information REF),
            if present.
            Start: 01/01/1995
      97  = The benefit for this service is included in
            the payment/allowance for another service/
            procedure that has already been adjudicated.
            Note: Refer to the 835 Healthcare Policy
            Identification Segment (loop 2110 Service
            Payment Information REF), if present.
            Start: 01/01/1995
      98  = The hospital must file the Medicare claim
            for this inpatient non-physician service.
            Start: 01/01/1995
            Stop: 10/16/2003
      99  = Medicare Secondary Payer Adjustment Amount.
            Start: 01/01/1995
            Stop: 10/16/2003
      100 = Payment made to patient/insured/responsible
            party/employer.
            Start: 01/01/1995
      101 = Predetermination: anticipated payment upon
            completion of services or claim
            adjudication.
            Start: 01/01/1995
      102 = Major Medical Adjustment.
            Start: 01/01/1995
      103 = Provider promotional discount (e.g., Senior
            citizen discount).
            Start: 01/01/1995
      104 = Managed care withholding.
            Start: 01/01/1995
      105 = Tax withholding.
            Start: 01/01/1995
      106 = Patient payment option/election not in
            effect.
            Start: 01/01/1995
      107 = The related or qualifying claim/service was
            not identified on this claim. Note: Refer
            to the 835 Healthcare Policy Identification
            Segment (loop 2110 Service Payment
            Information REF), if present.
            Start: 01/01/1995
      108 = Rent/purchase guidelines were not met.
            Note: Refer to the 835 Healthcare Policy
            Identification Segment (loop 2110 Service
            Payment Information REF), if present.
            Start: 01/01/1995
      109 = Claim/service not covered by this payer/
            contractor. You must send the claim/service
            to the correct payer/contractor.
            Start: 01/01/1995
      110 = Billing date predates service date.
            Start: 01/01/1995
      111 = Not covered unless the provider accepts
            assignment.
            Start: 01/01/1995
      112 = Service not furnished directly to the
            patient and/or not documented.
            Start: 01/01/1995
      113 = Payment denied because service/procedure
            was provided outside the United States or
            as a result of war.
            Start: 01/01/1995
            Stop: 06/30/2007
            Notes: Use Codes 157, 158 or 159.
      114 = Procedure/product not approved by the Food
            and Drug Administration.
            Start: 01/01/1995
      115 = Procedure postponed, canceled, or delayed.
            Start: 01/01/1995
      116 = The advance indemnification notice signed
            by the patient did not comply with
            requirements.
            Start: 01/01/1995
      117 = Transportation is only covered to the
            closest facility that can provide the
            necessary care.
            Start: 01/01/1995
      118 = ESRD network support adjustment.
            Start: 01/01/1995
      119 = Benefit maximum for this time period or
            occurrence has been reached.
            Start: 01/01/1995
      120 = Patient is covered by a managed care plan.
            Start: 01/01/1995
            Stop: 06/30/2007
            Notes: Use code 24.
      121 = Indemnification adjustment - compensation
            for outstanding member responsibility.
            Start: 01/01/1995
      122 = Psychiatric reduction.
            Start: 01/01/1995
      123 = Payer refund due to overpayment.
            Start: 01/01/1995
            Stop: 06/30/2007
            Notes: Refer to implementation guide for
            proper handling of reversals.
      124 = Payer refund amount - not our patient.
            Start: 01/01/1995
            Stop: 06/30/2007
            Notes: Refer to implementation guide for
            proper handling of reversals.
      125 =  Submission/billing error(s). At least one
            Remark Code must be provided (may be
            comprised of either the NCPDP Reject Reason
            Code, or Remittance Advice Remark Code that
            is not an ALERT.)
            Start: 01/01/1995
      126 = Deductible -- Major Medical
            Start: 02/28/1997
            Stop: 04/01/2008
            Notes: Use Group Code PR and code 1.
      127 = Coinsurance -- Major Medical
            Start: 02/28/1997
            Stop: 04/01/2008
            Notes: Use Group Code PR and code 2.
      128 = Newborn's services are covered in the
            mother's Allowance.
            Start: 02/28/1997
      129 = Prior processing information appears
            incorrect. At least one Remark Code must
            be provided (may be comprised of either the
            NCPDP Reject Reason Code, or Remittance
            Advice Remark Code that is not an ALERT.)
            Start: 02/28/1997
      130 = Claim submission fee.
            Start: 02/28/1997
      131 = Claim specific negotiated discount.
            Start: 02/28/1997
      132 = Prearranged demonstration project
            adjustment.
            Start: 02/28/1997
      133 = The disposition of the claim/service is
            pending further review. This change
            effective 1/1/2013: The disposition of the
            claim/service is pending further review.
            (Use only with Group Code OA)
            Start: 02/28/1997
      134 = Technical fees removed from charges.
            Start: 10/31/1998
      135 = Interim bills cannot be processed.
            Start: 10/31/1998
      136 = Failure to follow prior payer's coverage
            rules. (Use Group Code OA). This change
            effective 7/1/2013: Failure to follow prior
            payer's coverage rules. (Use only with
            Group Code OA)
            Start: 10/31/1998
      137 = Regulatory Surcharges, Assessments,
            Allowances or Health Related Taxes.
            Start: 02/28/1999
      138 = Appeal procedures not followed or time
            limits not met.
            Start: 06/30/1999
      139 = Contracted funding agreement - Subscriber
            is employed by the provider of services.
            Start: 06/30/1999
      140 = Patient/Insured health identification
            number and name do not match.
            Start: 06/30/1999
      141 = Claim spans eligible and ineligible periods
            of coverage.
            Start: 06/30/1999
            Stop: 07/01/2012
      142 = Monthly Medicaid patient liability amount.
            Start: 06/30/2000
      143 = Portion of payment deferred.
            Start: 02/28/2001
      144 = Incentive adjustment, e.g. preferred
            product/service.
            Start: 06/30/2001
      145 = Premium payment withholding
            Start: 06/30/2002
            Stop: 04/01/2008
            Notes: Use Group Code CO and code 45.
      146 = Diagnosis was invalid for the date(s) of
            service reported.
            Start: 06/30/2002
      147 = Provider contracted/negotiated rate expired
            or not on file.
            Start: 06/30/2002
      148 = Information from another provider was not
            provided or was insufficient/incomplete.
            At least one Remark Code must be provided
            (may be comprised of either the NCPDP
            Reject Reason Code, or Remittance Advice
            Remark Code that is not an ALERT.)
            Start: 06/30/2002
      149 = Lifetime benefit maximum has been reached
            for this service/benefit category.
            Start: 10/31/2002
      150 = Payer deems the information submitted does
            not support this level of service.
            Start: 10/31/2002
      151 = Payment adjusted because the payer deems
            the information submitted does not support
            this many/frequency of services.
            Start: 10/31/2002
      152 = Payer deems the information submitted does
            not support this length of service. Note:
            Refer to the 835 Healthcare Policy
            Identification Segment (loop 2110 Service
            Payment Information REF), if present.
            Start: 10/31/2002
      153 = Payer deems the information submitted does
            not support this dosage.
            Start: 10/31/2002
      154 = Payer deems the information submitted does
            not support this day's supply.
            Start: 10/31/2002
      155 = Patient refused the service/procedure.
            Start: 06/30/2003
      156 = Flexible spending account payments. Note:
            Use code 187.
            Start: 09/30/2003
            Stop: 10/01/2009
      157 = Service/procedure was provided as a result
            of an act of war.
            Start: 09/30/2003
      158 = Service/procedure was provided outside of
            the United States.
            Start: 09/30/2003
      159 = Service/procedure was provided as a result
            of terrorism.
            Start: 09/30/2003
      160 = Injury/illness was the result of an
            activity that is a benefit exclusion.
            Start: 09/30/2003
      161 = Provider performance bonus
            Start: 02/29/2004
      162 = State-mandated Requirement for Property and
            Casualty, see Claim Payment Remarks Code
            for specific explanation.
            Start: 02/29/2004
      163 = Attachment referenced on the claim was not
            received.
            Start: 06/30/2004
      164 = Attachment referenced on the claim was not
            received in a timely fashion.
            Start: 06/30/2004
      165 = Referral absent or exceeded.
            Start: 10/31/2004
      166 = These services were submitted after this
            payers responsibility for processing claims
            under this plan ended.
            Start: 02/28/2005
      167 = This (these) diagnosis(es) is (are) not
            covered. Note: Refer to the 835 Healthcare
            Policy Identification Segment (loop 2110
            Payment Information REF), if present.
            Start: 06/30/2005
      168 = Service(s) have been considered under the
            patient's medical plan. Benefits are not
            available under this dental plan.
            Start: 06/30/2005
      169 = Alternate benefit has been provided.
            Start: 06/30/2005
      170 = Payment is denied when performed/billed by
            this type of provider. Note: Refer to the
            835 Healthcare Policy Identification
            Segment (loop 2110 Service Payment
            Information REF), if present.
            Start: 06/30/2005
      171 = Payment is denied when performed/billed by
            this type of provider in this type of
            facility. Note: Refer to the 835 Healthcare
            Policy Identification Segment (loop 2110
            Service Payment Information REF), if
            present.
            Start: 06/30/2005
      172 = Payment is adjusted when performed/billed
            by a provider of this specialty. Note:
            Refer to the 835 Healthcare Policy
            Identification Segment (loop 2110 Service
            Payment Information REF), if present.
            Start: 06/30/2005
      173 = Service was not prescribed by a physician.
            This change effective 7/1/2013: Service/
            equipment was not prescribed by a
            physician.
            Start: 06/30/2005
      174 = Service was not prescribed prior to
            delivery.
            Start: 06/30/2005
      175 = Prescription is incomplete.
            Start: 06/30/2005
      176 = Prescription is not current.
            Start: 06/30/2005
      177 = Patient has not met the required
            eligibility requirements.
            Start: 06/30/2005
      178 = Patient has not met the required spend
            down requirements.
            Start: 06/30/2005
      179 = Patient has not met the required waiting
            requirements. Note: Refer to the 835
            Healthcare Policy Identification Segment
            (loop 2110 Service Payment Information REF)
            , if present.
            Start: 06/30/2005
      180 = Patient has not met the required residency
            requirements.
            Start: 06/30/2005
      181 = Procedure code was invalid on the date of
            service.
            Start: 06/30/2005
      182 = Procedure modifier was invalid on the date
            of service.
            Start: 06/30/2005
      183 = The referring provider is not eligible to
            refer the service billed. Note: Refer to
            the 835 Healthcare Policy Identification
            Segment (loop 2110 Service Payment
            Information REF), if present.
            Start: 06/30/2005
      184 = The prescribing/ordering provider is not
            eligible to prescribe/order the service
            billed. Note: Refer to the 835 Healthcare
            Policy Identification Segment (loop 2110
            Service Payment Information REF), if
            present.
            Start: 06/30/2005
      185 = The rendering provider is not eligible to
            perform the service billed. Note: Refer
            to the 835 Healthcare Policy Identification
            Segment (loop 2110 Service Payment
            Information REF), if present.
            Start: 06/30/2005
            Last Modified: 09/20/2009
      186 = Level of care change adjustment.
            Start: 06/30/2005
      187 = Consumer Spending Account payments
            (includes but is not limited to Flexible
            Spending Account, Health Savings Account,
            Health Reimbursement Account, etc.)
            Start: 06/30/2005
      188 = This product/procedure is only covered when
            used according to FDA recommendations.
            Start: 06/30/2005
      189 = 'Not otherwise classified' or 'unlisted'
            procedure code (CPT/HCPCS) was billed when
            there is a specific procedure code for this
            procedure/service
            Start: 06/30/2005
      190 = Payment is included in the allowance for a
            Skilled Nursing Facility (SNF) qualified
            stay.
            Start: 10/31/2005
      191 = Not a work related injury/illness and thus
            not the liability of the workers'
            compensation carrier Note: If adjustment is
            at the Claim Level, the payer must send and
            the provider should refer to the 835
            Insurance Policy Number Segment (Loop 2100
            Other Claim Related Information REF
            qualifier 'IG') for the jurisdictional
            regulation. If adjustment is at the Line
            Level, the payer must send and the provider
            should refer to the 835 Healthcare Policy
            Identification Segment (loop 2110 Service
            Payment information REF)
            Start: 10/31/2005
      192 = Non standard adjustment code from paper
            remittance. Note: This code is to be used
            by providers/payers providing Coordination
            of Benefits information to another payer in
            the 837 transaction only. This code is only
            used when the non-standard code cannot be
            reasonably mapped to an existing Claims
            Adjustment Reason Code, specifically
            Deductible, Coinsurance and Co-payment.
            Start: 10/31/2005
      193 = Original payment decision is being
            maintained. Upon review, it was determined
            that this claim was processed properly.
            Start: 02/28/2006
      194 = Anesthesia performed by the operating
            physician, the assistant surgeon or the
            attending physician.
            Start: 02/28/2006
      195 = Refund issued to an erroneous priority
            payer for this claim/service.
            Start: 02/28/2006
      196 = Claim/service denied based on prior payer's
            coverage determination.
            Start: 06/30/2006
            Stop: 02/01/2007
            Notes: Use code 136.
      197 = Precertification/authorization/notification
            absent.
            Start: 10/31/2006
      198 = Precertification/authorization exceeded.
            Start: 10/31/2006
      199 = Revenue code and Procedure code do not
            match.
            Start: 10/31/2006
      200 = Expenses incurred during lapse in coverage
            Start: 10/31/2006
      201 = Workers' Compensation case settled. Patient
            is responsible for amount of this claim/
            service through WC 'Medicare set aside
            arrangement' or other agreement. (Use group
            code PR). This change effective 7/1/2013:
            Workers Compensation case settled. Patient
            is responsible for amount of this claim/
            service through WC 'Medicare set aside
            arrangement' or other agreement. (Use only
            with Group Code PR)
            Start: 10/31/2006
      202 = Non-covered personal comfort or convenience
            services.
            Start: 02/28/2007
      203 = Discontinued or reduced service.
            Start: 02/28/2007
      204 = This service/equipment/drug is not covered
            under the patient's current benefit plan
            Start: 02/28/2007
      205 = Pharmacy discount card processing fee
            Start: 07/09/2007
      206 = National Provider Identifier - missing.
            Start: 07/09/2007
      207 = National Provider identifier - Invalid
            format
            Start: 07/09/2007
      208 = National Provider Identifier - Not matched.
            Start: 07/09/2007
      209 = Per regulatory or other agreement. The
            provider cannot collect this amount from
            the patient. However, this amount may be
            billed to subsequent payer. Refund to
            patient if collected. (Use Group code OA)
            This change effective 7/1/2013: Per
            regulatory or other agreement. The provider.
            cannot collect this amount from the patient
            However, this amount may be billed to
            subsequent payer. Refund to patient if
            collected. (Use only with Group code OA)
            Start: 07/09/2007
      210 = Payment adjusted because pre-certification/
            authorization not received in a timely fashion
            Start: 07/09/2007
      211 = National Drug Codes (NDC) not eligible for
            rebate, are not covered.
            Start: 07/09/2007
      212 = Administrative surcharges are not covered
            Start: 11/05/2007
      213 = Non-compliance with the physician self
            referral prohibition legislation or payer
            policy.
            Start: 01/27/2008
      214 = Workers' Compensation claim adjudicated as
            non-compensable. This Payer not liable for
            claim or service/treatment. Note: If
            adjustment is at the Claim Level, the payer
            must send and the provider should refer to
            the 835 Insurance Policy Number Segment
            (Loop 2100 Other Claim Related Information
            REF qualifier 'IG') for the jurisdictional
            regulation. If adjustment is at the Line
            Level, the payer must send and the provider
            should refer to the 835 Healthcare Policy
            Identification Segment (loop 2110 Service
            Payment information REF). To be used for
            Workers' Compensation only
            Start: 01/27/2008
      215 = Based on subrogation of a third party
            settlement
            Start: 01/27/2008
      216 = Based on the findings of a review
            organization
            Start: 01/27/2008
      217 = Based on payer reasonable and customary
            fees. No maximum allowable defined by
            legislated fee arrangement. (Note: To be
            used for Property and Casualty only)
            Start: 01/27/2008
      218 = Based on entitlement to benefits. Note:
            If adjustment is at the Claim Level, the
            payer must send and the provider should
            refer to the 835 Insurance Policy Number
            Segment (Loop 2100 Other Claim Related
            Information REF qualifier 'IG') for the
            jurisdictional regulation. If adjustment is
            at the Line Level, the payer must send and
            the provider should refer to the 835
            Healthcare Policy Identification Segment
            (loop 2110 Service Payment information REF)
            To be used for Workers' Compensation only
            Start: 01/27/2008
      219 = Based on extent of injury. Note: If
            adjustment is at the Claim Level, the payer
            must send and the provider should refer to
            the 835 Insurance Policy Number Segment
            (Loop 2100 Other Claim Related Information
            REF qualifier 'IG') for the jurisdictional
            regulation. If adjustment is at the Line
            Level, the payer must send and the provider
            should refer to the 835 Healthcare Policy
            Identification Segment (loop 2110 Service
            Payment information REF).
            Start: 01/27/2008
      220 = The applicable fee schedule/fee database
            does not contain the billed code. Please
            resubmit a bill with the appropriate fee
            schedule/fee database code(s) that best
            describe the service(s) provided and
            supporting documentation if required.
            (Note: To be used for Property and Casualty
            only)
            Start: 01/27/2008
      221 = Workers' Compensation claim is under
            investigation. Note: If adjustment is at
            the Claim Level, the payer must send and
            the provider should refer to the 835
            Insurance Policy Number Segment (Loop 2100
            Other Claim Related Information REF
            qualifier 'IG') for the jurisdictional
            regulation. If adjustment is at the Line
            Level, the payer must send and the provider
            should refer to the 835 Healthcare Policy
            Identification Segment (loop 2110 Service
            Payment information REF). This change
            effective 7/1/2013: Claim is under
            investigation. Note: If adjustment is at
            the Claim Level, the payer must send and
            the provider should refer to the 835
            Insurance Policy Number Segment (Loop 2100
            Other Claim Related Information REF
            qualifier 'IG') for the jurisdictional
            regulation. If adjustment is at the Line
            Level, the payer must send and the provider
            should refer to the 835 Healthcare Policy
            Identification Segment (loop 2110 Service
            Payment information REF). (Note: To be used
            by Property & Casualty only)
            Start: 01/27/2008
      222 = Exceeds the contracted maximum number of
            hours/days/units by this provider for this
            period. This is not patient specific. Note:
            Refer to the 835 Healthcare Policy
            Identification Segment (loop 2110 Service
            Payment Information REF), if present.
            Start: 06/01/2008
      223 = Adjustment code for mandated federal, state
            or local law/regulation that is not already
            covered by another code and is mandated
            before a new code can be created.
            Start: 06/01/2008
      224 = Patient identification compromised by
            identity theft. Identity verification
            required for processing this and future
            claims.
            Start: 06/01/2008
      225 = Penalty or Interest Payment by Payer (Only
            used for plan to plan encounter reporting
            within the 837)
            Start: 06/01/2008
      226 = Information requested from the Billing/
            Rendering Provider was not provided or was
            insufficient/incomplete. At least one
            Remark Code must be provided (may be
            comprised of either the NCPDP Reject Reason
            Code, or Remittance Advice Remark Code that
            is not an ALERT.) This change effective
            7/1/2013: Information requested from the
            Billing/Rendering Provider was not provided
            or not provided timely or was insufficient/
            incomplete. At least one Remark Code must
            be provided (may be comprised of either the
            NCPDP Reject Reason Code, or Remittance
            Advice Remark Code that is not an ALERT.)
            Start: 09/21/2008
      227 = Information requested from the patient/
            insured/responsible party was not provided
            or was insufficient/incomplete. At least
            one Remark Code must be provided (may be
            comprised of either the NCPDP Reject Reason
            Code, or Remittance Advice Remark Code that
            is not an ALERT.)
            Start: 09/21/2008
      228 = Denied for failure of this provider,
            another provider or the subscriber to
            supply requested information to a previous
            payer for their adjudication
            Start: 09/21/2008
      229 = Partial charge amount not considered by
            Medicare due to the initial claim Type of
            Bill being 12X. Note: This code can only
            be used in the 837 transaction to convey
            Coordination of Benefits information when
            the secondary payer's cost avoidance policy
            allows providers to bypass claim submission
            to a prior payer. Use Group Code PR. This
            change effective 7/1/2013: Partial charge
            amount not considered by Medicare due to
            the initial claim Type of Bill being 12X.
            Note: This code can only be used in the
            837 transaction to convey Coordination of
            Benefits information when the secondary
            payer's cost avoidance policy allows
            providers to bypass claim submission to a
            prior payer. (Use only with Group Code PR)
            Start: 01/25/2009
      230 = No available or correlating CPT/HCPCS code
            to describe this service. Note: Used only
            by Property and Casualty.
            Start: 01/25/2009
      231 = Mutually exclusive procedures cannot be
            done in the same day/setting. Note: Refer
            to the 835 Healthcare Policy Identification
            Segment (loop 2110 Service Payment
            Information REF), if present.
            Start: 07/01/2009
      232 = Institutional Transfer Amount. Note -
            Applies to institutional claims only and
            explains the DRG amount difference when the
            patient care crosses multiple institutions.
            Start: 11/01/2009
      233 = Services/charges related to the treatment
            of a hospital-acquired condition or
            preventable medical error.
            Start: 01/24/2010
      234 = This procedure is not paid separately. At
            least one Remark Code must be provided
            (may be comprised of either the NCPDP
            Reject Reason Code, or Remittance Advice
            Remark Code that is not an ALERT.)
            Start: 01/24/2010
      235 = Sales Tax
            Start: 06/06/2010
      236 = This procedure or procedure/modifier
            combination is not compatible with another
            procedure or procedure/modifier combination
            provided on the same day according to the
            National Correct Coding Initiative. This
            change effective 7/1/2013: This procedure
            or procedure/modifier combination is not
            compatible with another procedure or
            procedure/modifier combination provided on
            the same day according to the National
            Correct Coding Initiative or workers
            compensation state regulations/ fee
            schedule requirements.
            Start: 01/30/2011
      237 = Legislated/Regulatory Penalty. At least one
            Remark Code must be provided (may be
            comprised of either the NCPDP Reject Reason
            Code, or Remittance Advice Remark Code that
            is not an ALERT.)
            Start: 06/05/2011
      238 = Claim spans eligible and ineligible periods
            of coverage, this is the reduction for the
            ineligible period (use Group Code PR). This
            change effective 7/1/2013: Claim spans
            eligible and ineligible periods of coverage
            , this is the reduction for the ineligible
            period. (Use only with Group Code PR)
            Start: 03/01/2012
      239 = Claim spans eligible and ineligible periods
            of coverage. Rebill separate claims.
            Start: 03/01/2012
      240 = The diagnosis is inconsistent with the
            patient's birth weight. Note: Refer to the
            835 Healthcare Policy Identification
            Segment (loop 2110 Service Payment
            Information REF), if present.
            Start: 06/03/2012
      241 = Low Income Subsidy (LIS) Co-payment Amount
            Start: 06/03/2012
      242 = Services not provided by network/primary
            care providers.
            Start: 06/03/2012
      243 = Services not authorized by network/primary
            care providers.
            Start: 06/03/2012
      244 = Payment reduced to zero due to litigation.
            Additional information will be sent
            following the conclusion of litigation.
            To be used for Property & Casualty only.
            Start: 09/30/2012
      245 = Provider performance program withhold.
            Start: 09/30/2012
      246 = This non-payable code is for required
            reporting only.
            Start: 09/30/2012
      247 = Deductible for Professional service
            rendered in an Institutional setting and
            billed on an Institutional claim.
            Start: 09/30/2012
            Notes: For Medicare Bundled Payment use
            only, under the Patient Protection and
            Affordable Care Act (PPACA).
      248 = Coinsurance for Professional service
            rendered in an Institutional setting and
            billed on an Institutional claim.
            Start: 09/30/2012
            Notes: For Medicare Bundled Payment use
            only, under the Patient Protection and
            Affordable Care Act (PPACA).
      249 = This claim has been identified as a
            readmission. (Use only with Group Code CO)
            Start: 09/30/2012
      250 = The attachment content received is
            inconsistent with the expected content.
            Start: 09/30/2012
      251 = The attachment content received did not
            contain the content required to process
            this claim or service.
            Start: 09/30/2012
      252 = An attachment is required to adjudicate
            this claim/service. At least one Remark
            Code must be provided (may be comprised of
            either the NCPDP Reject Reason Code, or
            Remittance Advice Remark Code that is not
            an ALERT).
            Start: 09/30/2012
      A0  = Patient refund amount.
            Start: 01/01/1995
      A1  = Claim/Service denied. At least one Remark
            Code must be provided (may be comprised of
            either the NCPDP Reject Reason Code, or
            Remittance Advice Remark Code that is not
            an ALERT.)
            Start: 01/01/1995
      A2  = Contractual adjustment.
            Start: 01/01/1995
            Stop: 01/01/2008
            Notes: Use Code 45 with Group Code 'CO' or
            use another appropriate specific adjustment
            code.
      A3  = Medicare Secondary Payer liability met.
            Start: 01/01/1995
            Stop: 10/16/2003
      A4  = Medicare Claim PPS Capital Day Outlier
            Amount.
            Start: 01/01/1995
            Stop: 04/01/2008
      A5  = Medicare Claim PPS Capital Cost Outlier
            Amount.
            Start: 01/01/1995
      A6  = Prior hospitalization or 30 day transfer
            requirement not met.
            Start: 01/01/1995
      A7  = Presumptive Payment Adjustment
            Start: 01/01/1995
      A8  = Ungroupable DRG.
            Start: 01/01/1995
      B1  = Non-covered visits.
            Start: 01/01/1995
      B2  = Covered visits.
            Start: 01/01/1995
            Stop: 10/16/2003
      B3  = Covered charges.
            Start: 01/01/1995
            Stop: 10/16/2003
      B4  = Late filing penalty.
            Start: 01/01/1995
      B5  = Coverage/program guidelines were not met
            or were exceeded.
            Start: 01/01/1995
      B6  = This payment is adjusted when performed/
            billed by this type of provider, by this
            type of provider in this type of facility,
            or by a provider of this specialty.
            Start: 01/01/1995
            Stop: 02/01/2006
      B7  = This provider was not certified/eligible
            to be paid for this procedure/service on
            this date of service. Note: Refer to the
            835 Healthcare Policy Identification
            Segment (loop 2110 Service Payment
            Information REF), if present.
            Start: 01/01/1995
      B8  = Alternative services were available, and
            should have been utilized. Note: Refer to
            the 835 Healthcare Policy Identification
            Segment (loop 2110 Service Payment
            Information REF), if present.
            Start: 01/01/1995
      B9  = Patient is enrolled in a Hospice.
            Start: 01/01/1995
      B10 = Allowed amount has been reduced because a
            component of the basic procedure/test was
            paid. The beneficiary is not liable for
            more than the charge limit for the basic
            procedure/test.
            Start: 01/01/1995
      B11 = The claim/service has been transferred to
            the proper payer/processor for processing.
            Claim/service not covered by this payer/
            processor.
            Start: 01/01/1995
      B12 = Services not documented in patients'
            medical records.
            Start: 01/01/1995
      B13 = Previously paid. Payment for this claim/
            service may have been provided in a
            previous payment.
            Start: 01/01/1995
      B14 = Only one visit or consultation per
            physician per day is covered.
            Start: 01/01/1995
      B15 = This service/procedure requires that a
            qualifying service/procedure be received
            and covered. The qualifying other service/
            procedure has not been received/adjudicated
            . Note: Refer to the 835 Healthcare Policy
            Identification Segment (loop 2110 Service
            Payment Information REF), if present.
            Start: 01/01/1995
      B16 = 'New Patient' qualifications were not met.
            Start: 01/01/1995
      B17 = Payment adjusted because this service was
            not prescribed by a physician, not
            prescribed prior to delivery, the
            prescription is incomplete, or the
            prescription is not current.
            Start: 01/01/1995
            Stop: 02/01/2006
      B18 = This procedure code and modifier were
            invalid on the date of service.
            Start: 01/01/1995
            Stop: 03/01/2009
      B19 = Claim/service adjusted because of the
            finding of a Review Organization.
            Start: 01/01/1995
            Stop: 10/16/2003
      B20 = Procedure/service was partially or fully
            furnished by another provider.
            Start: 01/01/1995
      B21 = The charges were reduced because the
            service/care was partially furnished by
            another physician.
            Start: 01/01/1995
            Stop: 10/16/2003
      B22 = This payment is adjusted based on the
            diagnosis.
            Start: 01/01/1995
      B23 = Procedure billed is not authorized per
            your Clinical Laboratory Improvement
            Amendment (CLIA) proficiency test.
            Start: 01/01/1995
      D1  = Claim/service denied. Level of subluxation
            is missing or inadequate.
            Start: 01/01/1995
            Stop: 10/16/2003
            Notes: Use code 16 and remark codes if
            necessary.
      D2  = Claim lacks the name, strength, or dosage
            of the drug furnished.
            Start: 01/01/1995
            Stop: 10/16/2003
            Notes: Use code 16 and remark codes if
            necessary.
      D3  = Claim/service denied because information to
            indicate if the patient owns the equipment
            that requires the part or supply was
            missing.
            Start: 01/01/1995
            Stop: 10/16/2003
            Notes: Use code 16 and remark codes if
            necessary.
      D4  = Claim/service does not indicate the period
            of time for which this will be needed.
            Start: 01/01/1995
            Stop: 10/16/2003
            Notes: Use code 16 and remark codes if
            necessary.
      D5  = Claim/service denied. Claim lacks
            individual lab codes included in the test.
            Start: 01/01/1995
            Stop: 10/16/2003
            Notes: Use code 16 and remark codes if
            necessary.
      D6  = Claim/service denied. Claim did not include
            patient's medical record for the service.
            Start: 01/01/1995
            Stop: 10/16/2003
            Notes: Use code 16 and remark codes if
            necessary.
      D7  = Claim/service denied. Claim lacks date of
            patient's most recent physician visit.
            Start: 01/01/1995
            Stop: 10/16/2003
            Notes: Use code 16 and remark codes if
            necessary.
      D8  = Claim/service denied. Claim lacks
            indicator that 'x-ray is available for
            review.'
            Start: 01/01/1995
            Stop: 10/16/2003
            Notes: Use code 16 and remark codes if
            necessary.
      D9  = Claim/service denied. Claim lacks invoice
            or statement certifying the actual cost
            of the lens, less discounts or the type of
            intraocular lens used.
            Start: 01/01/1995
            Stop: 10/16/2003
            Notes: Use code 16 and remark codes if
            necessary.
      D10 = Claim/service denied. Completed physician
            financial relationship form not on file.
            Start: 01/01/1995
            Stop: 10/16/2003
            Notes: Use code 17.
      D11 = Claim lacks completed pacemaker
            registration form.
            Start: 01/01/1995
            Stop: 10/16/2003
            Notes: Use code 17.
      D12 = Claim/service denied. Claim does not
            identify who performed the purchased
            diagnostic test or the amount you were
            charged for the test.
            Start: 01/01/1995
            Stop: 10/16/2003
            Notes: Use code 17.
      D13 = Claim/service denied. Performed by a
            facility/supplier in which the ordering/
            referring physician has a financial
            interest.
            Start: 01/01/1995
            Stop: 10/16/2003
            Notes: Use code 17.
      D14 = Claim lacks indication that plan of
            treatment is on file.
            Start: 01/01/1995
            Stop: 10/16/2003
            Notes: Use code 17.
      D15 = Claim lacks indication that service was
            supervised or evaluated by a physician.
            Start: 01/01/1995
            Stop: 10/16/2003
            Notes: Use code 17.
      D16 = Claim lacks prior payer payment information
            Start: 01/01/1995
            Stop: 06/30/2007
            Notes: Use code 16 with appropriate claim
            payment remark code âN4ã.
      D17 = Claim/Service has invalid non-covered days.
            Start: 01/01/1995
            Stop: 06/30/2007
            Notes: Use code 16 with appropriate claim
            payment remark code.
      D18 = Claim/Service has missing diagnosis
            information.
            Start: 01/01/1995
            Stop: 06/30/2007
            Notes: Use code 16 with appropriate claim
            payment remark code.
      D19 = Claim/Service lacks Physician/Operative or
            other supporting documentation
            Start: 01/01/1995
            Stop: 06/30/2007
            Notes: Use code 16 with appropriate claim
            payment remark code.
      D20 = Claim/Service missing service/product
            information.
            Start: 01/01/1995
            Stop: 06/30/2007
            Notes: Use code 16 with appropriate claim
            payment remark code.
      D21 = This (these) diagnosis(es) is (are) missing
            or are invalid
            Start: 01/01/1995
            Stop: 06/30/2007
      D22 = Reimbursement was adjusted for the reasons
            to be provided in separate correspondence.
            (Note: To be used for Workers' Compensation
            only) - Temporary code to be added for time
            frame only until 01/01/2009. Another code
            to be established and/or for 06/2008
            meeting for a revised code to replace or
            strategy to use another existing code
            Start: 01/27/2008
            Stop: 01/01/2009
      D23 = This dual eligible patient is covered by
            Medicare Part D per Medicare Retro-
            Eligibility. At least one Remark Code must
            be provided (may be comprised of either the
            NCPDP Reject Reason Code, or Remittance
            Advice Remark Code that is not an ALERT.)
            Start: 11/01/2009
            Stop: 01/01/2012
      W1  = Workers' compensation jurisdictional fee
            schedule adjustment. Note: If adjustment
            is at the Claim Level, the payer must send
            and the provider should refer to the 835
            Class of Contract Code Identification
            Segment (Loop 2100 Other Claim Related
            Information REF). If adjustment is at the
            Line Level, the payer must send and the
            provider should refer to the 835 Healthcare
            Policy Identification Segment (loop 2110
            Service Payment information REF).
            Start: 02/29/2000
      W2  = Payment reduced or denied based on workers'
            compensation jurisdictional regulations or
            payment policies, use only if no other code
            is applicable. Note: If adjustment is at
            the Claim Level, the payer must send and
            the provider should refer to the 835
            Insurance Policy Number Segment (Loop 2100
            Other Claim Related Information REF
            qualifier 'IG') for the jurisdictional
            regulation. If adjustment is at the Line
            Level, the payer must send and the provider
            should refer to the 835 Healthcare Policy
            Identification Segment (loop 2110 Service
            Payment information REF). To be used for
            Workers' Compensation only.
            Start: 10/17/2010
      W3  = The Benefit for this Service is included
            in the payment/allowance for another
            service/procedure that has been performed
            on the same day. Note: Refer to the 835
            Healthcare Policy Identification Segment
            (loop 2110 Service Payment Information REF),
            if present. For use by Property and
            Casualty only.
            Start: 09/30/2012
      W4  = Workers' Compensation Medical Treatment
            Guideline Adjustment.
            Start: 09/30/2012
      Y1  = Payment denied based on Medical Payments
            Coverage (MPC) or Personal Injury
            Protection (PIP) Benefits jurisdictional
            regulations or payment policies, use only
            if no other code is applicable. Note: If
            adjustment is at the Claim Level, the payer
            must send and the provider should refer to
            the 835 Insurance Policy Number Segment
            (Loop 2100 Other Claim Related Information
            REF qualifier 'IG') for the jurisdictional
            regulation. If adjustment is at the Line
            Level, the payer must send and the provider
            should refer to the 835 Healthcare Policy
            Identification Segment (loop 2110 Service
            Payment information REF). To be used for
            P&C Auto only.
            Start: 09/30/2012
      Y2  = Payment adjusted based on Medical Payments
            Coverage (MPC) or Personal Injury
            Protection (PIP) Benefits jurisdictional
            regulations or payment policies, use only
            if no other code is applicable. Note: If
            adjustment is at the Claim Level, the payer
            must send and the provider should refer to
            the 835 Insurance Policy Number Segment
            (Loop 2100 Other Claim Related Information
            REF qualifier 'IG') for the jurisdictional
            regulation. If adjustment is at the Line
            Level, the payer must send and the provider
            should refer to the 835 Healthcare Policy
            Identification Segment (loop 2110 Service
            Payment information REF). To be used for
            P&C Auto only.
            Start: 09/30/2012
      Y3  = Medical Payments Coverage (MPC) or Personal
            Injury Protection (PIP) Benefits
            jurisdictional fee schedule adjustment.
            Note: If adjustment is at the Claim Level,
            the payer must send and the provider should
            refer to the 835 Class of Contract Code
            Identification Segment (Loop 2100 Other
            Claim Related Information REF). If
            adjustment is at the Line Level, the payer
            must send and the provider should refer to
            the 835 Healthcare Policy Identification
            Segment (loop 2110 Service Payment
            information REF). To be used for P&C Auto
            only.
            Start: 09/30/2012



 CLM_BENE_ID_TYPE_TB                     Claim Beneficiary Identifier Type Table

       M = MBI
       H = HICN



 CLM_CARE_IMPRVMT_MODEL_TB               Claim Care Improvement Model Table


      61 = CLAIM CARE IMPROVEMENT MODEL 1
      62 = CLAIM CARE IMPROVEMENT MODEL 2
      63 = CLAIM CARE IMPROVEMENT MODEL 3
      64 = CLAIM CARE IMPROVEMENT MODEL 4



 CLM_DEMO_ID_TB                          Claim Demonstration Identification Table

      01 = Nursing Home Case Mix and Quality Demo
      02 = National Home Health Agency Prospective Payment Demo
      03 = Telemedicine Waiver Demo (retired)
      04 = United Mine Workers of America
      05 = Medicare Choices Demo (retired)
      06 = Medicare Participating Heart Bypass Center Demo (retired)
      07 = Participating Centers of Excellence (retired)
      08 = Provider Partnership Demo (retired)
      09 = Colorado Integrated Care and Financing Project
      10 = Community Nursing Organization Demo
      11 = Consumer Directed DME Demo
      12 = Competitive Bidding for Clinical Labs (non-MMA demo)
      13 = Competitive Bidding for DME Demo
      14 = Competitive Pricing - Open Enrollment Demo (non-MMA)
      15 = ESRD Managed Care Demo (retired)
      16 = Utah All Payer Graduate Medical Education Demo
      17 = Group Specific Volume Performance Standards
      19 = Medicaid Working Group Dual Eligibles
      20 = Minnesota Senior Health Options
      21 = Municipal Health Services Program
      22 = New England Dual Eligible Waiver Project
      23 = PACE
      24 = Seattle Outlier Pool
      25 = SHMO II
      26 = VA Medicare Subvention Demo
      27 = Wisconsin Partnership Demo
      29 = On Lok
      30 = Lung Volume Reduction (NIH Clinical Trial) non-demo
      31 = VA Pricing (not a demo)
      32 = DoD Medicare Subvention Demo
      33 = Medical Savings Account (BBA)
      34 = New York Continuing Care Networks (aka Rochester and Monroe County)
      35 = Evercare Managed Care for Nursing Home Residents
      36 = SHMO I
      37 = Coordinated Care Demo (BBA)
      38 = Encounter Data (not a demo)
      39 = Flu/Pneumonia Vaccinations Encounter Data
      40 = Payment of Physician and Non-physician services in Certain Indian
           Providers (Rhem Gray)
      42 = ESRD DM - Basic ESRD demo bundle
      43 = ESRD DM - Expanded ESRD demo bundle including venous access
           procedures
      44 = Homebound demo (MMA)
      45 = Chiropratic (MMA)
      46 = Vision Rehab (2004 appropriation project)
      47 = Flu Medication Demo
      48 = Home Health Adult Day Care (s. 703 of MMA)
      49 = Frequent Hemodialysis Network Clinical Trial
      50 = Anti-Cancer Colorectal Drugs during Clinical Trials
      51 = Clinical Lab Competitive Bidding (MMA) (retired)
      52 = Inhalation Therapy (retired)
      53 = Frontier Extended Stay Clinic
      54 = ACE Demo (retired)
      55 = Avastin Lucentis Clinical trial
      56 = Section 3113 ACA - Lab demo (retired)
      57 = Medicaid Emergency Psych - section 2707 ACA
      58 = Multi-payer Advanced Primary Care Practice (MAPCP)(CMMI)
      59 = Pioneer ACO Model (CMI)
      60 = Medicare Pre-Payment Review and Prior Authorization of Power
           Mobility Devices Demonstration (OFM)
      61 = Bundled Payments for Care Improvement model 1 (CMMI)
      62 = Bundled Payments for Care Improvement model 2
      63 = Bundled Payments for Care Improvement model 3
      64 = Bundled Payments for Care Improvement model 4
      65 = A/B Rebilling Demonstration - rebilled claims due to auditor
           denials (OFM)
      66 = A/B Rebilling Demonstration - rebilled claims due to provider
           self-audit after claims submission/payment
      67 = A/B Rebilling Demonstration - rebilled claims due to provider
           self-audit after patient has been discharged but prior to payment
      68 = SNF Qualifying Stay - Pioneer ACO (SEE OTHER PIONEER NUMBER ABOVE)
      69   Advance Payment ACO Model Electrical Workers Insurance Fund (EWIF)
      70 = Electrical Workers Insurance Fund (EWIF)
      71   IVIG Demo
      72 = Payment Changes for Home Health Travel Reimbursement Changes
           for FCHIP
      73 = Medicare Care Choices Model
      74 = Next Generation ACO Model
      75 = Coordinated Quality Care -Comprehensive Care for Joint
           replacement (CCJR)
      76 = Million Hearts CVD Risk Reduction Model
      77 = Shared Savings Program (used in FISS and CWF to bypass the SNF
           3-day requirement)
      78 = Comprehensive Primary Care Plus Model - MCS analysis
      79 = Acute Myocardial Infarction (AMI), Episode payment Model
           (EPM) - REASSIGN
      80 = Coronary Artery Bypass Graft (CABG) Episode Payment Model
           (EPM) - REASSIGN
      81 = Surgical Hip/Femur Fracture Treatment (SHFFT) Episode Payment Model
           (EPM) - REASSIGN
      82 = Medicare Diabetes Prevention Program (MDPPs)
      83 = Maryland All Payer Model. This is the 3rd iteration of the Maryland
           All-Payer Model. This latest iteration encompasses Maryland Primary Care
           Program (MDPCP)
      84 = Diabetes Prevention Program Virtual Model Test
      85 = Comprehensive ESRD Care (CEC) Model
      86 = Bundled Payments for Care Improvement (BPCI) - Advanced
      87 = Radiation Oncology Bundled Payments
      88 = Shared Savings Program (TELEHEALTH waiver)
      89 = Vermont All Payer Model
      91 = Emergency Triage, Treat, and Transport (ET3)
      92 = Direct Contracting (DC)
      93 = Comprehensive Kidney Care Contracting (CKCC)
      94 = ESRD Treatment Choices (ETC)
      95 = Oncology Care Model Plus (OCM+)
      96 = Primary Care First (PCF) Seriously Ill Population (SIP) model
      97 = Kidney Care First (KCF)
      98 = The Pennsylvania Rural Health Model (PARHM)
      99 = Opioid Use Disorder (OUD) Treatment Demonstration Program



 CLM_DGNS_VRSN_TB                        Claim Diagnosis Version Code Table

      Valid Values:
      9 = ICD-9
      0 = ICD-10



 CLM_DISP_TB                             Claim Disposition Table

       01 = Debit accepted
       02 = Debit accepted (automatic adjustment)
            applicable through 4/4/93
       03 = Cancel accepted
       61 = *Conversion code: debit accepted
       62 = *Conversion code: debit accepted
             (automatic adjustment)
       63 = *Conversion code: cancel accepted

          *Used only during conversion period:
                1/1/91 - 2/21/91



 CLM_EXCPTD_NEXCPTD_TRTMT_TB             Claim Excepted/Nonexcepted Treatment Table

      0 = No Entry
      1 = Excepted
      2 = Nonexcepted



 CLM_FPS_MSN_CD_TB                       Claim FPS MSN Code Table

      Section 1 Ambulance
      1.1   = Payment for transportation is allowed
              only to the closest facility that can
              provide the necessary care.
      1.10  = Air ambulance is not covered since you
              were not taken to the airport by
              ambulance.
      1.11  = The information provided does not support
              the need for an air ambulance.
              The approved amount is based on ground
              ambulance.
      1.2   = Payment is denied because the ambulance
              company is not approved by Medicare.
      1.3   = Ambulance service to a funeral home is
              not covered.
      1.4   = Transportation in a vehicle other than
              an ambulance is not covered.
      1.5   = Transportation to a facility to be closer
              to home or family is not covered.
      1.6   = This service is included in the allowance
              for the ambulance transportation.
      1.7   = Ambulance services to or from a doctor's
              office are not covered.
      1.8   = This service is denied because you
              refused to be transported.
      1.9   = Payment for ambulance services does not
              include mileage when you were not in the
              ambulance.

      Section 10 Foot Care	
      10.1  = Shoes are only covered as part of a leg
              brace.

      Section 11 Transfer of Claims or Parts of Claims
      11.1  = Your claim has been forwarded to the
              correct Medicare contractor for
              processing. You will receive a notice
              from them.
      11.10 = We have identified you as a Railroad
              Retirement Board (RRB) Medicare
              beneficiary. You must send your claim
              for these services for processing to the
              RRB carrier Palmetto GBA, at PO Box
              10066, Augusta, GA 30999.
      11.11 = This claim/service is not payable under
              our claims jurisdiction. We have notified
              your provider to send your claim for
              these services to the United Mine
              Workers of America for processing.
      11.2  = This information is being sent to
              Medicaid. They will review it to see if
              additional benefits can be paid.
      11.3  = Our records show that you are enrolled in
              a Medicare health plan. Your provider
              must bill this service to the plan.
      11.4  = Our records show that you are enrolled in
              a Medicare health plan. Your claim was
              sent to the plan for processing.
      11.5  = This claim will need to be submitted to
              (another carrier, a Durable Medical
              Equipment Medicare Administrative
              Contractor (DME MAC), or Medicaid agency)
      11.6  = We have asked your provider to submit
              this claim to the proper Medicare
              Administrative Contractor (MAC). That
              MAC is (name and address).
              NOTE: Due to different systems'
              capabilities, DMACs may omit the final
              sentence in this message, "That MAC is
              (name and address)," whenever this
              message is used. Part A and Part B MACs
              are expected to use the complete message.
              This instruction also applies to the
              Spanish translation of the message.
      11.7  = This claim/service is not payable under
              our claims jurisdiction area. We have
              notified your provider that they must
              forward the claim/service to the correct
              carrier for processing.
      11.8  = This claim will need to be submitted to
              the Region B Durable Medical Equipment
              Regional Carrier.
      11.9  = This claim/service is not payable under
              our claims jurisdiction. We have
              notified your provider to send your
              claim for these services to the Railroad
              Retirement Board Medicare carrier.

      Section 12 Hearing Aids	
      12.1  = Hearing aids are not covered.

      Section 13 Skilled Nursing Facility
      13.1  = No qualifying hospital stay dates were
              shown for this skilled nursing facility
              stay.
      13.10 = Medicare Part B doesn't pay for items or
              services provided by this type of
              healthcare provider since our records
              show that you were receiving Medicare
              Part A benefits in a skilled nursing
              facility on this date.
      13.11 = You have ___ days(s) remaining of your
              total 100 days of skilled nursing
              facility benefits for this benefit period
      13.12 = Medicare Part B doesn't pay separately
              for this item/service. Payment for this
              item/service should be included in
              another Medicare benefit. The hospital/
              nursing facility must bill for this
              Medicare service.
      13.2  = Skilled nursing facility benefits are
              only available after a hospital stay of
              at least 3 days.
      13.3  = Information provided does not support the
              need for skilled nursing facility care.
      13.4  = Information provided does not support the
              need for continued care in a skilled
              nursing facility.
      13.5  = You were not admitted to the skilled
              nursing facility within 30 days of your
              hospital discharge.
      13.6  = Rural primary care skilled nursing
              facility benefits are only available
              after a hospital stay of at least 2 days.
      13.7  = Normally, care is not covered when
              provided in a bed that is not certified
              by Medicare. However, since you received
              covered care, we have decided that you
              will not have to pay the facility for
              anything more than Medicare coinsurance
              and noncovered items.
      13.8  = The skilled nursing facility should file
              a claim for Medicare benefits because
              you were an inpatient.
      13.9  = Medicare Part B does not pay for this
              item or service since our records show
              that you were in a skilled nursing
              facility on this date.

      Section 14 Laboratory
      14.1  = The laboratory is not approved for this
              type of test.
      14.10 = Medicare does not allow a separate
              payment for EKG readings.
      14.11 = A travel allowance is paid only when a
              covered specimen collection fee is billed
      14.12 = Payment for transportation can only be
              made if an X-ray or EKG is performed.
      14.13 = The laboratory was not approved for this
              test on the date it was performed.
      14.2  = Medicare approved less for this
              individual test because it can be done
              as part of a complete group of tests.
      14.3  = Services or items not approved by the
              Food and Drug Administration are not
              covered.
      14.4  = Payment denied because the claim did not
              show who performed the test and/or the
              amount charged.
      14.5  = Payment denied because the claim did not
              show if the test was purchased by the
              physician or if the physician performed
              the test.
      14.6  = This test must be billed by the
              laboratory that did the work.
      14.7  = This service is paid at 100% of the
              Medicare approved amount.
      14.8  = Payment cannot be made because the
              physician has a financial relationship
              with the laboratory.
      14.9  = Medicare cannot pay for this service for
              the diagnosis shown on the claim.

      Section  Medical Necessity
      15.1  = The information provided does not support
              the need for this many services or items.
      15.10 = Medicare does not pay for more than one
              assistant surgeon for this procedure.
      15.11 = Medicare does not pay for an assistant
              surgeon for this procedure/surgery.
      15.12 = Medicare does not pay for two surgeons
              for this procedure.
      15.13 = Medicare does not pay for team surgeons
              for this procedure.
      15.14 = Medicare does not pay for acupuncture.
      15.15 = Payment has been reduced because
              information provided does not support the
              need for this item as billed.
      15.16 = Your claim was reviewed by our medical
              staff.
      15.17 = We have approved this service at a
              reduced level.
      15.18 = Medicare does not cover this service at
              home.
      15.19 = Local Coverage Determinations (LCDs) help
              Medicare decide what is covered. An LCD
              was used for your claim. You can compare
              your case to the LCD, and send
              information from your doctor if you
              think it could change our decision.
              Call 1-800-MEDICARE (1-800-633-4227) for
              a copy of the LCD.
      15.2  = The information provided does not support
              the need for this equipment.
      15.20 = The following policies were used when we
              made this decision: _____
      15.21 = The information provided does not support
              the need for this many services or items
              in this period of time but you do not
              have to pay this amount.
      15.22 = The information provided does not support
              the need for this many services or items
              in this period of time so Medicare will
              not pay for this item or service.
      15.3  = The information provided does not support
              the need for the special features of this
              equipment.
      15.4  = The information provided does not support
              the need for this service or item.
      15.5  = The information provided does not support
              the need for similar services by more
              than one doctor during the same time
              period.
      15.6  = The information provided does not support
              the need for this many services or items
              within this period of time.
      15.7  = The information provided does not support
              the need for more than one visit a day.
      15.8  = The information provided does not support
              the level of service as shown on the
              claim.
      15.9  = The Quality Improvement Organization did
              not approve this service.
      15.96 = Medicare does not pay for this
              investigational device(s).
      15.97 = Medicare cannot pay for this
              investigational device because the
              approved period for the investigational
              device in the FDA clinical trial has not
              begun.
      15.98 = Medicare cannot pay for this
              investigational device because the
              approved period for the investigational
              device in the FDA clinical trial has
              expired.
      15.99 = Medicare does not pay for this many
              services on the same day. You cannot be
              billed for this service.

      Section 16 Miscellaneous
      16.1  = The service cannot be approved because
              the date on the claim shows it was billed
              before it was provided.
      16.10 = Medicare does not pay for this item or
              service.
      16.11 = Payment was reduced for late filing.  You
              cannot be billed for the reduction.
      16.12 = Outpatient mental health services are
              paid at 50% of the approved charges.
      16.13 = The code(s) your provider used is/are not
              valid for the date of service billed.
      16.14 = The attached check replaces your previous
              check (#____) dated (______).
      16.15 = The attached check replaces your previous
              check.
      16.16 = As requested, this is a duplicate copy of
              your Medicare Summary Notice.
              See "Message Expiration Date" and
              "Message Notes" columns ------->
      16.17 = Medicare only pays for these services if
              you get them with total parenteral
              nutrition.
      16.18 = Medicare won't pay for services provided
              before certified parenteral/enteral
              nutrition therapy started.
      16.19 = The amount Medicare pays for a
              parenteral/enteral nutrition supply is
              based on the level of care you need
              (based on your diagnosis).
      16.2  = This service cannot be paid when provided
              in this location/facility.
      16.20 = The approved payment for calories/grams
              is the most Medicare may allow for the
              diagnosis stated.
      16.21 = The procedure code was changed to reflect
              the actual service rendered.
      16.22 = Medicare does not pay for services when
              no charge is indicated.
      16.23 = This check is for the amount you overpaid
      16.24 = Services provided aboard a ship are
              covered only when the ship is of United
              States registry and is in United States
              waters. In addition, the service must be
              provided by a doctor licensed to practice
              in the United States.
      16.25 = Medicare does not pay for this much
              equipment, or this many services or
              supplies.
      16.26 = Medicare does not pay for services or
              items related to a procedure that has not
              been approved or billed.
      16.27 = This service is not covered since our
              records show you were in the hospital at
              this time.
      16.28 = Medicare does not pay for services or
              equipment that you have not received.
      16.29 = Payment is included in another service
              you have received.
      16.3  = The claim did not show that this service
              or item was prescribed by your doctor.
      16.30 = Services billed separately on this claim
              have been combined under this procedure.
      16.31 = You are responsible to pay the primary
              physician care the agreed monthly charge.
      16.32 = Medicare does not pay separately for this
              service.
      16.33 = Your payment includes interest because
              Medicare exceeded processing time limits.
      16.34 = You should not be billed for this service
              . You are only responsible for any
              deductible and coinsurance amounts listed
              in the "You May Be Billed" column.
              This message should be revised to read
              "Maximum You May Be Billed" (in place of
              "You May Be Billed") when your MAC
              implements the new MSN design.
              See "Message Implementation Date" and
              "Message Notes."
      16.35 = You do not have to pay this amount.
      16.36 = If you have already paid it, you are
              entitled to a refund from this provider.
      16.37 = Please see the back of this notice.
              See "Message Expiration Date" and
              "Message Notes" columns
      16.38 = Charges are not incurred for leave of
              absence days.
      16.39 = Only one provider can be paid for this
              service per calendar month. Payment has
              already been made to another provider for
              this service.
      16.4  = This service requires prior approval by
              the Quality Improvement Organization.
      16.40 = Only one inpatient service per day is
              allowed.
      16.41 = Payment is being denied because you
              refused to request reimbursement under
              your Medicare benefits.
      16.42 = The provider's determination of
              noncoverage is correct.
      16.43 = This service cannot be approved without a
              treatment plan and supervision of a
              doctor.
      16.44 = Routine care is not covered.
      16.45 = You cannot be billed separately for this
              item or service. You do not have to pay
              this amount.
      16.46 = Medicare payment limits do not affect a
              Native American's right to free care at
              Indian Health Institutions.
      16.47 = When deductible is applied to outpatient
              psychiatric services, you may be billed
              for up to the approved amount. The "You
              May Be Billed" column will tell you the
              correct amount to pay your provider.
              This message should be revised to read
              "Maximum You May Be Billed" (in place of
              "You May Be Billed" when your MAC
              implements the new MSN design.
      16.48 = Medicare does not pay for this item or
              service for this condition.
      16.49 = This claim/service is not covered because
              alternative services were available, and
              should have been utilized.
      16.5  = This service cannot be approved without a
              treatment plan by a physical or
              occupational therapist.
      16.50 = The doctor or supplier may not bill more
              than the Medicare allowed amount.
      16.51 = This service is not covered prior to July
              1, 2001.
      16.52 = This service was denied because coverage
              for this service is provided only after a
              documented failed trial of pelvic muscle
              exercise training.
      16.53 = The amount Medicare paid the provider for
              this claim is ($______).
      16.54 = This service is not covered prior to
              January 1, 2002.
      16.55 = The provider billed this charge as
              non-covered.
      16.56 = Claim denied because information from the
              Social Security Administration indicates
              that you have been deported.
      16.57 = Medicare Part B does not pay for this
              item or service since our records show
              that you were in a Medicare health plan
              on this date. Your provider must bill
              this service to the Medicare health plan.
      16.58 = The provider billed this charge as
              non-covered. You do not have to pay this
              amount.
      16.59 = Medicare doesn't pay for missed
              appointments.
      16.6  = This item or service cannot be paid
              unless the provider accepts assignment.
      16.60 = Want to see your MSN right away? Access
              your Original Medicare claims directly at
              www.MyMedicare.gov, usually within 24
              hours after Medicare processes the claim.
              You can also order duplicate MSNs, track
              your preventive services, and print an
              "On the Go" report to share with your
              provider.
      16.61 = Outpatient mental health services are
              paid at 55% of the approved amount.
      16.62 = Outpatient mental health services are
              paid at 60% of the approved amount
      16.63 = Outpatient mental health services are
              paid at 65% of the approved amount.
      16.64 = IMPORTANT:  Starting in March 2010,
              Medicare will begin to mail Part A and
              Part B MSNs in the same envelope when
              possible.
      16.66 = Medicare doesn't pay for DMEPOS items or
              services when provided by a hospital or
              physician if there is no matching date of
              discharge or date of service.
      16.67 = Medicare doesn't pay for services or
              items when provided by a hospital when
              there is no matching date of discharge.
      16.7  = Your provider must complete and submit
              your claim.
      16.71 = Your provider must complete and submit
              your claim.
      16.72 = This claim was denied because it was
              Submitted with a non-affirmative prior
              authorization request.
      16.73 = This claim has received a payment
              reduction because it did not first go
              through the prior authorization process.
      16.74 = This claim is denied because there is no
              record of a prior authorization request
              to support this record.
      16.76 = This service/item was not covered because
              you have exceeded the lifetime limit for
              getting this service/item.
      16.77 = This service/item was not covered because
              it was not provided as part of a
              qualifying trial/study.
      16.8  = Payment is included in another service
              received on the same day.
      16.9  = This allowance has been reduced by the
              amount previously paid for a related
              procedure.
      16.98 = The amount you paid to the provider for
              this claim was more than the required
              payment. You should be receiving a refund
              of $______ from your provider, which is
              the difference between what you paid and
              what you should have paid.
      16.99 = The amount owed you is $________.
              Medicare no longer routinely issues
              payment under $1 This amount due will be
              included on a future check issued to you.
              If you want this money issued immediately
              , please contact us at the address and
              phone number shown at the bottom of this
              page.

      Section 17 Non Physician Services	
      17.1  = Services performed by a private duty
              nurse are not covered.
      17.10 = The allowance has been reduced because
              the anesthesiologist medically directed
              concurrent procedures.
      17.11 = This item or service cannot be paid as
              billed.
      17.12 = This service is not covered when provided
              by an independent therapist.
      17.13 = Each year, Medicare pays for a limited
              amount of physical therapy and speech-
              language pathology services and a
              separate amount of occupational therapy
              services. Medically necessary therapy
              over these limits is covered when
              approved by Medicare.
      17.14 = Charges for maintenance therapy are not
              covered.
      17.15 = This service cannot be paid unless
              certified by your physician every (___)
              days.
      17.16 = The hospital should file a claim for
              Medicare benefits because these services
              were performed in a hospital setting.
      17.17 = Medicare already paid for an initial
              visit for this service with this
              physician, another physician in his group
              practice, or a provider. Your doctor or
              provider must use a different code to
              bill for subsequent visits.
      17.18 = ($) has been applied during this calendar
              year (CCYY) towards the ($) limit on
              outpatient physical therapy and speech-
              language pathology benefits.
      17.19 = ($) has been applied during this calendar
              year (CCYY) towards the ($) limit on
              outpatient occupational therapy benefits.
      17.2  = This anesthesia service must be billed by
              a doctor.
      17.21 = The items or service was denied because
              Medicare can't pay for services ordered
              by or referred by this provider at this
              time" for this message number.
      17.25 = Medicare does not pay for services of a
              nurse practitioner/clinical nurse
              specialist for this place and/or date of
              service.
      17.3  = This service was denied because you did
              not receive it under the direct
              supervision of a doctor.
      17.33 = Medicare does not pay for services by a
              noncertified nonphysician practitioner.
      17.4  = Services performed by an audiologist are
              not covered except for diagnostic
              procedures.
      17.5  = Your provider's employer must file this
              claim and agree to accept assignment.
      17.6  = Full payment was not made for this
              service(s) because the yearly limit has
              been met.
      17.7  = This service must be performed by a
              licensed clinical social worker.
      17.8  = Payment was denied because the maximum
              benefit allowance has been reached.
      17.9  = Medicare (Part A/Part B) pays for this
              service. The provider must bill the
              correct Medicare contractor.

      Section 18 Preventive Care	
      18.1  = Routine examinations and related services
              aren't covered.
      18.10 = Expired
      18.11 = Expired
      18.12 = Screening mammograms are covered annually
              for women 40 years of age and older.
      18.13 = This service isn't covered for people
              under 50 years old.
      18.14 = Service is being denied because it has
              not been (12/24/48) months since your
              last (test/procedure) of this kind.
      18.15 = Medicare only covers this procedure for
              people considered to be at high risk for
              colorectal cancer.
      18.16 = This service is being denied because
              payment has already been made for a
              similar procedure within a set time frame
      18.17 = Medicare pays for a screening Pap test
              and a screening pelvic examination once
              every 2 years unless high risk factors
              are present.
      18.18 = Medicare does not pay for this service
              separately since payment of it is
              included in our allowance for other
              services you received on the same day.
      18.19 = This service isn't covered until after
              your 50th birthday.
      18.2  = This immunization and/or preventive care
              is not covered.
      18.20 = Expired
      18.21 =	
      18.22 = This service was denied because Medicare
              only allows the Welcome to Medicare
              preventive visit within the first 12
              months you have Part B coverage.
      18.23 = You pay 25% of the Medicare-approved
              amount for this service.
      18.24 = This service was denied. Medicare doesn't
              cover an Annual Wellness Visit within the
              first 12 months of your Medicare Part B
              coverage. Medicare does cover a one-time
              Welcome to Medicare preventive visit with
              in the first 12 months.
      18.25 = Your Annual Wellness Visit has been
              approved. You will qualify for another
              Annual Wellness Visit 12 months after the
              date of this visit.
      18.26 = This service was denied because it
              occurred too soon after your last covered
              Annual Wellness Visit. Medicare only
              covers one Annual Wellness Visit within
              a 12 month period.
      18.27 = This service was denied because it
              occurred too soon after your Initial
              Preventive Physical Exam.
      18.3  = Screening mammography is not covered for
              women under 35 years of age.
      18.4  = This service is being denied because it
              has not been (__) months since your last
              examination of this kind.
      18.5  = Medicare will pay for another screening
              mammogram in 12 months.
      18.6  = A screening mammography is covered only
              once for women age 35 - 39.
      18.7  = Screening pap tests are covered only once
              every 24 months unless high risk factors
              are present.
      18.8  = Deleted during EOMB-MSN transition.
      18.9  = Deleted during EOMB-MSN transition.
      18.94 = Medicare pays for screening Pap smear
              and/or screening pelvic examination
              (including a clinical breast examination)
              only once every 2 years unless high risk
              factors are present.

      Section 19 Hospital Based Physician Services
      19.1  = Services of a hospital-based specialist
              are not covered unless there is an
              agreement between the hospital and the
              specialist.
      19.2  = Payment was reduced because this service
              was performed in a hospital outpatient
              setting rather than a provider's office.
      19.3  = Only one hospital visit or consultation
              per provider is allowed per day.

      Section 2 Blood
      2.1  = The first three pints of blood used in
              each year are not covered.
      2.2  = Charges for replaced blood are not covered

      Section 20 Benefit Limits
      20.1  = You have used all of your benefit days
              for this period.
      20.10 = This service was denied because Medicare
              only pays up to 10 hours of diabetes
              education training during the initial
              12-month period. Our records show you
              have already obtained 10 hours of
              training.
      20.11 = This service was denied because Medicare
              pays for two hours of follow-up diabetes
              education training during a calendar year
              . Our records show you have already
              obtained two hours of training for this
              calendar year.
      20.12 = This service was denied because Medicare
              only covers this service once a lifetime.
      20.13 = This service was denied because Medicare
              only pays up to three hours of medical
              nutrition therapy during a calendar year.
              Our records show you have already
              received three hours of medical nutrition
              therapy.
      20.14 = This service was denied because Medicare
              only pays two hours of follow-up for
              medical nutrition therapy during a
              calendar year. Our records show you have
              already received two hours of follow-up
              services for this calendar year.
      20.2  = You have reached your limit of 190 days
              of psychiatric hospital services.
      20.3  = You have reached your limit of 60
              lifetime reserve days.
      20.4  = (__) of the Benefit Days Used were
              charged to your Lifetime Reserve Day
              benefit.
      20.5  = These services cannot be paid because
              your benefits are exhausted at this time.
      20.6  = Days used has been reduced by the primary
              group insurer's payment.
      20.7  = You have (___) day(s) remaining of your
              190-day psychiatric limit.
      20.8  = Days are being subtracted from your total
              inpatient hospital benefits for this
              benefit period.
      20.9  = Services after (mm/dd/yy) cannot be paid
              because your benefits were exhausted.
      20.91 = This service was denied. Medicare covers
              a one-time initial preventative physical
              exam (Welcome to Medicare physical exam)
              if you get it within the first 12 months
              of the effective date of your Medicare
              Part B coverage.

      Section 21 Restrictions to Coverage
      21.1  = Services performed by an immediate
              relative or a member of the same
              household are not covered.
      21.10 = A surgical assistant is not covered for
              this place and/or date of service.
      21.11 = This service was not covered by Medicare
              at the time you received it.
      21.12 = This hospital service was not covered
              because the attending physician was not
              eligible to receive Medicare benefits at
              the time the service was performed.
      21.13 = This surgery was not covered because the
              attending physician was not eligible to
              receive Medicare benefits at the time the
              service was performed.
      21.14 = Medicare cannot pay for this
              investigational device because the FDA
              clinical trial period has not begun.
      21.15 = Medicare cannot pay for this
              investigational device because the FDA
              clinical trial period has ended.
      21.16 = Medicare does not pay for this
              investigational device.
      21.17 = Your provider submitted noncovered
              charges. You are responsible for paying
              these charges.
      21.18 = This item or service is not covered when
              performed or ordered by this provider.
      21.19 = This provider decided to dropout of
              Medicare. No payment can be made for
              this service. You are responsible for
              this charge. Under Federal law, your
              doctor cannot charge you more than the
              limiting charge amount.
      21.2  = The provider of this service is not
              eligible to receive Medicare payments.
      21.20 = This provider decided to dropout of
              Medicare. No payment can be made for
              this service. You are responsible for
              this charge.
      21.21 = This service was denied because Medicare
              only covers this service under certain
              circumstances.
      21.22 = Medicare does not pay for this service
              because it is considered investigational
              and/or experimental in these
              circumstances.
      21.23 = Your claim is being denied because the
              physician noted on the claim has been
              deceased for more than 15 months.
      21.24 = This service is not covered for patients
              over age 60.
      21.25 = This service was denied because Medicare
              only covers this service in certain
              settings.
      21.26 = Claim denied because services were
              provided by an Opt-Out physician or
              practitioner. No Medicare payment may be
              made.
      21.27 = Services provided by a Medicare
              sanctioned/excluded provider. No
              Medicare payment may be made.
      21.3  = This provider was not covered by
              Medicare when you received this service.
      21.30 = The provider decided to drop out of
              Medicare. No payment can be made for this
              service. You are responsible for this
              charge.
      21.31 = This service was not covered by Medicare
              at the time you recieved it.
      21.32 = This service was denied because Medicare
              only covers this service under certain
              circumstances.
      21.4  = Services provided outside the United
              States are not covered. See your
              Medicare Handbook for services received
              in Canada and Mexico.
      21.5  = Services needed as a result of war are
              not covered.
      21.6  = This item or service is not covered when
              performed, referred or ordered by this
              provider.
      21.7  = This service should be included on your
              inpatient bill.
      21.8  = Services performed using equipment that
              has not been approved by the Food and
              Drug Administration are not covered.
      21.9  = Payment cannot be made for unauthorized
              service outside the managed care plan.

      Section 22 Split Claims
      22.1  = Your claim was separated for processing.
              The remaining services may appear on a
              separate notice.

      Section 23 Surgery
      23.1  = The cost of care before and after the
              surgery or procedure is included in the
              approved amount for that service.
      23.10 = Payment has been reduced because this
              procedure was terminated before
              anesthesia was started.
      23.11 = Payment cannot be made because the
              surgery was canceled or postponed.
      23.12 = Payment has been reduced because the
              surgery was canceled after you were
              prepared for surgery.
      23.13 = Because you were prepared for surgery and
              anesthesia was started, full payment is
              being made even though the surgery was
              canceled.
      23.14 = The assistant surgeon must file a
              separate claim for this service.
      23.15 = The approved amount is less because the
              payment is divided between two doctors.
      23.16 = An additional amount is not allowed for
              this service when it is performed on both
              the left and right sides of the body.
      23.17 = Medicare won't cover these services
              because they are not considered medically
              necessary.
      23.2  = Cosmetic surgery and related services are
              not covered.
      23.3  = Medicare does not pay for surgical
              supports except primary dressings for
              skin grafts.
      23.4  = A separate charge is not allowed because
              this service is part of the major
              surgical procedure.
      23.5  = Payment has been reduced because a
              different doctor took care of you before
              and/or after the surgery.
      23.6  = This surgery was reduced because it was
              performed with another surgery on the
              same day.
      23.7  = Payment cannot be made for an assistant
              surgeon in a teaching hospital unless a
              resident doctor was not available.
      23.8  = This service is not payable because it is
              part of the total maternity care charge.
      23.9  = Payment has been reduced because the
              charges billed did not include post-
              operative care.

      Section 24 'Help Stop Fraud' messages
      24.1  = Protect your Medicare number as you would
              a credit card number.
      24.10 = Always read the front and back of your
              Medicare Summary Notice.
      24.11 = Beware of Medicare scams, such as offers
              of free milk or cheese for your Medicare
              number.
      24.12 = Read your Medicare Summary Notice
              carefully for accuracy of dates, services
              , and amounts billed to Medicare.
      24.13 = Be sure you understand anything you are
              asked to sign.
      24.14 = Be sure any equipment or services you
              received were ordered by your doctor.
      24.15 = Review your Medicare Summary Notice and
              report items and services that you did
              not receive to Medicare's Fraud Hotline
              at 1-866-417-2078.
              FLORIDA - SPECIFIC MESSAGE
      24.16 = Report items and services that you did
              not receive to Medicare's Fraud Hotline
              at 1-866-417-2078.
              FLORIDA - SPECIFIC MESSAGE
      24.19 = You may see some claims that have been
              adjusted. For an explanation see the
              General Information section
              See Expiration Date and Message Notes
              ------->
      24.2  = Beware of telemarketers or advertisements
              offering free or discounted Medicare
              items and services.
      24.22 = You can make a difference!  Last year,
              tax-payers saved $4 billion-the largest
              sum ever recovered in a single year-
              thanks in large part to people who came
              forward and reported suspicious activity.
              See "Message Implementation Date" and
              "Message Notes" columns. ---->
      24.3  = Beware of door-to-door solicitors
              offering free or discounted Medicare
              items or services.
      24.4  = Only your physician can order medical
              equipment for you.
      24.5  = Always review your Medicare Summary
              Notice for correct information about the
              items or services you received.
      24.6  = Do not sell your Medicare number or
              Medicare Summary Notice.
      24.7  = Do not accept free medical equipment you
              don't need.
      24.8  = Beware of advertisements that read,
              "This item is approved by Medicare", or
              "No out-of-pocket expenses."
      24.9  = Be informed - Read your Medicare Summary
              Notice.
              See "Message Expiration Date" and
              "Message Notes" columns ----->

      Section 25 Time Limit for filing
      25.1  = This claim was denied because it was
              filed after the time limit.
      25.2  = You can be billed only 20% of the charges
              that would have been approved.
      25.3  = The time limit for filing your claim has
              expired, therefore appeal rights are not
              applicable for this claim.

      Section 26 Vision	
      26.1  = Eye refractions are not covered.
      26.2  = Eyeglasses or contact lenses are only
              covered after cataract surgery or if the
              natural lens of your eye is missing.
      26.3  = Only one pair of eyeglasses or contact
              lenses is covered after cataract surgery
              with lens implant.
      26.4  = This service is not covered when
              performed by this provider.
      26.5  = This service is covered only in
              conjunction with cataract surgery.
      26.6  = Payment was reduced because the service
              was terminated early.

      Section 27 Hospice
      27.1  = This service is not covered because you
              are enrolled in a hospice.
      27.10 = The documentation indicates that the
              service level of continuous home care
              wasn't reasonable and necessary.
              Therefore, payment will be adjusted to
              the routine home care rate.
      27.11 = The provider has billed in error for the
              routine home care items or services
              received.
      27.12 = The documentation indicates that your
              respite level of care exceeded five
              consecutive days. Therefore, payment
              for every day beyond the 5th day will be
              paid at the routine home care rate.
      27.13 = According to Medicare hospice
              requirements, this service is not covered
              because the service was provided by a
              non-attending physician.
      27.2  = Medicare will not pay for inpatient
              respite care when it exceeds five
              consecutive days at a time.
      27.3  = The physician certification requesting
              hospice services was not received timely.
      27.4  = The documentation received indicates that
              the general inpatient care level of
              services were not necessary for care
              related to the terminal illness.
              Therefore, payment will be adjusted to
              the routine home care rate.
      27.5  = Payment for the day of discharge from the
              hospital will be made to the hospice
              agency at the routine home care rate.
      27.6  = The documentation indicates the level of
              care was at the respite level not the
              general inpatient level of care.
              Therefore, payment will be adjusted to
              the routine home care rate.
      27.7  = According to Medicare hospice
              requirements, the hospice election
              consent was not signed timely.
      27.8  = The documentation submitted does not
              support that your illness is terminal.
      27.9  = The documentation indicates your
              inpatient level of care was not
              reasonable and necessary. Therefore,
              payment will be adjusted to the routine
              home care rate.
      27.99 = Medicare allows your doctor to charge for
              developing a plan of treatment for your
              home health or hospice services.

      Section 28 Mandatory	
      28.1  = Because you have Medicaid, your provider
              must agree to accept assignment.

      Section 29 MSP	
      29.1  = Secondary payment cannot be made because
              the primary insurer information was
              either missing or incomplete.
      29.10 = These services cannot be paid because you
              received them on or before you received
              a liability insurance payment for this
              injury or illness.
      29.11 = Our records show that an automobile
              medical, liability, or no-fault insurance
              plan is primary for these services.
              Submit this claim to the primary payer.
      29.12 = Our records show that these services may
              be covered under the Black Lung Program.
              Contact the U.S. Department of Labor,
              Federal Black Lung Program, P.O. Box 8302
              , London, KY 40742-8302
      29.13 = Medicare does not pay for these services
              because they are payable by another
              government agency. Submit this claim to
              that agency.
      29.14 = Medicare's secondary payment is ($______)
              . This is the difference between the
              primary insurer's approved amount of
              ($______) and the primary insurer's paid
              amount of ($______).
      29.15 = Medicare's secondary payment is ($______)
              . This is the difference between
              Medicare's approved amount of ($______)
              and the primary insurer's paid amount of
              ($______).
      29.16 = Your primary insurer approved and paid (
              $______) on this claim. Therefore, no
              secondary payment will be made by
              Medicare.
      29.17 = Your provider agreed to accept ($______)
              as payment in full on this (claim/service
              ). Your primary insurer has already paid
              ($______) so Medicare's payment is the
              difference between the two amounts.
      29.18 = The amount listed in the "You May Be
              Billed" column assumes that your primary
              insurer paid the provider. If your
              primary insurer paid you, then you are
              responsible to pay the provider the
              amount your primary insurer paid to you
              plus the amount in the "You May Be Billed
              " column.
              This message should be revised to read
              "If your primary insurer paid you for
              this claim, you are responsible to pay
              that amount to your provider plus the
              amount in the "Maximum You May Be Billed"
              column."
              See "Message Implementation Date" and
              "Message Notes" columns.
      29.19 = If your primary insurer paid your
              provider for this claim, you now only
              need to pay your provider the difference
              between the amount charged and the amount
              your primary insurer paid.
      29.2  = No payment was made because your primary
              insurer's payment satisfied the
              provider's bill.
      29.20 = If your primary insurer paid your
              provider for this claim, you only need to
              pay the difference between the amount
              your provider agreed to accept and the
              amount your primary insurer paid.
      29.21 = If your primary insurer made payment on
              this claim, you may be billed the
              difference between the amount charged and
              your primary insurer's payment.
      29.22 = If your primary insurer paid the provider
              , you need to pay the provider the
              difference between the limiting charge
              amount and the amount the primary
              insurer paid your provider.
      29.23 = No payment can be made because payment
              was already made by either worker's
              compensation or the Federal Black Lung
              Program.
      29.24 = No payment can be made because payment
              was already made by another government
              entity.
      29.25 = Medicare paid all covered services not
              paid by other insurer.
      29.26 = The primary payer is _________.
      29.27 = Your primary group's payment satisfied
              Medicare deductible and coinsurance.
      29.28 = Your responsibility on this claim has
              been reduced by the amount paid by your
              primary insurer.
      29.29 = Your provider is allowed to collect a
              total of ($______) on this claim. Your
              primary insurer paid ($_____) and
              Medicare paid ($______). You are
              responsible for the unpaid portion of
              ($______).
      29.3  = Medicare benefits are reduced because
              some of these expenses have been paid by
              your primary insurer.
      29.30 = ($______) of the money approved by your
              primary insurer has been credited to your
              Medicare Part B (A) deductible. You do
              not have to pay this amount.
      29.31 = Resubmit this claim with the missing or
              correct information.
      29.32 = Medicare's secondary payment is ($______)
              . This is the difference between
              Medicare's limiting charge amount of
              ($______) and the primary insurer's paid
              amount of ($______).
      29.33 = Your claim has been denied by Medicare
              because you may have funds set aside from
              your settlement to pay for your future
              medical expenses and prescription drug
              treatment related to your injury(ies).
      29.34 = The claim for this item/service was
              submitted by your complementary insurer
              on your behalf.
      29.35 = Per statute, Medicare only accepts claims
              from your complementary insurer when
              Medicare is the primary payer.
      29.71 = Medicare benefits are being paid on the
              condition that if you receive payment
              from liability insurance, an automobile
              medical insurance policy or plan, or any
              other no-fault insurance, you must repay
              Medicare.
      29.4  = In the future, if you send claims to
              Medicare for secondary payment, please
              send them to (carrier MSP address).
      29.5  = Our records show that Medicare is your
              secondary payer. This claim must be sent
              to your primary insurer first.
      29.6  = Our records show that Medicare is your
              secondary payer. Services provided
              outside your prepaid health plan are not
              covered. We will pay this time only
              since you were not previously notified.
      29.7  = Medicare cannot pay for this service
              because it was furnished by a provider
              who is not a member of your employer
              prepaid health plan. Our records show
              that you were informed of this rule.
      29.8  = This claim is denied because the
              service(s) may be covered by the worker's
              compensation plan. Ask your provider to
              submit a claim to that plan.
      29.9  = Since your primary insurance benefits
              have been exhausted, Medicare will be
              primary on this accident related service.

      Section 3 Chiropractic
      3.1   = This service is covered only when recent
              x-rays support the need for the service.
      3.7   = Medicare does not pay for this unless a
              sympton or sign of a problem is stated
              on the claim.
      3.18  = This represents an adjustment of a
              previously processed claim. If an
              underpayment was made, the attached
              check pays the total claim allowed minus
              the amount originally paid. If an
              overpayment requiring a refund was made
              and a refund has not already been
              submitted, you will be contacted by
              letter from the Medicare claims office.

      Section 30 Reasonable Charge and Fee Schedule
      30.1  = The approved amount is based on a special
              payment method.
      30.2  = The facility fee allowance is greater
              than the billed amount.
      30.3  = Your doctor did not accept assignment for
              this service. Under Federal law, your
              doctor cannot charge more than ($______)
              . If you have already paid more than
              this amount, you are entitled to a refund
              from the provider.
      30.4  = A change in payment methods has resulted
              in a reduced or zero payment for this
              procedure.
      30.41 = What Medicare pays for a service or item
              may be higher than the billed amount.
              This amount is correct. Medicare pays
              this provider less than the billed amount
              on other claims since payment rates are
              set in advance for certain services and
              averaged out over an entire year.
      30.5  = This amount is the difference in billed
              amount and Medicare approved amount.

      Section 31 Adjustments	
      31.1  = This is a adjustment to a previously
              processed claim and/or deductible record.
      31.10 = This is an adjustment to a previously
              processed charge (s). This notice may
              not reflect the charges as they were
              originally submitted.
      31.11 = The previous notice we sent stated that
              your doctor could not charge more than
              ($______). This additional payment
              allows your doctor to bill you the full
              amount charged.
      31.12 = The previous notice we sent stated the
              amount you could be charged for this
              service. This additional payment changed
              that amount. Your doctor cannot charge
              you more than ($______).
      31.13 = The Medicare paid amount has been reduced
              by ($______) previously paid for this
              claim.
      31.14 = This payment is the result of an
              Administrative Law Judge's decision.
      31.15 = An adjustment was made based on a
              redetermination.
      31.16 = An adjustment was made based on a
              reconsideration.
      31.17 = This is an internal adjustment.  No
              action is required on your part.
      31.18 = This adjustment has resulted in an
              overpayment to your provide/supplier.
              Your provider/supplier has been requested
              to repay $________ to Medicare. You do
              not have to pay this amount.
      31.19 = If you do not agree with the Medicare
              approved amount(s), you may ask for a
              reconsideration. You must request a
              reconsideration within 180 days of the
              date of receipt of this notice. You may
              present any new evidence which could
              affect your decision. Call us at the
              number in the Customer Service block if
              you need more information about the
              reconsideration process.
              This message should be revised to read,
              "If you disagree with the Medicare-
              approved amount, you may ask for a
              redetermination within 120 days of
              receipt of this notice. Call
              1-800-MEDICARE if you need information
              on the redetermination process." when
              your MAC implements the new MSN design.
              See "Message Implementation Date" and
              "Message Notes" colums. ----->
      31.2  = A payment adjustment was made based on a
              telephone review.
      31.3  = This notice is being sent to you as the
              result of a reopening request.
      31.4  = This notice is being sent to you as the
              result of a fair hearing request.
      31.5  = If you do not agree with the Medicare
              approved amount(s) and $100 or more is
              in dispute (less deductible and
              coinsurance), you may ask for a hearing.
              You must request a hearing within 6
              months of the date of this notice. To
              meet the limit you may combine amounts
              on other claims that have been reviewed.
              At the hearing, you may present any new
              evidence which could affect the decision.
              Call us at the number in the Customer
              Service block if you need more
              information about the hearing process.
      31.6  = A payment adjustment was made based on a
              Quality Improvement Organization request.
      31.7  = This claim was previously processed under
              an incorrect Medicare claim number or
              name. Our records have been corrected.
      31.8  = This claim was adjusted to reflect the
              correct provider.
      31.9  = This claim was adjusted because there
              was an error in billing.
      31.95 = Per our telephone call, no payment can be
              made on your review request. The approved
              amount is the total allowance we can make
              for this service.
      31.96 = Per our telephone call, no payment can be
              made on your review request. Medicare
              does not separately pay for these charges
              because the cost of related care before
              and after the surgery/procedure is part
              of the approved amount for the surgery/
              procedure.
      31.97 = Per our telephone call, no payment can be
              made on your review request. Medicare
              does not pay for this many services
              within this period of time.
      31.98 = Per our telephone call, no payment can be
              made on your review request. Medicare
              does not pay for routine foot care.
      31.99 = As a result of the Hearing Officer's
              decision, no additional payment can be
              made.

      Section  Overpayments/Offsets	
      32.1  = ($______) of this payment has been
              withheld to recover a previous
              overpayment.
      32.2  = You should not be billed separately by
              your physician(s) for services provided
              during this inpatient stay.
      32.3  = Medicare has paid $_______ for hospital
              and doctor services. You shouldn't be
              billed separately by your doctor(s) for
              services you got during this inpatient
              stay.

      Section 33 Ambulatory Surgical Centers	
      33.1  = The ambulatory surgical center must bill
              for this service.

      Section 34 Patient Paid/Split Payments	
      34.1  = Of the total ($______) paid on this claim
              , we are paying you ($______) because
              you paid your provider more than your
              20% coinsurance on Medicare approved
              services. The remaining ($______) was
              paid to the provider.
      34.2  = The amount in the "You May Be Billed"
              column has been reduced by the amount
              you paid the provider at the time the
              services were rendered.
              This message should be revised to read
              "Maximum You May Be Billed" (in place of
              "You May Be Billed") when your MAC
              implements the new MSN design.
              See "Message Implementation Date" and
              "Message Notes" columns. ------>
      34.3  = After applying Medicare guidelines and
              the amount you paid to the provider at
              the time the services were rendered, our
              records indicate you are entitled to a
              refund. Please contact your provider.
      34.4  = We are paying you ($______) because the
              amount you paid the provider was more
              than you may be billed for Medicare
              approved charges.
      34.5  = The amount owed you is ($______).
              Medicare does not routinely issue checks
              for amounts under $1.00. This amount due
              will be included in your next check.
              If you want this money issued immediately
              , please contact us at the address or
              phone number in the Customer Service
              Information box.
              The last sentence of this message should
              be revised to read, "If you want this
              money issued immediately, please call
              1-800-MEDICARE (1-800-633-4227)." when
              your MAC implements the new MSN design.
               See "Message Implementation Date" and
               Message Notes" columns.
      34.6  = Your check includes ($_____) which was
              withheld on a prior claim.
      34.7  = This check includes an amount less than
              $1.00 that was withheld on a prior claim.
      34.8  = The amount you paid the provider for this
              claim was more than the required payment.
              You should be receiving a refund of
              ($_____) from your provider, which is
              the difference between what you paid and
              what you should have paid.
      34.9  = If you already paid the supplier/provider
              , the supplier/provider must refund any
              amount that exceeds the Medicare approved
              amount.

      Section 35 Supplemental Coverage/Medigap
      35.1  = This information is being sent to your
              private insurer(s). Send any questions
              regarding your benefits to them.
      35.2  = We have sent your claim to your Medigap
              insurer. Send any questions regarding
              your benefits to them.
      35.3  = A copy of this notice will not be
              forwarded to your Medigap insurer because
              the Medigap information submitted on the
              claim was incomplete or invalid. Please
              submit a copy of this notice to your
              Medigap insurer.
      35.4  = A copy of this notice will not be
              forwarded to your Medigap insurer because
              your provider does not participate in the
              Medicare program. Please submit a copy
              of this notice to your Medigap insurer.
      35.5  = We did not send this claim to your
              private insurer. They have indicated no
              additional payment can be made. Send any
              questions regarding your benefits to them
      35.6  = Your supplemental policy is not a Medigap
              policy under Federal and State law or
              regulation. It is your responsibility to
              file a claim directly with your insurer.
      35.7  = Please do not submit this notice to them
              (add-on to other messages as appropriate).

      Section 36 Limitation of Liability
      36.1  = Our records show that you were informed
              in writing, before receiving the service
              that Medicare would not pay. You are
              liable for this charge. If you do not
              agree with this statement, you may ask
              for a review.
      36.2  = You didn't know this service isn't
              covered so you don't have to pay. If you
              paid and do not receive a refund from
              your provider, you have 6 months to send
              a copy of this notice, your provider's
              bill, and proof that you paid to the
              address on the last page of this notice.
              Future services of this type won't be
              paid.
      36.3  = Your provider was told that you're owed
              a refund for this service. If you don't
              get a refund within 30 days of getting
              this notice, send a copy of this notice
              to the address on the last page. Refunds
              may be delayed if your provider appeals
              this decision.
      36.4  = You are getting a refund because your
              provider didn't tell you in writing that
              Medicare wouldn't pay for this service.
              In the future, you will have to pay for
              the service.
      36.5  = You are getting a refund because your
              provider didn't tell you in writing that
              Medicare would approve a reduced level/
              amount of services. In the future, you
              will have to pay for the service.
      36.6  = Medicare is paying this claim, this time
              only, because it appears that neither you
              nor the provider knew that the service(s)
              would be denied. You will have to pay for
              future services of this type.
      36.7  = This code is for informational/reporting
              purposes only. You should not be charged
              for this code. If there is a charge, you
              do not have to pay the amount.

      Section 37 Deductible/Coinsurance
      37.1  = This approved amount has been applied
              toward your deductible.
      37.10 = You have now met ($______) of your
              ($______) Part A deductible for this
              benefit period.
      37.11 = You have met the Part B deductible for
              (year).
      37.12 = You have met the Part A deductible for
              this benefit period.
      37.13 = You have met the blood deductible for
              (year).
      37.14 = You have met ($______) pint(s) of your
              blood deductible for (year).
      37.15 = After your deductible and coinsurance
              were applied, the amount Medicare paid
              was reduced due to Federal, State and
              local rules.
      37.16 = You have now met $_______ of your
              $_______ Part B deductible for calendar
              year ____.
      37.17 = The "Maximum You May Be Billed" column
              includes $_______ for your Part B
              deductible, $_______ for your Part B
              coinsurance, $_______ for your Part A
              deductible, and $_______ for your Part A
              coinsurance and/or lifetime reserve
              coinsurance.
              *If your MAC will implement the new MSN
              design AFTER 07/01/13, use the following
              language for this message from 07/01/13
              until your MAC DOES implement the new MSN
              design: The "You May Be Billed" column
              includes $_______ for your Part B
              deductible, $_______ for your Part B
              coinsurance, $_______ for your Part A
              deductible, and $_______ for your Part A
              coinsurance and/or lifetime reserve
              coinsurance.
      37.2  = ($______) of this approved amount has
              been applied toward your deductible.
      37.3  = ($______) was applied to your inpatient
              deductible.
      37.4  = ($______) was applied to your inpatient
              coinsurance.
      37.5  = ($______) was applied to your skilled
              nursing facility coinsurance.
      37.6  = ($______) was applied to your blood
              deductible.
      37.7  = Part B cash deductible does not apply to
              these services.
      37.8  = This coinsurance amount reflects the
              amount that you are required to pay for
              outpatient mental health treatment
              services under the Medicare program.
      37.9  = You have now met ($______) of your
              ($______) Part B deductible for (year).

      Section 38 General Information	
      38.1  = Discontinued 2002
      38.10 = Compare the services you receive with
              those that appear on your Medicare
              Summary Notice. If you have questions,
              call your doctor or provider. If you feel
              further investigation is needed due to
              possible fraud or abuse, call the phone
              number in the Customer Service
              Information Box.
              The last sentence of this message should
              be revised to read, "If you feel further
              investigation is needed due to possible
              fraud or abuse, call 1-800-MEDICARE
              (1-800-633-4227)." when your MAC
              implements the new MSN design.
              See "Message Implementation Date" and
              Message Notes" columns. ----->
      38.11 = Preventive Messages:

              January - Cervical Health

              January is cervical health month. The
              Pap test is the most effective way to
              screen for cervical cancer. Medicare
              helps pay for screening Pap tests every
              two years. For more information on Pap
              tests, call your Medicare carrier.

              January - National Glaucoma Awareness
              Month (Optional)
              Glaucoma may cause blindness. Medicare
              helps pay for a yearly dilated eye exam
              for people at high risk for Glaucoma.
              African-Americans over 50 and people with
              diabetes or a family history of glaucoma
              are at higher risk. Talk to your doctor
              to learn if this exam is right for you.

              February - General Preventive Services
              Medicare helps pay for many preventive
              services including flu and pneumococcal
              shots, tests for cancer, diabetes
              monitoring supplies and others. Call
              1-800-MEDICARE (1-800-633-4227) for more
              information.

              March - National Colorectal Cancer
              Awareness Month
              Colorectal cancer is the second leading
              cancer killer in the United States.
              Medicare helps pay for colorectal cancer
              screening tests. Talk to your doctor
              about screening options that are right
              for you.

              April - General Preventive Services
              Medicare helps pay for many preventive
              services including flu and pneumococcal
              shots, tests for cancer, diabetes
              monitoring supplies and others. Call
              1-800-MEDICARE (1-800-633-4227) for more
              information.

              May - National Osteoporosis Month
              Do you know how strong your bones are?
              Medicare helps pay for bone mass
              measurement tests to measure the strength
              of bones for people at risk of
              osteoporosis. Talk to your doctor to
              learn if this test is right for you.

              May - Breast Cancer Awareness (to
              coordinate with Mother's Day) - Optional
              Early detection is the best protection
              from breast cancer. Get a mammogram.
              Not just once, but for a lifetime.
              Medicare helps pay for screening
              mammograms.

              June - General Preventive Services
              Message:
              Medicare helps pay for many preventive
              services including flu and pneumococcal
              shots, tests for cancer, diabetes
              monitoring supplies and others. Call
              1-800-MEDICARE (1-800-633-4227) for more
              information.

              July- Glaucoma Awareness
              Glaucoma may cause blindness. Medicare
              helps pay for a yearly dilated eye exam
              for people at high risk for Glaucoma.
              African-American people over 50, and
              people with diabetes or a family history
              of glaucoma are at higher risk. Talk to
              your doctor to learn if this exam is
              right for you.

              August - National Immunization Awareness
              Month (Contractors may elect to print
              this message during a different month of
              their choosing, but the message about
              the pneumococcal shot must be printed one
              month of each year.)
              Get a pneumococcal shot. You may only
              need it once in a lifetime. Contact your
              health care provider about getting this
              shot. You pay nothing if your health
              care provider accepts Medicare assignment
              	
              September - Cold and Flu Campaign
              During this flu season, get your flu shot
              . Contact your health care provider for
              the flu shot. Get the flu shot, not the
              flu. You pay nothing if your health care
              provider accepts Medicare assignment.

              September - Prostate Cancer Awareness
              Month - Optional
              Prostate cancer is the second leading
              cause of cancer deaths in men. Medicare
              covers prostate screening tests once
              every 12 months for men with Medicare who
              are over age 50.

              October - Breast Cancer Awareness Month
              Early detection is your best protection.
              Schedule your mammogram today, and
              remember that Medicare helps pay for
              screening mammograms.

              October - Continuation of Cold/Flu
              Campaign (optional)
              If you have not received your flu shot,
              it is not too late. Please contact your
              health care provider about getting the
              flu shot.

              November - American Diabetes Month
              Medicare covers expanded benefits to help
              control diabetes

      Section 38 General Information
      38.12 = If you appeal this drug claim
              determination, send it to the Medicare
              contractor who processed your doctor's
              claim for giving you the drug.
      38.13 = If you aren't due a payment check from
              Medicare, your Medicare Summary Notices
              (MSN) will now be mailed to you on a
              quarterly basis. You will no longer get
              a monthly statement in the mail for these
              types of MSNs. You will now get a
              statement every 90 days summarizing all
              of your Medicare claims. Your provider
              may send you a bill that you may need to
              pay before you get your MSN. When you
              get your MSN, look to see if you paid
              more than the MSN says is due. If you
              paid more, call your provider about a
              refund. If you have any questions about
              the bill from your provider, you should
              call your provider.
      38.14 = Have limited income?  Social Security
              can help with prescription drug costs.
              For more information on Extra Help with
              prescription drug costs and how to apply,
              visit www.socialsecurity.gov on the web
              or call 1-800-772-1213. TTY users should
              call 1-800-325-0778.
      38.15 = If the coinsurance amount you paid is
              more than the amount shown on your notice
              , you are entitled to a refund. Please
              contact your provider.
      38.18 = ALERT:  Coverage by Medicare will be
              limited for outpatient physical therapy
              (PT), speech-language pathology (SLP),
              and occupational therapy (OT) services
              for services received on January 1, 2006
              through December 31, 2007. The limits are
              $1,740 in 2006 and $1780 in 2007 for PT
              and SLP combined and $1,740 in 2006 and
              $1780 in 2007 for OT. Medicare pays up
              to 80 percent of the limits after the
              deductible has been met. These limits
              don't apply to certain therapy approved
              by Medicare or to therapy you get at
              hospital outpatient departments, unless
              you are a resident of and occupy a
              Medicare-certified bed in a skilled
              nursing facility. If you have questions,
              please call 1-800-MEDICARE.
              You have the right to request an itemized
              statement which details each Medicare
              item or service which you have received
              from your physician, hospital, or any
              other health supplier or health
              professional. Please contact them
              directly, in writing, if you would like
              an itemized statement.
              Beneficiaries needing or receiving home
              health care may qualify for the new Home
              Health Independence Demonstration and
              have the freedom to leave home more often
              while remaining eligible for Medicare
              home health services. To qualify, you
              must meet several criteria, have a
              permanent disabling condition, and live
              in Colorado, Massachusetts, or Missouri.
              For more information, ask your home
              health agency about the "Home Health
              Independence Demonstration"; call 1(800)
              MEDICARE (1-800-633-4227); or visit our
              website at: www.cms.hhs.gov/researchers/
              demos/homehealthindependence.asp
      38.18 = ALERT:  Coverage by Medicare will be
              limited for outpatient physical therapy
              (PT), speech-language pathology (SLP),
              and occupational therapy (OT) services
              for services received on January 1, 2006
              through December 31, 2007. The limits are
              $1,740 in 2006 and $1780 in 2007 for PT
              and SLP combined and $1,740 in 2006 and
              $1780 in 2007 for OT. Medicare pays up
              to 80 percent of the limits after the
              deductible has been met. These limits
              don't apply to certain therapy approved
              by Medicare or to therapy you get at
              hospital outpatient departments, unless
              you are a resident of and occupy a
              Medicare-certified bed in a skilled
              nursing facility. If you have questions,
              please call 1-800-MEDICARE.
      38.19 = Medicare Open Enrollment is from October
              15 to December 7. This is when you can
              compare and change your health and drug
              plan coverage. If you're happy with your
              current plan, you don't have to do
              anything. Call 1-800-MEDICARE (1 800-633-
              4227) for more information.
      38.2  = Discontinued
      38.20 = You have the right to request an itemized
              statement which details each Medicare
              item or service you have received from a
              physician, hospital, or any other
              healthcare provider or supplier. Contact
              your provider to get an itemized
              statement.
      38.22 = Planning to retire? Does your current
              insurance pay before Medicare pays? Call
              Medicare within the 6 months before you
              retire to update your records. Make sure
              your health care bills get paid correctly
      38.23 = Save tax dollars by getting your
              "Medicare & You" handbook electronically.
              Visit www.mymedicare.gov to sign up.
      38.24 = Please have your complete Medicare number
              with you when you call so your record
              can be located. To protect your privacy,
              this MSN doesn't include your entire
              number.
      38.25 = This item or service is being denied.
              Medicare won't pay for a Medical
              Nutrition Therapy service and Diabetes
              Self Management Training item or service
              performed on the same date for the same
              person with Medicare.
      38.26 = Your claims may have been adjusted since
              Medicare changed how it pays for certain
              services in 2010. You can compare claims
              that have been changed to previous
              statements you received in the past.
              Your provider may owe you a refund or
              you may have to pay more coinsurance.
              Call your provider or 1-800-MEDICARE.
      38.27 = Get a pneumococcal shot. You may only
              need it once in a lifetime. Contact your
              health care provider about getting this
              shot. You pay nothing if your health
              care provider accepts Medicare assignment
      38.28 = Early detection is your best protection.
              Schedule your mammogram today, and
              remember that Medicare helps pay for
              screening mammograms.
      38.3  = If you change your address, contact the
              Social Security Administration by calling
              1-800-772-1213.
      38.31 = To report a change of address, call
              Social Security at 1-800-772-1213. TTY
              users should call 1-800-325-0778.
      38.32 = Welcome to your new Medicare Summary
              Notice! It has clear language, larger
              print, and a personal summary of your
              claims and deductibles. This improved
              notice better explains how to get help
              with your questions, report fraud, or
              file an appeal. It also includes
              important information from Medicare!
      38.4  = You're at high risk for complications
              from the flu and it's very important
              that you get vaccinated. Please contact
              your healthcare provider about getting
              the flu vaccine.
      38.5  = If you haven't gotten your flu vaccine,
              it isn't too late. Please contact your
              health care provider about getting the
              vaccine.
      38.6  = January is cervical cancer prevention
              month.
      38.7  = The Pap test is the most effective way
              to screen for cervical cancer.
      38.8  = Medicare helps pay for screening Pap
              tests once every two years.
      38.9  = Colorectal cancer is the second leading
              cancer killer in the United States.
              Medicare helps pay for screening tests
              that can find polyps before they become
              cancerous and find cancer early when
              treatment may work best. Medicare helps
              pay for screening tests. Talk to your
              doctor about the screening options that
              are right for you.

      Section 4 End-Stage Renal Disease (ESRD)
      4.1   = This charge is more than Medicare pays
              for maintenance treatment of renal
              disease.
      4.10  = No more than ($______) can be paid for
              these supplies each month.
      4.11  = The amount listed in the "You May Be
              Billed" column is based on the Medicare
              approved amount. You are not responsible
              for the difference between the amount
              charged and the approved amount.
              This message should be revised to read
              "Maximum You May Be Billed" (in place of
              "You May Be Billed") when your MAC
              implements the new MSN design.
      4.12  = This service has been denied/rejected
              since payment was made to your End Stage
              Renal Disease (ESRD) dialysis facility.
      4.18  = Medicare cannot pay more than $_____ each
              month for these supplies. The provider
              cannot bill you for the supplies over
              this limit.
      4.2   = This service is covered up to (insert
              appropriate number) months after
              transplant and release from the
              hospital.
      4.3   = Prescriptions for immunosuppressive drugs
              are limited to a 30-day supply.
      4.4   = Only one supplier per month may be paid
              for these supplies/services.
      4.5   = Medicare pays the professional part of
              this charge to the hospital.
      4.6   = Payment has been reduced by the number
              of days you were not in the usual place
              of treatment.
      4.7   = Payment for all equipment and supplies
              is made through your dialysis center.
              They will bill Medicare for these
              services.
      4.8   = This service cannot be paid because you
              did not choose an option for your
              dialysis equipment and supplies.
      4.9   = Payment was reduced or denied because the
              monthly maximum allowance for this home
              dialysis equipment and supplies has been
              reached.

      Section 41 Home Health Messages
      41.1  = Medicare will only pay for this service
              when it is provided in addition to other
              services.
      41.10 = Patients eligible to receive home health
              benefits from another government agency
              are not eligible to receive Medicare
              benefits for the same service.
      41.11 = The doctor's orders for home health
              services were incomplete.
      41.12 = According to the medical record, the
              provider has billed in error for these
              items/services.
      41.13 = The provider has billed for services/
              items not documented in your record.
      41.14 = This service/item was billed incorrectly.
      41.15 = The information provided indicates that
              you are able to perform personal care
              activities on your own.
      41.16 = To receive Medicare payment, you must
              have a signed doctor's order before you
              receive the services.
      41.2  = This service must be performed by a nurse
              who has the required psychiatric nurse
              credentials.
      41.3  = The medical information did not support
              the need for continued services.
      41.4  = Medicare considers this item to be
              inappropriate for home use.
      41.5  = Medicare does not pay for comfort or
              convenience items.
      41.6  = This item was not furnished under a plan
              of care established by your physician.
      41.7  = This item is not considered by Medicare
              to be a prosthetic and/or orthotic device
      41.8  = The information provided indicates that
              your illness or injury doesn't restrict
              your ability to leave your home, except
              with the assistance of another individual
              or the aid of a supportive device (such
              as crutches, a cane, a wheelchair, or a
              walker).
      41.9  = Services exceeded those ordered by your
              physician.

      Section 42 Religious Nonmedical Health Care
      Institutions
      42.1  = You received medical care at a facility
              other than a religious nonmedical health
              care institution but that care did not
              revoke your election to receive benefits
              for religious nonmedical health care.
      42.2  = Since you received medical care at a
              facility other than a religious
              nonmedical health care institution,
              benefits for religious nonmedical health
              care services have been revoked for these
              services unless you file a new election.
      42.3  = This service is not covered since you did
              not elect to receive religious
              nonmedical health care services instead
              of regular Medicare services.
      42.4  = This service is not covered because you
              received medical health care services
              which revoked your election to religious
              nonmedical health care services.
      42.5  = This service is not covered because you
              requested in writing that your election
              to religious nonmedical health care
              services be revoked.

      Section 5 Number/Name/Enrollment
      5.1   = Our records show that you do not have
              Medicare entitlement under the number
              shown on this notice. If you do not
              agree, please contact your local Social
              Security office.
      5.2   = The name or Medicare number was incorrect
              or missing. Please check your Medicare
              card. If the information on this notice
              is different from your card, contact your
              provider.
      5.3   = Our records show that the date of death
              was before the date of service.
      5.4   = If you cash the enclosed check, you are
              legally obligated to make payment for
              these services. If you do not wish to
              assume this obligation, please return
              this check.
      5.5   = Our records show you did not have Part A
              (B) coverage when you received this
              service. If you disagree, please contact
              us at the customer service number shown
              on this notice.
      5.6   = The name or Medicare number was incorrect
              or missing. Ask your provider to use the
              name or number shown on this notice for
              future claims.
      5.7   = Medicare payment may not be made for the
              item or service because on the date of
              service you were not lawfully present in
              the United States.

      Section 6 Drugs	
      6.1   = This drug is covered only when Medicare
              pays for the transplant.
      6.2   = Drugs not specifically classified as
              effective by the Food and Drug
              Administration are not covered.
      6.3   = Payment cannot be made for oral drugs
              that do not have the same active
              ingredients as they would have if given
              by injection.
      6.4   = Medicare does not pay for an oral
              anti-emetic drug that is not administered
              for use immediately before, at, or within
              48 hours after administration of a
              Medicare covered chemotherapy drug.
      6.5   = Medicare cannot pay for this injection
              because one or more requirements for
              coverage were not met.

      Section 43 Demonstration Project Messages
      60.1  = In partnership with physicians in your
              area, ____________ is participating in a
              Medicare demonstration project that uses
              a simplified payment method to combine
              all hospital and physician care related
              to your hospital service.
      2/18/13= Even though this service is being paid
              in accordance with the rules and
              guidelines under the Competitive Bidding
              Demonstration, future claims may be
              denied when this item is provided to this
              patient by a non-demonstration supplier.
              If you would like more information
              egarding this project, you may contact
              1-888-289-0710.
      60.11 = These services are covered by a
              demonstration project or payment model
              pilot. It will pay for all services
              related to this hospital stay. If you
              have already paid a provider for any of
              these services, you should receive a
              refund.
      60.12 = Your co-payment under this demonstration
              is the lesser of 20% of the Medicare
              allowed amount or 20% of the allowed
              amount under your drug discount card.
      60.13 = This claim is being processed under a
              demonstration project. Services cannot
              be covered because you do not reside in
              one of the demonstration areas.
      60.14 = This claim is being processed under a
              demonstration project. Services cannot
              be covered because your doctor does not
              have a practice in one of the
              demonstration areas.
      60.15 = Beginning April 1, 2005 through March 31,
              2007, Medicare will cover additional
              chiropractic services. For more
              information, talk to your chiropractor,
              call 1-800-MEDICARE, or go to
              http://www.cms.hhs.gov/researchers/demos
              /eccs/default.asp.
      60.16 = This claim is being processed under a
              demonstration or payment model pilot.
              All hospital and doctor services related
              to your hospital stay have been combined
              into a single payment. You may have to
              pay any unmet deductible and coinsurance
              amounts.
      60.2  = The total Medicare approved amount for
              your hospital service is ($______).
              ($______) is the Part A Medicare amount
              for hospital services and ($_______) is
              the Part B Medicare amount for physician
              services (of which Medicare pays 80
              percent). You are responsible for any
              deductible and coinsurance amounts
              represented.
      60.3  = Medicare has paid ($______) for hospital
              and physician services. Your Part A
              deductible is ($______). Your Part A
              coinsurance is ($______) Your Part B
              coinsurance is ($______).
      60.4  = This claim is being processed under a
              demonstration project.
      60.5  = This claim is being processed under a
              demonstration project. If you would like
              more information about this project,
              please contact 1-888-289-0710.
      60.6  = A claim has been submitted on your behalf
              indicating that you are participating in
              the Medicare Coordinated Care
              Demonstration project. However, our
              records indicate that you are not
              currently enrolled or your enrollment
              has not yet been approved for the
              demonstration.
      60.7  = A claim has been submitted on your behalf
              indicating that you are participating in
              the Medicare Coordinated Care
              Demonstration project. However, our
              records indicate that either you have
              terminated your election to participate
              in the demonstration project or the dates
              of service are outside the demonstration
              participation dates.
      60.8  = The approved amount is based on the
              maximum allowance for this item under the
              DMEPOS Competitive Bidding Demonstration.
      60.9  = Our records indicate that this patient
              began using this service(s) prior to the
              current round of the DMEPOS Competitive
              Bidding Demonstration. Therefore, the
              approved amount is based on the allowance
              in effect prior to this round of bidding
              for this item.

      Section 7 Duplicate Bills
      7.1   = This is a duplicate of a charge already
              submitted.
      7.15  = Medicare records show that payment for
              this service has already been made by
              another contractor.
      7.2   = This is a duplicate of a claim processed
              by another contractor. You should
              receive a Medicare Summary Notice from
              them.
      7.3   = This service/item is a duplicate of a
              previously processed service. You may
              only appeal the decision that this
              service/item is a duplicate. The appeals
              information on this notice only applies
              to the duplicate service issue.
      7.4   = The claim for the billing fee was denied
              because it was submitted past the allowed
              time frame.
      7.7   = Your physician has elected to participate
              in the Competitive Acquisition Program
              for these drugs. Claims for these drugs
              must be billed by the appropriate drug
              vendor instead of your physician.
      7.8   = Your physician has elected to participate
              in the Competitive Acquisition Program
              (CAP) for Medicare Part B drugs. Medicare
              cannot pay for the administration of the
              drug(s) being billed because these
              drug(s) are not available from the CAP
              vendor.

      Section 8 Durable Medical Equipment (DME)
      8.1   = Your supplier is responsible for the
              servicing and repair of your rented
              equipment.
      8.2   = To receive Medicare payment, you must
              have a doctor's prescription before you
              rent or purchase this equipment.
      8.10  = Payment is included in the approved
              amount for other equipment.
      8.11  = The purchase allowance has been reached.
              If you continue to rent this piece of
              equipment, the rental charges are your
              responsibility.
      8.12  = The approved charge is based on the
              amount of oxygen prescribed by the doctor
      8.13  = Monthly rental payments can be made for
              up to 15 months from the first paid
              rental month or until the equipment is
              no longer needed, whichever comes first.
      8.14  = Your equipment supplier must furnish and
              service this item for as long as you
              continue to need it. Medicare will pay
              for maintenance and/or servicing for
              every 6 month period after the end of
              the 15th paid rental month.
      8.15  = Maintenance and/or servicing of this item
              is not covered until 6 months after the
              end of the 15th paid rental month.
      8.16  = Monthly allowance includes payment for
              oxygen and supplies.
      8.17  = Payment for this item is included in the
              monthly rental payment amount.
      8.18  = Payment is denied because the supplier
              did not have a written order from your
              doctor prior to delivery of this item.
      8.19  = Sales tax is included in the approved
              amount for this item.
      8.2   = To receive Medicare payment, you must
              have a doctor's prescription before you
              rent or purchase this equipment.
      8.20  = Medicare does not pay for this equipment
              or item.
      8.21  = Medicare won't cover this item without a
              new, revised or renewed certificate of
              medical necessity.
      8.22  = No further payment can be made because
              the cost of repairs has added up to the
              purchase price of this item.
      8.23  = No payment can be made because the item
              has reached the 15-month limit.
              Separate payments can be made for
              maintenance or servicing every 6 months.
      8.24  = The claim doesn't show that you own the
              equipment requiring these parts or
              supplies.
      8.25  = Payment cannot be made until you tell
              your supplier whether you want to rent
              or buy this equipment.
      8.26  = Payment is reduced by 25% beginning the
              4th month of rental.
      8.27  = Payment is limited to 13 monthly rental
              payments because you have decided to
              purchase this equipment.
      8.28  = Maintenance, servicing, replacement, or
              repair of this item is not covered.
      8.29  = Payment is allowed only for the seat lift
              mechanism, not the entire chair.
      8.3   = This equipment is not covered because its
              primary use is not for medical purposes.
      8.30  = This item is not covered because the
              doctor did not complete the certificate
              of medical necessity.
      8.31  = Payment is denied because blood gas tests
              cannot be performed by a durable medical
              equipment supplier.
      8.32  = This item can only be rented for 2 months
              . If the item is still needed, it must
              be purchased.
      8.33  = This is the next to last payment for this
              item.
      8.34  = This is the last payment for this item.
      8.35  = This item is not covered when oxygen is
              not being used.
      8.36  = Payment is denied because the certificate
              of medical necessity on file was not in
              effect for this date of service.
      8.37  = An oxygen recertification form was sent
              to the physician.
      8.38  = This item must be rented for 2 months
              before purchasing it.
      8.39  = This is the 10th month of rental payment.
              Your supplier should offer you the choice
              of changing the rental to a purchase
              agreement.
      8.4   = Payment can't be made for equipment
              that's the same or similar to equipment
              already being used.
      8.40  = We have previously paid for the purchase
              of this item.
      8.41  = Payment for the amount of oxygen supplied
              has been reduced or denied because the
              monthly limit has been reached.
      8.42  = Standby equipment is not covered.
      8.43  = Payment has been denied because this
              equipment cannot deliver the liters per
              minute prescribed by your doctor.
      8.44  = Payment is based on a standard item
              because information did not support the
              need for a deluxe or more expensive item.
      8.45  = Payment for electric wheelchairs is
              allowed only if the purchase decision is
              made in the first or tenth month of
              rental.
      8.46  = Payment is included in the allowance for
              another item or service provided at the
              same time.
      8.47  = Supplies or accessories used with
              noncovered equipment are not covered.
      8.48  = Payment for this drug is denied because
              the need for the equipment has not been
              established.
      8.49  = This allowance has been reduced because
              part of this item was paid on another
              claim.
      8.5   = Rented equipment that is no longer needed
              or used is not covered.
      8.50  = Medicare can't pay for this drug/
              equipment because our records show that
              your supplier isn't licensed to dispense
              prescription drugs, and, therefore, can't
              assure the safety and effectiveness of
              the drug/equipment.
      8.51  = You are not liable for any additional
              charge as a result of receiving an
              upgraded item.
      8.52  = You signed an Advanced Beneficiary Notice
              (ABN). You are responsible for the
              difference between the upgrade amount and
              the Medicare payment.
      8.53  = This item or service was denied because
              the upgrade information was invalid.
      8.54  = If a supplier knew that Medicare wouldn't
              pay and you paid, you might get a refund
              unless you signed a notice in advance.
              Refunds may be delayed if the provider
              appeals. Call your supplier if you don't
              hear anything within 30 days.
      8.55  = Medicare will process your first claim
              but, from now on, you must use a
              Medicare-enrolled supplier and put the
              supplier ID number on your claim. For a
              list of Medicare-enrolled suppliers call
              1-800-MEDICARE or visit www.medicare.gov/
              supplier
      8.56  = Medicare can't process this claim because
              you were already notified that you must
              use a supplier who has a Medicare
              supplier identification number, and this
              supplier doesn't have one.
      8.57  = Your equipment supplier must furnish and
              service this item for as long as you
              continue to need it. Medicare will pay
              for maintenance and/or servicing for
              every 3-month period after the end of
              the 15th paid rental month.
      8.58  = No payment can be made because the item
              has reached the 15-month limit. Separate
              payments can be made for maintenance or
              servicing every 3 months.
      8.59  = Durable Medical Equipment Regional
              Carriers only pay for Epoetin Alfa and
              Darbepoetin Alfa for Method II End Stage
              Renal Disease home dialysis patients.
      8.6   = A partial payment has been made because
              the purchase allowance has been reached.
              No further rental payments can be made.
      8.60  = Payment is denied because there is no
              hospital stay/surgery on file for
              implantation of the Durable Medical
              Equipment (DME) or prosthetic device.
      8.61  = This supplier isn't located in your
              competitive bidding area, but is required
              to accept the same price as a supplier
              in your area. This supplier may not
              charge you more than 20% of the bid price
              , plus any unmet deductibles.
      8.62  = This supplier didn't win a contract for
              furnishing this item in the competitive
              bidding area where you received it. This
              supplier isn't allowed to charge you for
              this item unless you signed a written
              notice agreeing to pay before you got
              the item.
      8.63  = This supplier isn't located in your
              competitive bidding area, but is located
              in a different competitive bidding area.
              This supplier won a contract under
              national competitive bidding in their
              area. They must accept the bid price from
              your area as payment in full, and may not
              charge you more than 20% of the bid
              price for your area, plus any unmet
              deductibles.
      8.64  = Monthly payments can be made for 13
              months, or until the equipment is no
              longer needed, whichever comes first.
              After the 13th month, your supplier must
              transfer title of this equipment to you.
      8.65  = Medicare will pay for medically necessary
              maintenance and/or servicing as needed
              after the end of the 13th paid rental
              month.
      8.66  = Medicare has paid for 36 months of rental
              for your oxygen equipment. Your supplier
              must transfer title of this equipment to
              you. No further rental payments will be
              made. We will continue to pay for
              delivery of oxygen contents, as
              appropriate, and necessary maintenance of
              your equipment.
      8.67  = Medicare has already paid for 36 months
              of rental for your oxygen equipment. The
              supplier should have transferred the
              title for the equipment to you. The
              supplier may not collect any more money
              from you for this equipment, and must
              provide you with a refund of any money
              you have already paid.
      8.68  = Medicare will pay for you to rent oxygen
              for up to 36 months (or until you no
              longer need the equipment). After
              Medicare makes 36 payments, your supplier
              will transfer the title of the equipment
              to you, and you will own the equipment.
      8.69  = Medicare will pay to maintain and service
              your oxygen equipment. This will start
              six months after the supplier transfers
              the title of the equipment to you.
      8.7   = This equipment is covered only if rented.
      8.70  = The Medicare-approved amount is based on
              the bid price for this item under the
              DMEPOS competitive bidding program.
      8.71  = Our records show that you began using
              this item before the current round of
              competitive bidding and you decided to
              keep getting this item from your current
              supplier. The Medicare-approved amount
              is based on the bid price for this item.
      8.72  = This item must be provided by a contract
              supplier under the DMEPOS competitive
              bidding program. You should not be billed
              for this item or service. You do not have
              to pay this amount. There are no Medicare
              appeal rights related to this item.	
      8.73  = The claim for this service was processed
              according to rules of the DMEPOS
              competitive bidding program.
      8.74  = You signed an Advanced Beneficiary Notice
              (ABN) saying that you wanted to get this
              item from a non-winning supplier under
              the DMEPOS Competitive Bidding Program.
              Therefore, Medicare will not pay for this
              item. You must pay the supplier in full.
      8.75  = Our records show that you began using
              this item before competitive bidding
              started for this item in your area.
              Because you decided to keep getting this
              item from your current supplier, this
              item will be paid at the standard payment
              amount and not at the bid price.
      8.76  = This item or service is not covered
              because the claim shows that it was not
              given in a skilled nursing facility or a
              nursing facility. The claim for this item
              or service was processed according to the
              rules of the DMEPOS competitive bidding
              program.
      8.78  = Medicare has paid for 36 months for your
              oxygen equipment. Your supplier is
              required to provide the oxygen equipment
              and related supplies, at no charge, for
              the remainder of the equipment's 5 year
              lifetime.
      8.79  = Medicare has paid 36 months of rental for
              your oxygen equipment. The supplier may
              not collect any more money from you for
              this equipment, and must refund any money
              you have already paid.
      8.8   = This equipment is covered only if
              purchased.
      8.80  = Medicare will pay for rental of this
              equipment for 36 months (or until you no
              longer need the equipment). After 36
              months, Medicare will continue to pay for
              delivery of liquid or gaseous contents,
              as long as it is still medically
              necessary.
      8.81  = If the provider/supplier should have
              known that Medicare would not pay for the
              denied items or services and did not
              tell you in writing before providing them
              that Medicare probably would deny payment
              , you may be entitled to a refund of any
              amounts you paid. However, if the
              provider/supplier requests a review of
              this claim within 30 days, a refund is
              not required until we complete our review
              . If you paid for this service and do not
              hear anything about a refund within the
              next 30 days, contact your provider/
              supplier.
      8.9   = Payment has been reduced by the amount
              already paid for the rental of this
              equipment.
      8.90  = You live in a Competitive Bidding Area.
              This is a Competitive Bidding item.
              The Medicare approved amount is based on
              the bid price for this item under the
              DMEPOS competitive bidding program.
      8.91  = Our records show that you began using
              this item before the DMEPOS Competitive
              Bidding program began and you decided to
              keep renting this item from your current
              supplier. The Medicare-approved amount is
              based on the bid price for this item for
              the area where you live.
      8.92  = You live in a Competitive Bidding Area
              and this item must be provided by a
              Medicare-contract supplier under the
              DMEPOS competitive bidding program.
              Medicare won't pay for this item and you
              shouldn't be billed for this item or
              service. You don't have to pay this
              amount. Medicare appeal rights don't
              apply to this item.
      8.93  = Medicare only pays 36 monthly payments
              for your oxygen. After 36 months, the
              supplier is still responsible for
              providing you with that equipment for 5
              years. You shouldn't pay any more
              copayments.
      8.95  = Our records show that you began using
              this item before the DMEPOS Competitive
              Bidding program started for this item in
              your area. Because you decided to keep
              renting this item from your current
              supplier, this item will be paid at the
              standard payment amount and not at the
              bid price.
      8.96  = This item or service isn't covered
              because the claim shows that it wasn't
              provided in a skilled nursing facility or
              nursing facility. The claim for this item
              or service was processed according to the
              rules of the DMEPOS competitive bidding
              program.
      8.97  = Starting January 1, 2011, you may have to
              use certain Medicare-contracted suppliers
              to get certain medical equipment and
              supplies. Visit www.medicare.gov or call
              1-800-MEDICARE for details

      Section 9 Failure to Furnish Information
      9.1   = The information we requested was not
              received.
      9.2   = This item or service was denied because
              information required to make payment was
              missing.
      9.3   = Please ask your provider to submit a new,
              complete claim to us.
      9.4   = This item or service was denied because
              information required to make payment was
              incorrect.
      9.5   = Our records show your doctor did not
              order this supply or amount of supplies.
      9.6   = Please ask your provider to resubmit this
              claim with a breakdown of the charges or
              services.
      9.7   = We have asked your provider to resubmit
              the claim with the missing or correct
              information.
      9.8   = The hospital has been asked to submit
              additional information, you should not be
              billed at this time.
      9.9   = This service is not covered unless the
              supplier/provider files an electronic
              media claim (EMC).

      Section 96 Jurisdiction-Specific	
      96.10 = Go paperless, go green! If you live in
              CT or NY you can stop getting paper
              Medicare Summary Notices (MSNs) in the
              mail, and get Electronic MSNs (eMSNs)
              online instead. To sign up, go to
              www.mymedicare.gov or call 1-800-
              MEDICARE (1-800-633-4227).
              * See Message Notes ----------->

      Section 97 FISS Part A	
      97.xx = The entire range of 97.xx messages
              have been blocked off for FISS/Part A
              usage.

      Section 99 Florida-Specific	
      99.xx = The entire range of 99.xx messages have
              been blocked off for Florida usage.



 CLM_MASS_ADJSTMT_IND_CD_TB              Claim Mass Adjustment Indicator Code Table

      I = Mass Adjustment (Incarcerated Beneficiary)
      M = Mass Adjustment (MPFS)
      O = Mass Adjustment (Other)



 CLM_PAPER_PRVDR_TB                      Claim Paper Claim Provider Code Table

      DK = Ordering Provider
      DN = Referring Provider
      DQ = Supervising Provider



 CLM_PWK_TB                              Claim Paperwork Code Table


      P1 = one iteration is present
      P2 = two iterations are present
      P3 = three iterations are present
      P4 = four iterations are present
      P5 = five iterations are present
      P6 = six iterations are present
      P7 = seven iterations are present
      P8 = eight iterations are present
      P9 = nine iterations are present
      P0 = ten iterations are present



 CLM_RAC_ADJSTMT_TB                      Recovery Audit Contractor (RAC) Adjustment Indicator Table

      R = RAC adjusted claim
      Spaces



 CLM_RMTNC_ADVC_TB                       Claim Remittance Advice Code Table

       M1 =   X-ray not taken within the past 12 months
              or near enough to the start of treatment.
              Start: 01/01/1997
       M2 =   Not paid separately when the patient is
              an inpatient.
              Start: 01/01/1997
       M3 =   Equipment is the same or similar to
              equipment already being used.
              Start: 01/01/1997
       M4 =   Alert: This is the last monthly
              installment payment for this durable
              medical equipment.
              Start: 01/01/1997
       M5 =   Monthly rental payments can continue
              until the earlier of the 15th month from
              the first rental month, or the month when
              the equipment is no longer needed.
              Start: 01/01/1997
       M6 =   Alert: You must furnish and service this
              item for any period of medical need for
              the remainder of the reasonable useful
              lifetime of the equipment.
              Start: 01/01/1997
       M7 =   No rental payments after the item is
              purchased, or after the total of issued
              rental payments equals the purchase
              price.
              Start: 01/01/1997
       M8 =   We do not accept blood gas tests results
              when the test was conducted by a medical
              supplier or taken while the patient is on
              oxygen.
              Start: 01/01/1997
       M9 =   Alert: This is the tenth rental month.
              You must offer the patient the choice of
              changing the rental to a purchase
              agreement.
              Start: 01/01/1997 |
      M10 =   Equipment purchases are limited to the
              first or the tenth month of medical
              necessity.
              Start: 01/01/1997
      M11 =   DME, orthotics and prosthetics must be
              billed to the DME carrier who services
              the patient's zip code.
              Start: 01/01/1997
      M12 =   Diagnostic tests performed by a
              physician
              must indicate whether purchased services
              are included on the claim.
              Start: 01/01/1997
      M13 =   Only one initial visit is covered per
              specialty per medical group.
              Start: 01/01/1997 |
      M14 =   No separate payment for an injection
              administered during an office visit, and
              no payment for a full office visit if the
              patient only received an injection.
              Start: 01/01/1997
      M15 =   Separately billed services/tests have
              been bundled as they are considered
              components of the same procedure.
              Separate payment is not allowed.
              Start: 01/01/1997
      M16 =   Alert: Please see our web site,
              mailings,
              or bulletins for more details concerning
              this policy/procedure/decision.
              Start: 01/01/1997 |
              Notes: (Reactivated 4/1/04, Modified
              11/18/05, 4/1/07)
      M17 =   Alert: Payment approved as you did not
              know, and could not reasonably have been
              expected to know, that this would not
              normally have been covered for this
              patient. In the future, you will be
              liable for charges for the same
              service(s) under the same or similar
              conditions.
              Start: 01/01/1997
      M18 =   Certain services may be approved for
              home
              use. Neither a hospital nor a Skilled
              Nursing Facility (SNF) is considered to
              be a patient's home.
              Start: 01/01/1997
      M19 =   Missing oxygen certification/
              recertification.
              Start: 01/01/1997
      M20 =   Missing/incomplete/invalid HCPCS.
              Start: 01/01/1997
      M21 =   Missing/incomplete/invalid place of
              residence for this service/item provided
              in a home.
              Start: 01/01/1997
      M22 =   Missing/incomplete/invalid number of
              miles traveled.
              Start: 01/01/1997
      M23 =   Missing invoice.
              Start: 01/01/1997
      M24 =   Missing/incomplete/invalid number of
              doses per vial.
              Start: 01/01/1997 |
      M25 =   The information furnished does not
              substantiate the need for this level
              of service. If you believe the service
              should have been fully covered as billed,
              or if you did not know and could not
              reasonably have been expected to know
              that we would not pay for this level of
              service, or if you notified the patient
              in writing in advance that we would not
              pay for this level of service and he/she
              agreed in writing to pay, ask us to
              review your claim within 120 days of the
              date of this notice. If you do not
              request an appeal, we will, upon
              application from the patient, reimburse
              him/her for the amount you have collected
              from him/her in excess of any deductible
              and coinsurance amounts. We will recover
              the reimbursement from you as an
              overpayment.
              Start: 01/01/1997 |
              Notes: (Modified 10/1/02, 6/30/03,
              8/1/05, 11/5/07, 11/1/10)
      M26 =   The information furnished does not
              substantiate the need for this level of
              service. If you have collected any amount
              from the patient for this level of
              service /any amount that exceeds the
              limiting charge for the less extensive
              service, the law requires you to refund
              that amount to the patient within 30 days
              of receiving this notice.= The
              requirements for refund are in 1824(I) of
              the Social Security Act and 42CFR411.408.
              The section specifies that physicians who
              knowingly and willfully fail to make
              appropriate refunds may be subject to
              civil monetary penalties and/or exclusion
              from the program. If you have any
              questions about this notice, please
              contact this office.
              Start: 01/01/1997 |
              Notes: (Modified 10/1/02, 6/30/03,
              8/1/05, 11/5/07. Also refer to N356)
      M27 =   Alert: The patient has been relieved of
              liability of payment of these items and
              services under the limitation of
              liability provision of the law. The
              provider is ultimately liable for the
              patient's waived charges, including any
              charges for coinsurance, since the items
              or services were not reasonable and
              necessary or constituted custodial care,
              and you knew or could reasonably have
              been expected to know, that they were
              not covered. You may appeal this
              determination. You may ask for an appeal
              regarding both the coverage
              determination and the issue of whether
              you exercised due care. The appeal
              request must be filed within 120 days of
              the date you receive this notice. You
              must make the request through this
              office.
              Start: 01/01/1997 |
              Notes: (Modified 10/1/02, 8/1/05,
              4/1/07, 8/1/07)
      M28 =   This does not qualify for payment under
              Part B when Part A coverage is exhausted
              or not otherwise available.
              Start: 01/01/1997
      M29 =   Missing operative note/report.
              Start: 01/01/1997 |
              Notes: (Modified 2/28/03, 7/1/2008)
              Related to N233
      M30 =   Missing pathology report.
              Start: 01/01/1997 |
              Notes: (Modified 8/1/04, 2/28/03)
              Related to N236
      M31 =   Missing radiology report.
              Start: 01/01/1997 |
              Notes: (Modified 8/1/04, 2/28/03) Related
              to N240
      M32 =   Alert: This is a conditional payment
              made pending a decision on this service
              by the patient's primary payer. This
              payment may be subject to refund upon
              your receipt of any additional payment
              for this service from another payer. You
              must contact this office immediately
              upon receipt of an additional payment
              for this service.
              Start: 01/01/1997 |
              Notes: (Modified 4/1/07)
      M33 =   Missing/incomplete/invalid UPIN for the
              ordering/referring/performing provider.
              Start: 01/01/1997 | Stop: 08/01/2004
              Notes: Consider using M68
      M34 =   Claim lacks the CLIA certification
              number.
              Start: 01/01/1997 |
              Stop: 08/01/2004
              Notes: Consider using MA120
      M35 =   Missing/incomplete/invalid pre-
              operative
              photos or visual field results.
              Start: 01/01/1997 | Stop: 02/05/2005
              Notes: Consider using N178
      M36 =   This is the 11th rental month. We
              cannot
              pay for this until you indicate that the
              patient has been given the option of
              changing the rental to a purchase.
              Start: 01/01/1997
      M37 =   Not covered when the patient is under
              age 35.
              Start: 01/01/1997 |
              Notes: (Modified 3/8/11)
      M38 =   The patient is liable for the charges
              for this service as you informed the
              patient in writing before the service
              was furnished that we would not pay for
              it, and the patient agreed to pay.
              Start: 01/01/1997
      M39 =   The patient is not liable for payment
              for this service as the advance notice
              of non-coverage you provided the patient
              did not comply with program
              requirements.
              Start: 01/01/1997 |
              Notes: (Modified 2/1/04, 4/1/07,
              11/1/09, 11/1/12) Related to N563
      M40 =   Claim must be assigned and must be
              filed
              by the practitioner's employer.
              Start: 01/01/1997
      M41 =   We do not pay for this as the patient
              has no legal obligation to pay for this.
              Start: 01/01/1997
      M42 =   The medical necessity form must be
              personally signed by the attending
              physician.
              Start: 01/01/1997
      M43 =   Payment for this service previously
              issued to you or another provider by
              another carrier/intermediary.
              Start: 01/01/1997 |
              Stop: 01/31/2004
              Notes: Consider using Reason Code 23
      M44 =   Missing/incomplete/invalid condition
              code.
              Start: 01/01/1997 |
              Notes: (Modified 2/28/03)
      M45 =   Missing/incomplete/invalid occurrence
              code(s).
              Start: 01/01/1997 |
              Notes: (Modified 12/2/04) Related to
              N299
      M46 =   Missing/incomplete/invalid occurrence
              span code(s).
              Start: 01/01/1997 |
              Notes: (Modified 12/2/04) Related to
              N300
      M47 =   Missing/incomplete/invalid internal or
              document control number.
              Start: 01/01/1997 |
              Notes: (Modified 2/28/03)
      M48 =   Payment for services furnished to
              hospital inpatients (other than
              professional services of physicians) can
              only be made to the hospital. You must
              request payment from the hospital rather
              than the patient for this service.
              Start: 01/01/1997 |
              Stop: 01/31/2004
              Notes: Consider using M97
      M49 =   Missing/incomplete/invalid value
              code(s)
              or amount(s).
              Start: 01/01/1997 |
              Notes: (Modified 2/28/03)
      M50 =   Missing/incomplete/invalid revenue
              code(s).
              Start: 01/01/1997 |
              Notes: (Modified 2/28/03)
      M51 =   Missing/incomplete/invalid procedure
              code(s).
              Start: 01/01/1997 |
              Notes: (Modified 12/2/04) Related to N301
      M52 =   Missing/incomplete/invalid "from"
              date(s) of service.
              Start: 01/01/1997 |
              Notes: (Modified 2/28/03)
      M53 =   Missing/incomplete/invalid days or
              units
              of service.
              Start: 01/01/1997 |
              Notes: (Modified 2/28/03)
      M54 =   Missing/incomplete/invalid total
              charges.
              Start: 01/01/1997 |
      M55 =   We do not pay for self-administered
              anti-emetic drugs that are not
              administered with a covered oral
              anti-cancer drug.
              Start: 01/01/1997
      M56 =   Missing/incomplete/invalid payer
              identifier.
              Start: 01/01/1997 |
              Notes: (Modified 2/28/03)
      M57 =   Missing/incomplete/invalid provider
              identifier.
              Start: 01/01/1997 |
              Stop: 06/02/2005
      M58 =   Missing/incomplete/invalid claim
              information. Resubmit claim after
              corrections.
              Start: 01/01/1997 | Stop: 02/05/2005
      M59 =   Missing/incomplete/invalid "to" date(s)
              of service.
              Start: 01/01/1997 |
              Notes: (Modified 2/28/03)
      M60 =   Missing Certificate of Medical
              Necessity.
              Start: 01/01/1997 |
              Notes: (Modified 8/1/04, 6/30/03)
              Related to N227
      M61 =   We cannot pay for this as the approval
              period for the FDA clinical trial has
              expired.
              Start: 01/01/1997
      M62 =   Missing/incomplete/invalid treatment
              authorization code.
              Start: 01/01/1997 |
              Notes: (Modified 2/28/03)
      M63 =   We do not pay for more than one of
              these
              on the same day.
              Start: 01/01/1997 |
              Stop: 01/31/2004
              Notes: Consider using M86
      M64 =   Missing/incomplete/invalid other
              diagnosis.
              Start: 01/01/1997 |
              Notes: (Modified 2/28/03)
      M65 =   One interpreting physician charge can
              be submitted per claim when a purchased
              diagnostic test is indicated.
              Please submit a separate claim for each
              interpreting physician.
              Start: 01/01/1997
      M66 =   Our records indicate that you billed
              diagnostic tests subject to price
              limitations and the procedure code
              submitted includes a professional
              component. Only the technical component
              is subject to price limitations.
              Please submit the technical and
              professional components of this service
              as separate line items.
              Start: 01/01/1997
      M67 =   Missing/incomplete/invalid other
              procedure code(s).
              Start: 01/01/1997
              Notes: (Modified 12/2/04) Related to
              N302
      M68 =   Missing/incomplete/invalid attending,
              ordering, rendering, supervising or
              referring physician identification.
              Start: 01/01/1997
              Stop: 06/02/2005
      M69 =   Paid at the regular rate as you did not
              submit documentation to justify the
              modified procedure code.
              Start: 01/01/1997 |
              Notes: (Modified 2/1/04)
      M70 =   Alert: The NDC code submitted for this
              service was translated to a HCPCS code
              for processing, but please continue to
              submit the NDC on future claims for this
              item.
              Start: 01/01/1997 |
              Notes: (Modified 4/1/2007, 8/1/07)
      M71 =   Total payment reduced due to overlap of
              tests billed.
              Start: 01/01/1997
      M72 =   Did not enter full 8-digit date
              (MM/DD/CCYY).
              Start: 01/01/1997 |
              Stop: 10/16/2003
              Notes: Consider using MA52
      M73 =   The HPSA/Physician Scarcity bonus can
              only be paid on the professional
              component of this service. Rebill as
              separate professional and technical
              components.
              Start: 01/01/1997
              Notes: (Modified 8/1/04)
      M74 =   This service does not qualify for a
              HPSA/Physician Scarcity bonus payment.
              Start: 01/01/1997
              Notes: (Modified 12/2/04)
      M75 =   Multiple automated multichannel tests
              performed on the same day combined for
              payment.
              Start: 01/01/1997
              Notes: (Modified 11/5/07)
      M76 =   Missing/incomplete/invalid diagnosis or
              condition.
              Start: 01/01/1997
              Notes: (Modified 2/28/03)
      M77 =   Missing/incomplete/invalid place of
              service.
              Start: 01/01/1997
              Last Modified: 02/28/2003
              Notes: (Modified 2/28/03)
      M78 =   Missing/incomplete/invalid HCPCS
              modifier.
              Start: 01/01/1997
              Stop: 05/18/2006
              Notes: (Modified 2/28/03,) Consider
              using Reason Code 4
      M79 =   Missing/incomplete/invalid charge.
              Start: 01/01/1997
              Notes: (Modified 2/28/03)
      M80 =   Not covered when performed during the
              same session/date as a previously
              processed service for the patient.
              Start: 01/01/1997
              Notes: (Modified 10/31/02)
      M81 =   You are required to code to the highest
              level of specificity.
              Start: 01/01/1997
              Notes: (Modified 2/1/04)
      M82 =   Service is not covered when patient is
              under age 50.
              Start: 01/01/1997
      M83 =   Service is not covered unless the
              patient is classified as at high risk.
              Start: 01/01/1997
      M84 =   Medical code sets used must be the
              codes
              in effect at the time of service
              Start: 01/01/1997
              Notes: (Modified 2/1/04)
      M85 =   Subjected to review of physician
              evaluation and management services.
              Start: 01/01/1997
      M86 =   Service denied because payment already
              made for same/similar procedure within
              set time frame.
              Start: 01/01/1997
      M87 =   Claim/service(s) subjected to CFO-CAP
              prepayment review.
              Start: 01/01/1997
      M88 =   We cannot pay for laboratory tests
              unless billed by the laboratory that did
              the work.
              Start: 01/01/1997
              Stop: 08/01/2004
              Notes: Consider using Reason Code B20
      M89 =   Not covered more than once under age
              40.
              Start: 01/01/1997
      M90 =   Not covered more than once in a 12
              month
              period.
              Start: 01/01/1997
      M91 =   Lab procedures with different CLIA
              certification numbers must be billed on
              separate claims.
              Start: 01/01/1997
      M92 =   Services subjected to review under the
              Home Health Medical Review Initiative.
              Start: 01/01/1997 | Stop: 08/01/2004
      M93 =   Information supplied supports a break
              in
              therapy. A new capped rental period
              began with delivery of this equipment.
              Start: 01/01/1997
      M94 =   Information supplied does not support a
              break in therapy. A new capped rental
              period will not begin.
              Start: 01/01/1997
      M95 =   Services subjected to Home Health
              Initiative medical review/cost report
              audit.
              Start: 01/01/1997
      M96 =   The technical component of a service
              furnished to an inpatient may only be
              billed by that inpatient facility. You
              must contact the inpatient facility for
              technical component reimbursement. If
              not already billed, you should bill us
              for the professional component only.
              Start: 01/01/1997
      M97 =   Not paid to practitioner when provided
              to patient in this place of service.
              Payment included in the reimbursement
              issued the facility.
              Start: 01/01/1997
      M98 =   Begin to report the Universal Product
              Number on claims for items of this type.
              We will soon begin to deny payment for
              items of this type if billed without the
              correct UPN.
              Start: 01/01/1997
              Stop: 01/31/2004
              Notes: Consider using M99
      M99 =   Missing/incomplete/invalid Universal
              Product Number/Serial Number.
              Start: 01/01/1997
      M100 =  We do not pay for an oral anti-emetic
              drug that is not administered for use
              immediately before, at, or within 48
              hours of administration of a covered
              chemotherapy drug.
              Start: 01/01/1997
      M101 =  Begin to report a G1-G5 modifier with
              this HCPCS. We will soon begin to deny
              payment for this service if billed
              without a G1-G5 modifier.
              Start: 01/01/1997
              Stop: 01/31/2004
              Notes: Consider using M78
      M102 =  Service not performed on equipment
              approved by the FDA for this purpose.
              Start: 01/01/1997
      M103 =  Information supplied supports a break
              in therapy.  However, the medical info-
              mation we have for this patient does not
              support the need for this item
              as billed. We have approved payment for
              this item at a reduced level, and a new
              capped rental period will begin with the
              delivery of this equipment.
              Start: 01/01/1997
      M104 =  Information supplied supports a break
              in therapy. a new capped rental period
              will begom wieth delivery of the
              equipment.  This is the maximum approved
              under the fee schedule for this item or
              service.
              Start: 01/01/1997
      M105 =  Information supplied does not support a
              break in therapy. The medical
              information we have for this patient
              does not support the need for this item
              as billed. We have approved payment for
              this item at a reduced level, and a new
              capped rental period will not begin.
              Start: 01/01/1997
      M106 =  Information supplied does not support a
              break in therapy. A new capped rental
              period will not begin. This is the
              maximum approved under the fee schedule
              for this item or service.
              Start: 01/01/1997 |
              Stop: 01/31/2004
              Notes: Consider using MA 31
      M107 =  Payment reduced as 90-day rolling
              average hematocrit for ESRD patient
              exceeded 36.5%.
              Start: 01/01/1997
      M108 =  Missing/incomplete/invalid provider
              identifier for the provider who
              interpreted the diagnostic test.
              Start: 01/01/1997 | Stop: 06/02/2005
      M109 =  We have provided you with a bundled
              payment for a teleconsultation. You must
              send 25 percent of the teleconsultation
              payment to the referring practitioner.
              Start: 01/01/1997
      M110 =  Missing/incomplete/invalid provider
              identifier for the provider from whom
              you purchased interpretation services.
              Start: 01/01/1997 | Stop: 06/02/2005
      M111 =  We do not pay for chiropractic
              manipulative treatment when the patient
              refuses to have an x-ray taken.
              Start: 01/01/1997
      M112 =  Reimbursement for this item is based on
              the single payment amount required under
              the DMEPOS Competitive Bidding Program
              for the area where the patient resides.
              Start: 01/01/1997
      M113 =  Our records indicate that this patient
              began using this item/service prior to
              the current contract period for the
              DMEPOS Competitive Bidding Program.
              Start: 01/01/1997
      M114 =  This service was processed in
              accordance with rules and guidelines
              under the DMEPOS Competitive Bidding
              Program or a Demonstration Project.
              For more information regarding these
              these projects, contact your local
              contractor.
              Start: 01/01/1997
      M115 =  This item is denied when provided to
              this patient by a non-contract or non-
              demonstration supplier.
              Start: 01/01/1997
      M116 =  Processed under a demonstration project
              or program. Project or program is
              ending and additional services may not
              be paid under this project or program.
              Start: 01/01/1997
      M117 =  Not covered unless submitted via
              electronic claim.
              Start: 01/01/1997
      M118 =  Letter to follow containing further
              information.
              Start: 01/01/1997
              Stop: 01/01/2011
      M119 =  Missing/incomplete/invalid/
              deactivated/withdrawn National Drug
              Code (NDC).
              Start: 01/01/1997
      M120 =  Missing/incomplete/invalid provider
              identifier for the substituting
              physician who furnished the service(s)
              under a reciprocal billing or locum
              tenens arrangement.
              Start: 01/01/1997
              Stop: 06/02/2005
      M121 =  We pay for this service only when
              performed with a covered cryosurgical
              ablation.
              Start: 01/01/1997
      M122 =  Missing/incomplete/invalid level of
              subluxation.
              Start: 01/01/1997
      M123 =  Missing/incomplete/invalid name,
              strength, or dosage of the drug
              furnished.
              Start: 01/01/1997
      M124 =  Missing indication of whether the
              patient owns the equipment that
              requires the part or supply.
              Start: 01/01/1997
              Notes: Related to N230
      M125 =  Missing/incomplete/invalid information
              on the period of time for which the
              service/supply/equipment will be
              needed.
              Start: 01/01/1997 |
      M126 =  Missing/incomplete/invalid individual
              lab codes included in the test.
              Start: 01/01/1997 |
      M127 =  Missing patient medical record for this
              service.
              Start: 01/01/1997 |
              Notes: Related to N237
      M128 =  Missing/incomplete/invalid date of the
              patient's last physician visit.
              Start: 01/01/1997 |
              Stop: 06/02/2005
      M129 =  Missing/incomplete/invalid indicator of
              x-ray availability for review.
              Start: 01/01/1997
      M130 =  Missing invoice or statement certifying
              the actual cost of the lens, less
              discounts, and/or the type of
              intraocular lens used.
              Start: 01/01/1997
              Notes: Related to N231
      M131 =  Missing physician financial
              relationship form.
              Start: 01/01/1997
              Notes: Related to N239
      M132 =  Missing pacemaker registration form.
              Start: 01/01/1997
              Notes: Related to N235
      M133 =  Claim did not identify who performed
              the purchased diagnostic test or the
              amount you were charged for the test.
              Start: 01/01/1997
      M134 =  Performed by a facility/supplier in
              which the provider has a financial
              interest.
              Start: 01/01/1997
      M135 =  Missing/incomplete/invalid plan of
              treatment.
              Start: 01/01/1997
      M136 =  Missing/incomplete/invalid indication
              that the service was supervised or
              evaluated by a physician.
              Start: 01/01/1997
      M137 =  Part B coinsurance under a
              demonstration project or pilot program.
              Start: 01/01/1997
      M138 =  Patient identified as a demonstration
              participant but the patient was not
              enrolled in the demonstration at the
              time services were rendered. Coverage
              is limited to demonstration
              participants.
              Start: 01/01/1997
      M139 =  Denied services exceed the coverage
              limit for the demonstration.
              Start: 01/01/1997
      M140 =  Service not covered until after the
              patient's 50th birthday, i.e., no
              coverage prior to the day after the
              50th birthday
              Start: 01/01/1997
              Stop:  1/30/2004
              Notes: Consider using M82
      M141 =  Missing physician certified plan of
              care.
              Start: 01/01/1997
              Notes: Related to N238
      M142 =  Missing American Diabetes Association
              Certificate of Recognition.
              Start: 01/01/1997
              Last Modified: 02/28/2003
              Notes: Related to N226
      M143 =  The provider must update license
              information with the payer.
              Start: 01/01/1997 |
      M144 =  Pre-/post-operative care payment is
              included in the allowance for the
              surgery/procedure.
              Start: 01/01/1997
      MA01 =  Alert: If you do not agree with what we
              approved for these services, you may
              appeal our decision. To make sure that
              we are fair to you, we require another
              individual that did not process your
              initial claim to conduct the appeal.
              However, in order to be eligible for an
              appeal, you must write to us within 120
              days of the date you received this
              notice, unless you have a good reason
              for being late.
              Start: 01/01/1997
              8/1/05, 4/1/07)
      MA02 =  Alert: If you do not agree with this
              determination, you have the right to
              appeal. You must file a written request
              for an appeal within 180 days of the
              date you receive this notice.
              Start: 01/01/1997
      MA03 =  If you do not agree with the approved
              amounts and $100 or more is in dispute
              (less deductible and coinsurance), you
              may ask for a hearing within six months
              of the date of this notice. To meet the
              $100, you may combine amounts on other
              claims that have been denied, including
              reopened appeals if you received a
              revised decision. You must appeal each
              claim on time.
              Start: 01/01/1997
              Stop: 10/01/2006
              Last Modified: 11/18/2005
              Notes: Consider using MA02 (Modified
              10/31/02, 6/30/03, 8/1/05, 11/18/05)
      MA04 =  Secondary payment cannot be considered
              without the identity of or payment
              information from the primary payer. The
              information was either not reported or
              was illegible.
              Start: 01/01/1997
      MA05 =  Incorrect admission date patient status
              or type of bill entry on claim.
              Start: 01/01/1997
              Stop: 10/16/2003
              Notes: Consider using MA30, MA40 or
              MA43
      MA06 =  Missing/incomplete/invalid beginning
              and/or ending date(s).
              Start: 01/01/1997
              Stop: 08/01/2004
              Notes: Consider using MA31
      MA07 =  Alert: The claim information has also
              been forwarded to Medicaid for review.
              Start: 01/01/1997
      MA08 =  Alert: Claim information was not
              forwarded because the supplemental
              coverage is not with a Medigap plan,
              or you do not participate in Medicare.
              Start: 01/01/1997
      MA09 =  Claim submitted as unassigned but
              processed as assigned. You agreed to
              accept assignment for all claims.
              Start: 01/01/1997
      MA10 =  Alert: The patient's payment was in
              excess of the amount owed. You must
              refund the overpayment to the patient.
              Start: 01/01/1997
      MA11 =  Payment is being issued on a
              conditional basis. If no-fault
              insurance, liability insurance,
              Workers' Compensation, Department of
              Veterans Affairs, or a group health
              plan for employees and dependents also
              covers this claim, a refund may be due
              us. Please contact us if the patient is
              covered by any of these sources.
              Start: 01/01/1997
              Stop: 01/31/2004
              Notes: Consider using M32
      MA12 =  You have not established that you have
              the right under the law to bill for
              services furnished by the person(s)
              that furnished this (these) service(s).
              Start: 01/01/1997
      MA13 =  Alert: You may be subject to penalties
              if you bill the patient for amounts not
              reported with the PR (patient
              responsibility) group code.
              Start: 01/01/1997
      MA14 =  Alert: The patient is a member of an
              employer-sponsored prepaid health plan.
              Services from outside that health plan
              are not covered. However, as you were
              not previously notified of this, we are
              paying this time. In the future, we
              will not pay you for non-plan services.
              Start: 01/01/1997
      MA15 =  Alert: Your claim has been separated to
              expedite handling. You will receive a
              separate notice for the other services
              reported.
              Start: 01/01/1997 |
      MA16 =  The patient is covered by the Black
              Lung Program. Send this claim to the
              Department of Labor, Federal Black Lung
              Program, P.O. Box 828, Lanham-Seabrook
              MD 20703.
              Start: 01/01/1997
      MA17 =  We are the primary payer and have paid
              at the primary rate. You must contact
              the patient's other insurer to refund
              any excess it may have paid due to its
              erroneous primary payment.
              Start: 01/01/1997
      MA18 =  Alert: The claim information is also
              being forwarded to the patient's
              supplemental insurer. Send any
              questions regarding supplemental
              benefits to them.
              Start: 01/01/1997
      MA19 =  Alert: Information was not sent to the
              Medigap insurer due to
              incorrect/invalid information you
              submitted concerning that insurer.
              Please verify your information and
              submit your secondary claim directly to
              that insurer.
              Start: 01/01/1997
      MA20 =  Skilled Nursing Facility (SNF) stay not
              covered when care is primarily related
              to the use of an urethral catheter for
              convenience or the control of
              incontinence.
              Start: 01/01/1997
      MA21 =  SSA records indicate mismatch with name
              and sex.
              Start: 01/01/1997
      MA22 =  Payment of less than $1.00 suppressed.
              Start: 01/01/1997
      MA23 =  Demand bill approved as result of
              medical review.
              Start: 01/01/1997
      MA24 =  Christian Science Sanitarium/ Skilled
              Nursing Facility (SNF) bill in the same
              benefit period.
              Start: 01/01/1997 |
      MA25 =  A patient may not elect to change a
              hospice provider more than once in a
              benefit period.
              Start: 01/01/1997
      MA26 =  Alert: Our records indicate that you
              were previously informed of this rule.
              Start: 01/01/1997 |
      MA27 =  Missing/incomplete/invalid entitlement
              number or name shown on the claim.
              Start: 01/01/1997 |
      MA28 =  Alert: Receipt of this notice by a
              physician or supplier who did not
              accept assignment is for information
              only and does not make the physician or
              supplier a party to the determination.
              No additional rights to appeal this
              decision, above those rights already
              provided for by regulation/instruction,
              are conferred by receipt of this
              notice.
              Start: 01/01/1997 |
      MA29 =  Missing/incomplete/invalid provider
              name, city, state, or zip code.
              Start: 01/01/1997 |
              Stop: 06/02/2005
      MA30 =  Missing/incomplete/invalid type of
              bill.
              Start: 01/01/1997 |
      MA31 =  Missing/incomplete/invalid beginning
              and ending dates of the period billed.
              Start: 01/01/1997 |
      MA32 =  Missing/incomplete/invalid number of
              covered days during the billing period.
              Start: 01/01/1997 |
      MA33 =  Missing/incomplete/invalid noncovered
              days during the billing period.
              Start: 01/01/1997 |
      MA34 =  Missing/incomplete/invalid number of
              coinsurance days during the billing
              period.
              Start: 01/01/1997
      MA35 =  Missing/incomplete/invalid number of
              lifetime reserve days.
              Start: 01/01/1997 |
      MA36 =  Missing/incomplete/invalid patient
              name.
              Start: 01/01/1997 |
      MA37 =  Missing/incomplete/invalid patient's
              address.
              Start: 01/01/1997 |
      MA38 =  Missing/incomplete/invalid birth date.
              Start: 01/01/1997 |
              Stop: 06/02/2005
      MA39 =  Missing/incomplete/invalid gender.
              Start: 01/01/1997 |
      MA40 =  Missing/incomplete/invalid admission
              date.
              Start: 01/01/1997 |
      MA41 =  Missing/incomplete/invalid admission
              type.
              Start: 01/01/1997 |
      MA42 =  Missing/incomplete/invalid admission
              source.
              Start: 01/01/1997 |
      MA43 =  Missing/incomplete/invalid patient
              status.
              Start: 01/01/1997 |
      MA44 =  Alert: No appeal rights. Adjudicative
              decision based on law.
              Start: 01/01/1997
      MA45 =  Alert: As previously advised, a portion
              or all of your payment is being held in
              a special account.
              Start: 01/01/1997
      MA46 =  The new information was considered but
              additional payment will not be issued.
              Start: 01/01/1997 |
      MA47 =  Our records show you have opted out of
              Medicare, agreeing with the patient not
              to bill Medicare for
              services/tests/supplies furnished. As
              result, we cannot pay this claim. The
              patient is responsible for payment.
              Start: 01/01/1997
      MA48 =  Missing/incomplete/invalid name or
              address of responsible party or primary
              payer.
              Start: 01/01/1997
              Last Modified: 02/28/2003
              Notes: (Modified 2/28/03)
      MA49 =  Missing/incomplete/invalid six-digit
              provider identifier for home health
              agency or hospice for physician(s)
              performing care plan oversight
              services.
              Start: 01/01/1997
              Stop: 08/01/2004
              Notes: Consider using MA76
      MA50 =  Missing/incomplete/invalid
              Investigational Device Exemption number
              for FDA-approved clinical trial
              services.
              Start: 01/01/1997 |
      MA51 =  Missing/incomplete/invalid CLIA
              certification number for laboratory
              services billed by physician office
              laboratory.
              Start: 01/01/1997 |
              Stop: 02/05/2005
              Notes: Consider using MA120
      MA52 =  Missing/incomplete/invalid date.
              Start: 01/01/1997 | Stop: 06/02/2005
      MA53 =  Missing/incomplete/invalid Competitive
              Bidding Demonstration Project
              identification.
              Start: 01/01/1997 |
      MA54 =  Physician certification or election
              consent for hospice care not received
              timely.
              Start: 01/01/1997
      MA55 =  Not covered as patient received medical
              health care services, automatically
              revoking his/her election to receive
              religious non-medical health care
              services.
              Start: 01/01/1997
      MA56 =  Our records show you have opted out of
              Medicare, agreeing with the patient not
              to bill Medicare for
              services/tests/supplies furnished. As
              result, we cannot pay this claim. The
              patient is responsible for payment, but
              under  Federal law, you cannot charge
              the patient more than the limiting
              charge amount.
              Start: 01/01/1997
      MA57 =  Patient submitted written request to
              revoke his/her election for religious
              non-medical health care services.
              Start: 01/01/1997
      MA58 =  Missing/incomplete/invalid release of
              information indicator.
              Start: 01/01/1997 |
      MA59 =  Alert: The patient overpaid you for
              these services. You must issue the
              patient a refund within 30 days for the
              difference between his/her payment and
              the total amount shown as patient
              responsibility on this notice.
              Start: 01/01/1997 |
      MA60 =  Missing/incomplete/invalid patient
              relationship to insured.
              Start: 01/01/1997 |
      MA61 =  Missing/incomplete/invalid social
              security number or health insurance
              claim number.
              Start: 01/01/1997 |
      MA62 =  Alert: This is a telephone review
              decision.
              Start: 01/01/1997 |
      MA63 =  Missing/incomplete/invalid principal
              diagnosis.
              Start: 01/01/1997 |
      MA64 =  Our records indicate that we should be
              the third payer for this claim. We
              cannot process this claim until we have
              received payment information from the
              primary and secondary payers.
              Start: 01/01/1997
      MA65 =  Missing/incomplete/invalid admitting
              diagnosis.
              Start: 01/01/1997 |
      MA66 =  Missing/incomplete/invalid principal
              procedure code.
              Start: 01/01/1997 |
              Notes: Related to N303
      MA67 =  Correction to a prior claim.
              Start: 01/01/1997
      MA68 =  Alert: We did not crossover this claim
              because the secondary insurance
              information on the claim was incomplete.
              Please supply complete information or
              use the PLANID of the insurer to assure
              correct and timely routing of the claim.
              Start: 01/01/1997 |
      MA69 =  Missing/incomplete/invalid remarks.
              Start: 01/01/1997
      MA70 =  Missing/incomplete/invalid provider
              representative signature.
              Start: 01/01/1997 |
      MA71 =  Missing/incomplete/invalid provider
              representative signature date.
              Start: 01/01/1997 |
      MA72 =  Alert: The patient overpaid you for
              these assigned services. You must issue
              the patient a refund within 30 days for
              the difference between his/her payment
              to you and the total of the amount
              shown as patient responsibility and as
              paid to the patient on this notice.
              Start: 01/01/1997 |
      MA73 =  Informational remittance associated
              with a Medicare demonstration. No
              payment issued under fee-for-service
              Medicare as patient has elected managed
              care.
              Start: 01/01/1997
      MA74 =  This payment replaces an earlier
              payment for this claim that was either
              lost, damaged or returned.
              Start: 01/01/1997
      MA75 =  Missing/incomplete/invalid patient or
              authorized representative signature.
              Start: 01/01/1997
      MA76 =  Missing/incomplete/invalid provider
              identifier for home health agency or
              hospice when physician is performing
              care plan oversight services.
              Start: 01/01/1997
      MA77 =  Alert: The patient overpaid you. You
              must issue the patient a refund within
              30 days for the difference between the
              patient's payment less the total of our
              and other payer payments and the amount
              shown as patient responsibility on this
              notice.
              Start: 01/01/1997
      MA78 =  The patient overpaid you. You must
              issue the patient a refund within 30
              days for the difference between our
              allowed amount total and the amount
              paid by the patient.
              Start: 01/01/1997
              Stop: 01/31/2004
              Notes: Consider using MA59
      MA79 =  Billed in excess of interim rate.
              tart: 01/01/1997
      MA80 =  Informational notice. No payment issued
              for this claim with this notice.
              Payment issued to the hospital by its
              intermediary for all services for this
              encounter under a demonstration
              project.
              Start: 01/01/1997
      MA81 =  Missing/incomplete/invalid
              provider/supplier signature.
              Start: 01/01/1997 |
      MA82 =  Missing/incomplete/invalid
              provider/supplier billing
              number/identifier or billing name,
              address, city, state, zip code, or
              phone number.
              Start: 01/01/1997 |
              Stop: 06/02/2005
      MA83 =  Did not indicate whether we are the
              primary or secondary payer.
              Start: 01/01/1997 |
      MA84 =  Patient identified as participating in
              the National Emphysema Treatment Trial
              but our records indicate that this
              patient is either not a participant,
              or has not yet been approved for this
              phase of the study. Contact Johns
              Hopkins University, the study coordinator,
              to resolve if there was a discrepancy.
              Start: 01/01/1997
      MA85 =  Our records indicate that a primary
              payer exists (other than ourselves);
              however, you did not complete or enter
              accurately the insurance
              plan/group/program name or
              identification number. Enter the PlanID
              when effective.
              Start: 01/01/1997 |
              Stop: 08/01/2004
              Notes: Consider using MA92
      MA86 =  Missing/incomplete/invalid group or
              policy number of the insured for the
              primary coverage.
              Start: 01/01/1997 |
              Stop: 08/01/2004
              Notes: Consider using MA92
      MA87 =  Missing/incomplete/invalid insured's
              name for the primary payer.
              Start: 01/01/1997 |
              Stop: 08/01/2004
              Notes: Consider using MA92
      MA88 =  Missing/incomplete/invalid insured's
              address and/or telephone number for the
              primary payer.
              Start: 01/01/1997 |
      MA89 =  Missing/incomplete/invalid patient's
              relationship to the insured for the
              primary payer.
              Start: 01/01/1997 |
      MA90 =  Missing/incomplete/invalid employment
              status code for the primary insured.
              Start: 01/01/1997
      MA91 =  This determination is the result of the
              appeal you filed.
              Start: 01/01/1997
      MA92 =  Missing plan information for other
              insurance.
              Start: 01/01/1997
              Notes: Related to N245
              N245
      MA93 =  Non-PIP (Periodic Interim Payment)
              claim.
              Start: 01/01/1997
      MA94 =  Did not enter the statement "Attending
              physician not hospice employee" on the
              claim form to certify that the
              rendering physician is not an employee
              of the hospice.
              Start: 01/01/1997
              Notes: (Reactivated 4/1/04, Modified
              8/1/05)
      MA95 =  A not otherwise classified or unlisted
              procedure code(s) was billed but a
              narrative description of the procedure
              was not entered on the claim. Refer to
              item 19 on the HCFA-1500.
              Start: 01/01/1997
              Stop:  01/01/2004
              Notes: (Deactivated 2/28/2003)
              (Erroneous description corrected
              9/2/2008) Consider using M51
      MA96 =  Claim rejected. Coded as a Medicare
              Managed Care Demonstration but patient
              is not enrolled in a Medicare managed
              care plan.
              Start: 01/01/1997
      MA97 =  Missing/incomplete/invalid Medicare
              Managed Care Demonstration contract
              number or clinical trial registry
              number.
              Start: 01/01/1997 |
      MA98 =  Claim Rejected. Does not contain the
              correct Medicare Managed Care
              Demonstration contract number for this
              beneficiary.
              Start: 01/01/1997 |
              Stop: 10/16/2003
              Notes: Consider using MA97
      MA99 =  Missing/incomplete/invalid Medigap
              information.
              Start: 01/01/1997 |
      MA100 = Missing/incomplete/invalid date of
              current illness or symptoms
              Start: 01/01/1997 |
      MA101 = A Skilled Nursing Facility (SNF) is
              responsible for payment of outside
              providers who furnish these
              services/supplies to residents.
              Start: 01/01/1997
              Stop: 01/01/2011
              Notes: Consider using N538
      MA102 = Missing/incomplete/invalid name or
              provider identifier for the
              rendering/referring/ ordering/
              supervising provider.
              Start: 01/01/1997
              Stop: 08/01/2004
              Notes: Consider using M68
      MA103 = Hemophilia Add On.
              Start: 01/01/1997
      MA104 = Missing/incomplete/invalid date the
              patient was last seen or the provider
              identifier of the attending physician.
              Start: 01/01/1997
              Stop: 01/31/2004
              Notes: Consider using M128 or M57
      MA105 = Missing/incomplete/invalid provider
              number for this place of service.
              Start: 01/01/1997
              Stop: 06/02/2005
      MA106 = PIP (Periodic Interim Payment) claim.
              Start: 01/01/1997
      MA107 = Paper claim contains more than three
              separate data items in field 19.
              Start: 01/01/1997
      MA108 = Paper claim contains more than one data
              item in field 23.
              Start: 01/01/1997
      MA109 = Claim processed in accordance with
              ambulatory surgical guidelines.
              Start: 01/01/1997
      MA110 = Missing/incomplete/invalid information
              on whether the diagnostic test(s) were
              performed by an outside entity or if no
              purchased tests are included on the
              claim.
              Start: 01/01/1997
      MA111 = Missing/incomplete/invalid purchase
              price of the test(s) and/or the
              performing laboratory's name and
              address.
              Start: 01/01/1997
      MA112 = Missing/incomplete/invalid group
              practice information.
              Start: 01/01/1997
      MA113 = Incomplete/invalid taxpayer
              identification number (TIN) submitted
              by you per the Internal Revenue
              Service. Your claims cannot be
              processed without your correct TIN, and
              you may not bill the patient pending
              correction of your TIN. There are no
              appeal rights for unprocessable claims,
              but you may resubmit this claim after
              you have notified this office of your
              correct TIN.
              Start: 01/01/1997
      MA114 = Missing/incomplete/invalid information
              on where the services were furnished.
              Start: 01/01/1997
      MA115 = Missing/incomplete/invalid physical
              location (name and address, or PIN)
              where the service(s) were rendered in a
              Health Professional Shortage Area
              (HPSA).
              Start: 01/01/1997
      MA116 = Did not complete the statement
              'Homebound' on the claim to validate
              whether laboratory services were
              performed at home or in an institution.
              Start: 01/01/1997
              Notes: (Reactivated 4/1/04)
      MA117 = This claim has been assessed a $1.00
              user fee.
              Start: 01/01/1997
      MA118 = Coinsurance and/or deductible amounts
              apply to a claim for services or
              supplies furnished to a Medicare-
              eligible veteran through a facility of
              the Department of Veterans Affairs. No
              Medicare payment issued.
              Start: 01/01/1997
      MA119 = Provider level adjustment for late
              claim filing applies to this claim.
              Start: 01/01/1997
              Stop: 05/01/2008
              Notes: Consider using Reason Code B4
      MA120 = Missing/incomplete/invalid CLIA
              certification number.
              Start: 01/01/1997
      MA121 = Missing/incomplete/invalid x-ray date.
              Start: 01/01/1997
      MA122 = Missing/incomplete/invalid initial
              treatment date.
              Start: 01/01/1997
      MA123 = Your center was not selected to
              participate in this study, therefore,
              we cannot pay for these services.
              Start: 01/01/1997
      MA124 = Processed for IME only.
              Start: 01/01/1997
              Stop: 01/31/2004
              Notes: Consider using Reason Code 74
      MA125 = Per legislation governing this program,
              payment constitutes payment in full.
              Start: 01/01/1997
      MA126 = Pancreas transplant not covered unless
              kidney transplant performed.
              Start: 10/12/2001
      MA127 = Reserved for future use.
              Start: 10/12/2001
              Stop:  06/02/2005
      MA128 = Missing/incomplete/invalid FDA approval
              number.
              Start: 10/12/2001
      MA129 = This provider was not certified for
              this procedure on this date of service.
              Start: 10/12/2001
              Stop:  01/31/2004
              Notes: Consider using MA120 and Reason
              Code B7
      MA130 = Your claim contains incomplete and/or
              invalid information, and no appeal
              rights are afforded because the claim
              is unprocessable. Please submit a new
              claim with the complete/correct
              information.
              Start: 10/12/2001
      MA131 = Physician already paid for services in
              conjunction with this demonstration
              claim. You must have the physician
              withdraw that claim and refund the
              payment before we can process your
              claim.
              Start: 10/12/2001
      MA132 = Adjustment to the pre-demonstration
              rate.
              Start: 10/12/2001
      MA133 = Claim overlaps inpatient stay. Rebill
              only those services rendered outside
              the inpatient stay.
              Start: 10/12/2001
      MA134 = Missing/incomplete/invalid provider
              number of the facility where the patient resides.
              Start: 10/12/2001
      N1 = Alert: You may appeal this decision in
           writing within the required time limits
           following receipt of this notice by
           following the instructions included in
           your contract or plan benefit
           documents.
           Start: 01/01/2000
      N2 = This allowance has been made in
           accordance with the most appropriate
           course of treatment provision of the
           plan.
           Start: 01/01/2000
      N3 = Missing consent form.
           Start: 01/01/2000
           Notes: Related to N228
      N4 = Missing/Incomplete/Invalid prior Insurance
           Carrier(s) EOB.
           Start: 01/01/2000
      N5 = EOB received from previous payer. Claim
           not on file.
           Start: 01/01/2000
      N6 = Under FEHB law (U.S.C. 8904(b)), we
           cannot pay more for covered care than
           the amount Medicare would have allowed
           if the patient were enrolled in
           Medicare Part A and/or Medicare Part B.
           Start: 01/01/2000
      N7 = Processing of this claim/service has
           included consideration under Major
           Medical provisions.
           Start: 01/01/2000
      N8 = Crossover claim denied by previous
           payer and complete claim data not
           forwarded. Resubmit this claim to this
           payer to provide adequate data for
           adjudication.
           Start: 01/01/2000
      N9 = Adjustment represents the estimated
           amount a previous payer may pay.
           Start: 01/01/2000
      N10 = Payment based on the findings of a
            review organization/professional
            consult/manual adjudication/medical or
            dental advisor.
            Start: 01/01/2000
      N11 = Denial reversed because of medical
            review.
            Start: 01/01/2000
      N12 = Policy provides coverage supplemental
            to Medicare. As the member does not
            appear to be enrolled in the applicable
            part of Medicare, the member is
            responsible for payment of the portion
            of the charge that would have been
            covered by Medicare.
            Start: 01/01/2000 |
      N13 = Payment based on professional/technical
            component modifier(s).
            Start: 01/01/2000
      N14 = Payment based on a contractual amount
            or agreement, fee schedule, or maximum
            allowable amount.
            Start: 01/01/2000 |
            Stop: 10/01/2007
            Notes: Consider using Reason Code 45
      N15 = Services for a newborn must be billed
            separately.
            Start: 01/01/2000
      N16 = Family/member Out-of-Pocket maximum has
            been met. Payment based on a higher
            percentage.
            Start: 01/01/2000
      N17 = Per admission deductible.
            Start: 01/01/2000
            Stop: 08/01/2004
            Notes: Consider using Reason Code 1
      N18 = Payment based on the Medicare allowed
            amount.
            Start: 01/01/2000
            Stop: 01/31/2004
            Notes: Consider using N14
      N19 = Procedure code incidental to primary
            procedure.
            Start: 01/01/2000
      N20 = Service not payable with other service
            rendered on the same date.
            Start: 01/01/2000
      N21 = Alert: Your line item has been
            separated into multiple lines to
            expedite handling.
            Start: 01/01/2000
      N22 = This procedure code was added/changed
             because it more accurately describes
             the services rendered.
             Start: 01/01/2000
      N23 = Alert: Patient liability may be
            affected due to coordination of
            benefits with other carriers and/or
            maximum benefit provisions.
            Start: 01/01/2000
      N24 = Missing/incomplete/invalid Electronic
            Funds Transfer (EFT) banking
            information.
            Start: 01/01/2000
      N25 = This company has been contracted by
             your benefit plan to provide
             administrative claims payment services
             only. This company does not assume
             financial risk or obligation with
             respect to claims processed on behalf
             of your benefit plan.
             Start: 01/01/2000
      N26 = Missing itemized bill/statement.
             Start: 01/01/2000
             Related to N232
      N27 = Missing/incomplete/invalid treatment
            number.
            Start: 01/01/2000
            Last Modified: 02/28/2003
            Notes: (Modified 2/28/03)
      N28 = Consent form requirements not
            fulfilled.
            Start: 01/01/2000
      N29 = Missing documentation/orders/
            notes/summary/report/chart.
            Start: 01/01/2000
            Notes: Related to N225
      N30 = Patient ineligible for this service.
            Start: 01/01/2000 | Last Modified: 06/30/2003
      N31 = Missing/incomplete/invalid prescribing
            provider identifier.
            Start: 01/01/2000
      N32 = Claim must be submitted by the provider
            who rendered the service.
            Start: 01/01/2000
      N33 = No record of health check prior to
            initiation of treatment.
            Start: 01/01/2000
      N34 = Incorrect claim form/format for this
            service.
            Start: 01/01/2000
      N35 = Program integrity/utilization review
            decision.
            Start: 01/01/2000
      N36 = Claim must meet primary payer's
            processing requirements before we can
            consider payment.
            Start: 01/01/2000
      N37 = Missing/incomplete/invalid tooth
            number/letter.
            Start: 01/01/2000
      N38 = Missing/incomplete/invalid place of
            service.
            Start: 01/01/2000
            Stop: 02/05/2005
            Notes: Consider using M77
      N39 = Procedure code is not compatible with
            tooth number/letter.
            Start: 01/01/2000
      N40 = Missing radiology film(s)/image(s).
            Start: 01/01/2000
            Notes: Related to N242
      N41 = Authorization request denied.
            Start: 01/01/2000 |
            Stop: 10/16/2003
            Notes: Consider using Reason Code 39
      N42 = No record of mental health assessment.
            Start: 01/01/2000
      N43 = Bed hold or leave days exceeded.
            Start: 01/01/2000
      N44 = Payer's share of regulatory surcharges,
            assessments, allowances or health
            care-related taxes paid directly to the
            regulatory authority.
            Start: 01/01/2000 |
            Stop: 10/16/2003
            Notes: Consider using Reason Code 137
      N45 = Payment based on authorized amount.
            Start: 01/01/2000
      N46 = Missing/incomplete/invalid admission
            hour.
            Start: 01/01/2000
      N47 = Claim conflicts with another inpatient
            stay.
            Start: 01/01/2000
      N48 = Claim information does not agree with
            information received from other
            insurance carrier.
            Start: 01/01/2000
      N49 = Court ordered coverage information
            needs validation.
            Start: 01/01/2000
      N50 = Missing/incomplete/invalid discharge
            information.
            Start: 01/01/2000
      N51 = Electronic interchange agreement not on
            file for provider/submitter.
            Start: 01/01/2000
      N52 = Patient not enrolled in the billing
            provider's managed care plan on the
            date of service.
            Start: 01/01/2000
      N53 = Missing/incomplete/invalid point of
            pick-up address.
            Start: 01/01/2000
            Notes: (Modified 2/28/03)
      N54 = Claim information is inconsistent with
            pre-certified/authorized services.
            Start: 01/01/2000
      N55 = Procedures for billing with
            group/referring/performing providers
            were not followed.
            Start: 01/01/2000
      N56 = Procedure code billed is not
            correct/valid for the services billed
            or the date of service billed.
            Start: 01/01/2000
      N57 = Missing/incomplete/invalid prescribing
            date.
            Start: 01/01/2000
            Notes: Related to N304
      N58 = Missing/incomplete/invalid patient
            liability amount.
            Start: 01/01/2000
      N59 = Please refer to your provider manual
            for additional program and provider
            information.
            Start: 01/01/2000
      N60 = A valid NDC is required for payment of
            drug claims effective October 02.
            Start: 01/01/2000
            Stop: 01/31/2004
            Notes: Consider using M119
      N61 = Rebill services on separate claims.
            Start: 01/01/2000
      N62 = Dates of service span multiple rate
            periods. Resubmit separate claims.
            Start: 01/01/2000
      N63 = Rebill services on separate claim
            lines.
            Start: 01/01/2000
      N64 = The "from" and "to" dates must be
            different.
            Start: 01/01/2000
      N65 = Procedure code or procedure rate count
            cannot be determined, or was not on
            file, for the date of service/provider.
            Start: 01/01/2000
      N66 = Missing/incomplete/invalid
            documentation.
            Start: 01/01/2000
            Stop: 02/05/2005
            Notes: Consider using N29 or N225.
      N67 = Professional provider services not paid
            separately. Included in facility
            payment under a demonstration project.
            Apply to that facility for payment, or
            resubmit your claim if: the facility
            notifies you the patient was excluded
            from this demonstration; or if you
            furnished these services in another
            location on the date of the patient's
            admission or discharge from a
            demonstration hospital. If services
            were furnished in a facility not
            involved in the demonstration on the
            same date the patient was discharged
            from or admitted to a demonstration facility,
            you must report the provider
            ID number for the non-demonstration
            facility on the new claim.
            Start: 01/01/2000
      N68 = Prior payment being cancelled as we
            were subsequently notified this patient
            was covered by a demonstration project
            in this site of service. Professional
            services were included in the payment
            made to the facility. You must contact
            the facility for your payment. Prior
            payment made to you by the patient or
            another insurer for this claim must be
            refunded to the payer within 30 days.
            Start: 01/01/2000
      N69 = PPS (Prospective Payment System) code
            changed by claims processing system.
            Start: 01/01/2000
      N70 = Consolidated billing and payment
            applies.
            Start: 01/01/2000
      N71 = Your unassigned claim for a drug or
            biological, clinical diagnostic
            laboratory services or ambulance
            service was processed as an assigned
            claim. You are required by law to
            accept assignment for these types of
            claims.
            Start: 01/01/2000
      N72 = PPS (Prospective Payment System) code
            changed by medical reviewers. Not
            supported by clinical records.
            Start: 01/01/2000
      N73 = A Skilled Nursing Facility is
            responsible for payment of outside
            providers who furnish these services/
            supplies under arrangement to
            its residents.
            Start: 01/01/2000
            Stop: 01/31/2004
            Notes: Consider using MA101 or N200
      N74 = Resubmit with multiple claims, each
            claim covering services provided in
            only one calendar month.
            Start: 01/01/2000
      N75 = Missing/incomplete/invalid tooth
            surface information.
            Start: 01/01/2000
      N76 = Missing/incomplete/invalid number of
            riders.
            Start: 01/01/2000
      N77 = Missing/incomplete/invalid designated
            provider number.
            Start: 01/01/2000
      N78 = The necessary components of the child
            and teen checkup (EPSDT) were not
            completed.
            Start: 01/01/2000
      N79 = Service billed is not compatible with
            patient location information.
            Start: 01/01/2000
      N80 = Missing/incomplete/invalid prenatal
            screening information.
            Start: 01/01/2000 |
      N81 = Procedure billed is not compatible with
            tooth surface code.
            Start: 01/01/2000
      N82 = Provider must accept insurance payment
            as payment in full when a third party
            payer contract specifies full
            reimbursement.
            Start: 01/01/2000
      N83 = No appeal rights. Adjudicative decision
            based on the provisions of a
            demonstration project.
            Start: 01/01/2000
      N84 = Alert: Further installment payments are
            forthcoming.
            Start: 01/01/2000 |
      N85 = Alert: This is the final installment
            payment.
            Start: 01/01/2000 | Last Modified: 04/01/2007
            Notes: (Modified 4/1/07, 8/1/07)
      N86 = A failed trial of pelvic muscle
            exercise training is required in order
            for biofeedback training for the
            treatment of urinary incontinence to be
            covered.
            Start: 01/01/2000
      N87 = Home use of biofeedback therapy is not
            covered.
            Start: 01/01/2000
      N88 = Alert: This payment is being made
            conditionally. An HHA episode of care
            notice has been filed for this patient.
            When a patient is treated under a HHA
            episode of care, consolidated billing
            requires that certain therapy services
            and supplies, such as this, be included
            in the HHA's payment. This payment will
            need to be recouped from you if we
            establish that the patient is
            concurrently receiving treatment under
            a HHA episode of care.
            Start: 01/01/2000
      N89 = Alert: Payment information for this
            claim has been forwarded to more than
            one other payer, but format limitations
            permit only one of the secondary payers
            to be identified in this remittance
            advice.
            Start: 01/01/2000
      N90 = Covered only when performed by the
            attending physician.
            Start: 01/01/2000
      N91 = Services not included in the appeal
            review.
            Start: 01/01/2000
      N92 = This facility is not certified for
            digital mammography.
            Start: 01/01/2000
      N93 = A separate claim must be submitted for
            each place of service. Services
            furnished at multiple sites may not be
            billed in the same claim.
            Start: 01/01/2000
      N94 = Claim/Service denied because a more
            specific taxonomy code is required for
            adjudication.
            Start: 01/01/2000
      N95 = This provider type/provider specialty
            may not bill this service.
            Start: 07/31/2001
      N96 = Patient must be refractory to
            conventional therapy (documented
            behavioral, pharmacologic and/or
            surgical corrective therapy) and be an
            appropriate surgical candidate such
            that implantation with anesthesia can
            occur.
            Start: 08/24/2001
      N97 = Patients with stress incontinence,
            urinary obstruction, and specific
            neurologic diseases (e.g., diabetes
            with peripheral nerve involvement)
            which are associated with secondary
            manifestations of the above three
            indications are excluded.
            Start: 08/24/2001
      N98 = Patient must have had a successful test
            stimulation in order to support
            subsequent implantation. Before a
            patient is eligible for permanent
            implantation, he/she must demonstrate a
            50 percent or greater improvement
            through test stimulation. Improvement
            is measured through voiding diaries.
            Start: 08/24/2001
      N99 = Patient must be able to demonstrate
            adequate ability to record voiding
            diary data such that clinical results
            of the implant procedure can be
            properly evaluated.
            Start: 08/24/2001
      N100 = PPS (Prospect Payment System) code
             corrected during adjudication.
             Start: 09/14/2001
      N101 = Additional information is needed in
             order to process this claim. Please
             resubmit the claim with the
             identification number of the provider
             where this service took place. The
             Medicare number of the site of service
             provider should be preceded with the
             letters 'HSP' and entered into item #32
             on the claim form. You may bill only one
             site of service provider number per
             claim.
             Start: 10/31/2001
             Stop: 01/31/2004
             Notes: Consider uisng MA105
      N102 = This claim has been denied without
             reviewing the medical record because
             the requested records were not received
             or were not received timely.
             Start: 10/31/2001
      N103 = Social Security records indicate that
             this patient was a prisoner when the
             service was rendered. This payer does
             not cover items and services furnished
             to an individual while he or she is in
             a Federal facility, or while he or she
             is in State or local custody under a
             penal authority, unless under State or
             local law, the individual is personally
             liable for the cost of his or her
             health care while incarcerated and the
             State or local government pursues such
             debt in the same way and with the same
             vigor as any other debt.
             Start: 10/31/2001
      N104 = This claim/service is not payable under
             our claims jurisdiction area. You can
             identify the correct Medicare
             contractor to process this
             claim/service through the CMS website
             at www.cms.gov.
             Start: 01/29/2002
      N105 = This is a misdirected claim/service for
             an RRB beneficiary. Submit paper claims
             to the RRB carrier: Palmetto GBA, P.O.
             Box 10066, Augusta, GA 30999. Call
             866-749-4301 for RRB EDI information
             for electronic claims processing.
             Start: 01/29/2002
      N106 = Payment for services furnished to
             Skilled Nursing Facility (SNF)
             inpatients (except for excluded
             services) can only be made to the SNF.
             You must request payment from the SNF
             rather than the patient for this
             service.
             Start: 01/31/2002
      N107 = Services furnished to Skilled Nursing
             Facility (SNF) inpatients must be
             billed on the inpatient claim. They
             cannot be billed separately as
             outpatient services.
             Start: 01/31/2002
      N108 = Missing/incomplete/invalid upgrade
             information.
             Start: 01/31/2002 |
             Last Modified: 02/28/2003
             Notes: (Modified 2/28/03)
      N109 = This claim/service was chosen for
             complex review and was denied after
             reviewing the medical records.
             Start: 02/28/2002
             Last Modified: 03/01/2009
             Notes: (Modified 3/1/2009)
      N110 = This facility is not certified for film
             mammography.
             Start: 02/28/2002
      N111 = No appeal right except duplicate
             claim/service issue. This service was
             included in a claim that has been
             previously billed and adjudicated.
             Start: 02/28/2002
      N112 = This claim is excluded from your
             electronic remittance advice.
             Start: 02/28/2002
      N113 = Only one initial visit is covered per
             physician, group practice or provider.
             Start: 04/16/2002
      N114 = During the transition to the Ambulance
             Fee Schedule, payment is based on the
             lesser of a blended amount calculated
             using a percentage of the reasonable
             charge/cost and fee schedule amounts,
             or the submitted charge for the
             service. You will be notified yearly
             what the percentages for the blended
             payment calculation will be.
             Start: 05/30/2002
      N115 = This decision was based on a Local
             Coverage Determination (LCD). An LCD
             provides a guide to assist in
             determining whether a particular item
             or service is covered. A copy of this
             policy is available at www.cms.gov/mcd,
             or if you do not have web access, you
             may contact the contractor to request a
             copy of the LCD.
             Start: 05/30/2002
      N116 = This payment is being made
             conditionally because the service was
             provided in the home, and it is
             possible that the patient is under a
             home health episode of care. When a
             patient is treated under a home health
             episode of care, consolidated billing
             requires that certain therapy services
             and supplies, such as this, be included
             in the home health agency's (HHA's)
             payment. This payment will need to be
             recouped from you if we establish that
             the patient is concurrently receiving
             treatment under an HHA episode of care.
             Start: 06/30/2002
      N117 = This service is paid only once in a
             patient's lifetime.
             Start: 07/30/2002
      N118 = This service is not paid if billed more
             than once every 28 days.
             Start: 07/30/2002
      N119 = This service is not paid if billed once
             every 28 days, and the patient has
             spent 5 or more consecutive days in any
             inpatient or Skilled /nursing Facility
             (SNF) within those 28 days.
             Start: 07/30/2002
      N120 = Payment is subject to home health
             prospective payment system partial
             episode payment adjustment. Patient was
             transferred/discharged/readmitted
             during payment episode.
             Start: 08/09/2002
      N121 = Medicare Part B does not pay for items
             or services provided by this type of
             practitioner for beneficiaries in a
             Medicare Part A covered Skilled Nursing
             Facility (SNF) stay.
             Start: 09/09/2002
      N122 = Add-on code cannot be billed by itself.
             Start: 09/12/2002
      N123 = This is a split service and represents
             a portion of the units from the
             originally submitted service.
             Start: 09/24/2002
      N124 = Payment has been denied for the/made
             only for a less extensive service/item
             because the information furnished does
             not substantiate the need for the (more
             extensive) service/item. The patient is
             liable for the charges for this
             service/item as you informed the
             patient in writing before the
             service/item was furnished that we
             would not pay for it, and the patient
             agreed to pay.
             Start: 09/26/2002
             "Payment has been (denied for the/made
             only for a less extensive) service/item
             because the information furnished does
             not substantiate the need for the (more
             extensive) service/item. If you have
             collected any amount from the patient,
             you must refund that amount to the
             patient within 30 days of receiving
             this notice.
             The requirements for a refund are in
             Ì1834(a)(18) of the Social Security Act
             (and in ÌÌ1834(j)(4) and 1879(h) by
             cross-reference to Ì1834(a)(18)).
             Section 1834(a)(18)(B) specifies that
             suppliers which knowingly and willfully
             fail to make appropriate refunds may be
             subject to civil money penalties and/or
             exclusion from the Medicare program. If
             you have any questions about this
             notice, please contact this office."
             Start: 09/26/2002
      N126 = Social Security Records indicate that
             this individual has been deported. This
             payer does not cover items and services
             furnished to individuals who have been
             deported.
             Start: 10/17/2002
      N127 = This is a misdirected claim/service for
             a United Mine Workers of America (UMWA)
             beneficiary. Please submit claims to
             them.
             Start: 10/31/2007
      N128 = This amount represents the prior to
             coverage portion of the allowance.
             Start: 10/31/2002
      N129 = Not eligible due to the patient's age.
             Start: 10/31/2002
      N130 = Consult plan benefit
             documents/guidelines for information
             about restrictions for this service.
             Start: 10/31/2002
      N131 = Total payments under multiple contracts
             cannot exceed the allowance for this
             service.
             Start: 10/31/2002
      N132 = Alert: Payments will cease for services
             rendered by this US Government debarred
             or excluded provider after the 30 day
             grace period as previously notified.
             Start: 10/31/2002
      N133 = Alert: Services for predetermination
             and services requesting payment are
             being processed separately.
             Start: 10/31/2002
      N134 = Alert: This represents your scheduled
             payment for this service. If treatment
             has been discontinued, please contact
             Customer Service.
             Start: 10/31/2002
      N135 = Record fees are the patient's
             responsibility and limited to the
             specified co-payment.
             Start: 10/31/2002
      N136 = Alert: To obtain information on the
             process to file an appeal in Arizona,
             call the Department's Consumer
             Assistance Office at (602) 912-8444
             or (800) 325-2548.
             Start: 10/31/2002
      N137 = Alert: The provider acting on the
             Member's behalf, may file an appeal with
             the Payer. The provider, acting on the
             Member's behalf, may file a complaint
             with the State Insurance Regulatory
             Authority without first filing an appeal,
             if the coverage decision involves an
             urgent condition for which care has not
             been rendered. The address may be
             obtained from the State Insurance
             Regulatory Authority.
             Start: 10/31/2002
      N138 = Alert: In the event you disagree with
             the Dental Advisor's opinion and have
             additional information relative to the
             case, you may submit radiographs to the
             Dental Advisor Unit at the subscriber's
             dental insurance carrier for a second
             Independent Dental Advisor Review.
             Start: 10/31/2002
      N139 = Alert: Under the Code of Federal
             Regulations, Chapter 32, Section 199.13
             a non-participating provider is not an
             appropriate appealing party. Therefore,
             if you disagree with the Dental
             Advisor's opinion, you may appeal the
             determination if appointed in writing,
             by the beneficiary, to act as his/her
             representative. Should you be appointed
             as a representative, submit a copy of
             this letter, a signed statement
             explaining the matter in which you
             disagree, and any radiographs and
             relevant information to the subscriber's
             Dental insurance carrier within 90 days
             from the date of this letter.
             Start: 10/31/2002
      N140 = Alert: You have not been designated as
             an authorized OCONUS provider therefore
             are not considered an appropriate
             appealing party. If the beneficiary has
             appointed you, in writing, to act as
             his/her representative and you disagree
             with the Dental Advisor's opinion, you
             may appeal by submitting a copy of this
             letter, a signed statement explaining
             the matter in which you disagree, and
             any relevant information to the
             subscriber's Dental insurance carrier
             within 90 days from the date of this
             letter.
             Start: 10/31/2002
      N141 = The patient was not residing in a
             long-term care facility during all or
             part of the service dates billed.
             Start: 10/31/2002
      N142 = The original claim was denied. Resubmit
             a new claim, not a replacement claim.
             Start: 10/31/2002
      N143 = The patient was not in a hospice
             program
             during all or part of the service dates
             billed.
             Start: 10/31/2002
      N144 = The rate changed during the dates of
             service billed.
             Start: 10/31/2002
      N145 = Missing/incomplete/invalid provider
             identifier for this place of service.
             Start: 10/31/2002
             Stop: 06/02/2005
      N146 = Missing screening document.
             Start: 10/31/2002
             Notes: Related to N243
      N147 = Long term care case mix or per diem
             rate cannot be determined because the
             patient ID number is missing, incomplete
             or invalid on the assignment request.
             Start: 10/31/2002
      N148 = Missing/incomplete/invalid date of last
             menstrual period.
             Start: 10/31/2002
      N149 = Rebill all applicable services on a
             single claim.
             Start: 10/31/2002
      N150 = Missing/incomplete/invalid model
             number.
             Start: 10/31/2002
      N151 = Telephone contact services will not be
             paid until the face-to-face contact
             requirement has been met.
             Start: 10/31/2002
      N152 = Missing/incomplete/invalid replacement
             claim information.
             Start: 10/31/2002
      N153 = Missing/incomplete/invalid room and
             board rate.
             Start: 10/31/2002
      N154 = Alert: This payment was delayed for
             correction of provider's mailing
             address.
             Start: 10/31/2002
      N155 = Alert: Our records do not indicate that
             other insurance is on file. Please
             submit other insurance information for
             our records.
             Start: 10/31/2002
      N156 = Alert: The patient is responsible for
             the difference between the approved
             treatment and the elective treatment.
             Start: 10/31/2002
      N157 = Transportation to/from this destination
             is not covered.
             Start: 02/28/2003
      N158 = Transportation in a vehicle other than
             an ambulance is not covered.
             Start: 02/28/2003
      N159 = Payment denied/reduced because mileage
             is not covered when the patient is not
             in the ambulance.
             Start: 02/28/2003
      N160 = The patient must choose an option
             before a payment can be made for this
              procedure/ equipment/ supply/ service.
              Start: 02/28/2003
      N161 = This drug/service/supply is covered
             only when the associated service is
             covered.
             Start: 02/28/2003
      N162 = Alert: Although your claim was paid,
             you have billed for a test/specialty
             not included in your laboratory
             Certification. Your failure to correct
             the laboratory certification information
             will result in a denial of payment in
             the near future.
             Start: 02/28/2003|
      N163 = Medical record does not support code
             billed per the code definition.
             Start: 02/28/2003
      N164 = Transportation to/from this destination
             is not covered.
             Start: 02/28/2003
             Stop: 01/31/2004
             Notes: Consider using N157
      N165 = Transportation in a vehicle other than
             an ambulance is not covered.
             Start: 02/28/2003
             Stop: 01/31/2004
             Notes: Consider using N158)
      N166 = Payment denied/reduced because mileage
             is not covered when the patient is not
             in the ambulance.
             Start: 02/28/2003
             Stop: 01/31/2004
             Notes: Consider using N159
      N167 = Charges exceed the post-transplant
             coverage limit.
             Start: 02/28/2003
      N168 = The patient must choose an option
              before
              a payment can be made for this
              procedure/ equipment/ supply/ service.
              Start: 02/28/2003
              Stop: 01/31/2004
              Notes: Consider using N160
      N169 = This drug/service/supply is covered
             only when the associated service is
             covered.
             Start: 02/28/2003
             Stop: 01/31/2004
             Notes: Consider using N161
      N170 = A new/revised/renewed certificate of
             medical necessity is needed.
             Start: 02/28/2003
      N171 = Payment for repair or replacement is
             not covered or has exceeded the purchase
             price.
             Start: 02/28/2003
      N172 = The patient is not liable for the
             denied/adjusted charge(s) for receiving
             any updated service/item.
             Start: 02/28/2003
      N173 = No qualifying hospital stay dates were
             provided for this episode of care.
             Start: 02/28/2003
      N174 = This is not a covered
             service/procedure/
             equipment/bed, however patient liability
             is limited to amounts shown in the
             adjustments under group 'PR'.
             Start: 02/28/2003
      N175 = Missing review organization approval.
             Start: 02/28/2003
             Notes: Related to N241
      N176 = Services provided aboard a ship are
             covered only when the ship is of United
             States registry and is in United States
             waters. In addition, a doctor licensed
             to practice in the United States must
             provide the service.
             Start: 02/28/2003
      N177 = Alert: We did not send this claim to
             patient's other insurer. They have
             indicated no additional payment can be
             made.
             Start: 02/28/2003
      N178 = Missing pre-operative photos or visual
             field results.
             Start: 02/28/2003
             Notes: Related to N244
      N179 = Additional information has been
             requested from the member. The charges
             will be reconsidered upon receipt of that
             information.
             Start: 02/28/2003
      N180 = This item or service does not meet the
             criteria for the category under which it
             was billed.
             Start: 02/28/2003
      N181 = Additional information is required from
             another provider involved in this service.
             Start: 02/28/2003
             Last Modified: 12/01/2006
             Notes: (Modified 12/1/06)
      N182 = This claim/service must be billed
             according to the schedule for this plan.
             Start: 02/28/2003
      N183 = Alert: This is a predetermination
             advisory message, when this service is
             submitted for payment additional
             documentation as specified in plan
             documents will be required to process
             benefits.
             Start: 02/28/2003
      N184 = Rebill technical and professional
             components separately.
             Start: 02/28/2003
      N185 = Alert: Do not resubmit this
             claim/service.
             Start: 02/28/2003
      N186 = Non-Availability Statement (NAS)
             required for this service. Contact the
             nearest Military Treatment Facility
             (MTF) for assistance.
              Start: 02/28/2003
      N187 = Alert: You may request a review in
             writing within the required time limits
             following receipt of this notice by
             following the instructions included in
             your contract or plan benefit documents.
             Start: 02/28/2003
      N188 = The approved level of care does not
             match the procedure code submitted.
             Start: 02/28/2003
      N189 = Alert: This service has been paid as a
             one-time exception to the plan's benefit
             restrictions.
             Start: 02/28/2003
      N190 = Missing contract indicator.
             Start: 02/28/2003
             Notes: Related to N229
      N191 = The provider must update insurance
             information directly with payer.
             Start: 02/28/2003
      N192 = Patient is a Medicaid/Qualified
             Medicare Beneficiary
             Start: 02/28/2003
      N193 = Specific federal/state/local program may
             cover this service through another payer.
             Start: 02/28/2003
      N194 = Technical component not paid if
             provider does not own the equipment
             used.
             Start: 02/25/2003
      N195 = The technical component must be billed
             separately.
             Start: 02/25/2003
      N196 = Alert: Patient eligible to apply for
             other coverage which may be primary.
             Start: 02/25/2003
      N197 = The subscriber must update insurance
             information directly with payer.
             Start: 02/25/2003
      N198 = Rendering provider must be affiliated
             with the pay-to provider.
             Start: 02/25/2003
      N199 = Additional payment/recoupment approved
             based on payer-initiated review/audit.
             Start: 02/25/2003
      N200 = The professional component must be
             billed separately.
             Start: 02/25/2003
      N201 = A mental health facility is responsible
             for payment of outside providers who
             furnish these services/supplies to residents.
             Start: 02/25/2003
             Stop: 01/01/2011
             Notes: Consider using N538
      N202 = Additional information/explanation will
             be sent separately
             Start: 06/30/2003
      N203 = Missing/incomplete/invalid anesthesia
             time/units
             Start: 06/30/2003
      N204 = Services under review for possible
             pre-existing condition. Send medical
             records for prior 12 months
             Start: 06/30/2003
      N205 = Information provided was illegible
             Start: 06/30/2003
      N206 = The supporting documentation does not
             match the information sent on the claim.
             Start: 06/30/2003
             Notes: (Modified 3/6/12)
      N207 = Missing/incomplete/invalid weight.
             Start: 06/30/2003
      N208 = Missing/incomplete/invalid DRG code
             Start: 06/30/2003
      N209 = Missing/incomplete/invalid taxpayer
             identification number (TIN).
             Start: 06/30/2003
      N210 = Alert: You may appeal this decision
             Start: 06/30/2003
      N211 = Alert: You may not appeal this decision
             Start: 06/30/2003
      N212 = Charges processed under a Point of
             Service benefit
             Start: 02/01/2004
      N213 = Missing/incomplete/invalid
             facility/discrete unit DRG/DRG exempt
             status information
             Start: 04/01/2004
      N214 = Missing/incomplete/invalid history of
             the related initial surgical
             procedure(s)
             Start: 04/01/2004
      N215 = Alert: A payer providing supplemental
             or secondary coverage shall not require
             a claims determination for this service
             from a primary payer as a condition of
             making its own claims determination.
             Start: 04/01/2004
      N216 = We do not offer coverage for this type
             of service or the patient is not
             enrolled in this portion of our benefit
             package
             Start: 04/01/2004
      N217 = We pay only one site of service per
             provider per claim
             Start: 08/01/2004
      N218 = You must furnish and service this item
             for as long as the patient continues to
             need it. We can pay for maintenance
             and/or servicing for the time period
             specified in the contract or coverage manual.
             Start: 08/01/2004
      N219 = Payment based on previous payer's
             allowed amount.
             Start: 08/01/2004
      N220 = Alert: See the payer's web site or
             contact the payer's Customer Service
             department to obtain forms and
             instructions for filing a provider
             dispute.
             Start: 08/01/2004
      N221 = Missing Admitting History and Physical
             report.
             Start: 08/01/2004
      N222 = Incomplete/invalid Admitting History
             and Physical report.
             Start: 08/01/2004
      N223 = Missing documentation of benefit to the
             patient during initial treatment period.
      N224 = Incomplete/invalid documentation of
             benefit to the patient during initial
             treatment period.
             Start: 08/01/2004
      N225 = Incomplete/invalid
             documentation/orders/notes/summary/
             report/chart.
             Start: 08/01/2004
      N226 = Incomplete/invalid American Diabetes
             Association Certificate of Recognition.
             Start: 08/01/2004
      N227 = Incomplete/invalid Certificate of
             Medical Necessity.
             Start: 08/01/2004
      N228 = Incomplete/invalid consent form.
             Start: 08/01/2004
      N229 = Incomplete/invalid contract indicator.
             Start: 08/01/2004
      N230 = Incomplete/invalid indication of
             whether the patient owns the equipment
             equipment that requires the part or
             or supply.
             Start: 08/01/2004
      N231 = Incomplete/invalid invoice or statement
             certifying the actual cost of the lens,
             less discounts, and/or the type of
             intraocular lens used.
             Start: 08/01/2004
      N232 = Incomplete/invalid itemized
             bill/statement.
             Start: 08/01/2004
      N233 = Incomplete/invalid operative
             note/report.
             Start: 08/01/2004
      N234 = Incomplete/invalid oxygen
             certification/re-certification.
             Start: 08/01/2004
      N235 = Incomplete/invalid pacemaker
             registration form.
             Start: 08/01/2004
      N236 = Incomplete/invalid pathology report.
             Start: 08/01/2004
      N237 = Incomplete/invalid patient medical
             record for this service.
             Start: 08/01/2004
      N238 = Incomplete/invalid physician certified
             plan of care
             Start: 08/01/2004
      N239 = Incomplete/invalid physician financial
             relationship form.
             Start: 08/01/2004
      N240 = Incomplete/invalid radiology report.
             Start: 08/01/2004
      N241 = Incomplete/invalid review organization
             approval.
             Start: 08/01/2004
      N242 = Incomplete/invalid radiology film(s)
             /image(s).
             Start: 08/01/2004
      N243 = Incomplete/invalid/not approved
             screening document.
             Start: 08/01/2004
      N244 = Incomplete/invalid pre-operative
             photos/visual field results.
             Start: 08/01/2004
      N245 = Incomplete/invalid plan information for
             other insurance
             Start: 08/01/2004
      N246 = State regulated patient payment
             limitations apply to this service.
             Start: 12/02/2004
      N247 = Missing/incomplete/invalid assistant
             surgeon taxonomy.
             Start: 12/02/2004
      N248 = Missing/incomplete/invalid assistant
             surgeon name.
             Start: 12/02/2004
      N249 = Missing/incomplete/invalid assistant
             surgeon primary identifier.
             Start: 12/02/2004
      N250 = Missing/incomplete/invalid assistant
             surgeon secondary identifier.
             Start: 12/02/2004
      N251 = Missing/incomplete/invalid attending
             provider taxonomy.
             Start: 12/02/2004
      N252 = Missing/incomplete/invalid attending
             provider name.
             Start: 12/02/2004
      N253 = Missing/incomplete/invalid attending
             provider primary identifier.
             Start: 12/02/2004
      N254 = Missing/incomplete/invalid attending
             provider secondary identifier.
             Start: 12/02/2004
      N255 = Missing/incomplete/invalid billing
             provider taxonomy.
             Start: 12/02/2004
      N256 = Missing/incomplete/invalid billing
             provider/supplier name.
             Start: 12/02/2004
      N257 = Missing/incomplete/invalid billing
             provider/supplier primary identifier.
             Start: 12/02/2004
      N258 = Missing/incomplete/invalid billing
             provider/supplier address.
             Start: 12/02/2004
      N259 = Missing/incomplete/invalid billing
             provider/supplier secondary identifier.
             Start: 12/02/2004
      N260 = Missing/incomplete/invalid billing
             provider/supplier contact information.
             Start: 12/02/2004
      N261 = Missing/incomplete/invalid operating
             provider name.
             Start: 12/02/2004
      N262 = Missing/incomplete/invalid operating
             provider primary identifier.
             Start: 12/02/2004
      N263 = Missing/incomplete/invalid operating
             provider secondary identifier.
             Start: 12/02/2004
      N264 = Missing/incomplete/invalid ordering
             provider name.
             Start: 12/02/2004
      N265 = Missing/incomplete/invalid ordering
             provider primary identifier.
             Start: 12/02/2004
      N266 = Missing/incomplete/invalid ordering
             provider address.
             Start: 12/02/2004
      N267 = Missing/incomplete/invalid ordering
             provider secondary identifier.
             Start: 12/02/2004
      N268 = Missing/incomplete/invalid ordering
             provider contact information.
             Start: 12/02/2004
      N269 = Missing/incomplete/invalid other
             provider name.
             Start: 12/02/2004
      N270 = Missing/incomplete/invalid other
             provider primary identifier.
             Start: 12/02/2004
      N271 = Missing/incomplete/invalid other
             provider secondary identifier.
             Start: 12/02/2004
      N272 = Missing/incomplete/invalid other payer
             attending provider identifier.
             Start: 12/02/2004
      N273 = Missing/incomplete/invalid other payer
             operating provider identifier.
             Start: 12/02/2004
      N274 = Missing/incomplete/invalid other payer
             other provider identifier.
             Start: 12/02/2004
      N275 = Missing/incomplete/invalid other payer
             purchased service provider identifier.
             Start: 12/02/2004
      N276 = Missing/incomplete/invalid other payer
             referring provider identifier.
             Start: 12/02/2004
      N277 = Missing/incomplete/invalid other payer
             rendering provider identifier.
             Start: 12/02/2004
      N278 = Missing/incomplete/invalid other payer
             service facility provider identifier.
             Start: 12/02/2004
      N279 = Missing/incomplete/invalid pay-to
             provider name.
             Start: 12/02/2004
      N280 = Missing/incomplete/invalid pay-to
             provider primary identifier.
             Start: 12/02/2004
      N281 = Missing/incomplete/invalid pay-to
             provider address.
             Start: 12/02/2004
      N282 = Missing/incomplete/invalid pay-to
             provider secondary identifier.
             Start: 12/02/2004
      N283 = Missing/incomplete/invalid purchased
             service provider identifier.
             Start: 12/02/2004
      N284 = Missing/incomplete/invalid referring
             provider taxonomy.
             Start: 12/02/2004
      N285 = Missing/incomplete/invalid referring
             provider name.
             Start: 12/02/2004
      N286 = Missing/incomplete/invalid referring
             provider primary identifier.
             Start: 12/02/2004
      N287 = Missing/incomplete/invalid referring
             provider secondary identifier.
             Start: 12/02/2004
      N288 = Missing/incomplete/invalid rendering
             provider taxonomy.
             Start: 12/02/2004
      N289 = Missing/incomplete/invalid rendering
             provider name.
             Start: 12/02/2004
      N290 = Missing/incomplete/invalid rendering
             provider primary identifier.
             Start: 12/02/2004
      N291 = Missing/incomplete/invalid rendering
             provider secondary identifier.
             Start: 12/02/2004
      N292 = Missing/incomplete/invalid service
             facility name.
             Start: 12/02/2004
      N293 = Missing/incomplete/invalid service
             facility primary identifier.
             Start: 12/02/2004
      N294 = Missing/incomplete/invalid service
             facility primary address.
             Start: 12/02/2004
      N295 = Missing/incomplete/invalid service
             facility secondary identifier.
             Start: 12/02/2004
      N296 = Missing/incomplete/invalid supervising
             provider name.
             Start: 12/02/2004
      N297 = Missing/incomplete/invalid supervising
             provider primary identifier.
             Start: 12/02/2004
      N298 = Missing/incomplete/invalid supervising
             provider secondary identifier.
             Start: 12/02/2004
      N299 = Missing/incomplete/invalid occurrence
             date(s).
             Start: 12/02/2004
      N300 = Missing/incomplete/invalid occurrence
             span date(s).
             Start: 12/02/2004
      N301 = Missing/incomplete/invalid procedure
             date(s).
             Start: 12/02/2004
      N302 = Missing/incomplete/invalid other
             procedure date(s).
             Start: 12/02/2004
      N303 = Missing/incomplete/invalid principal
             procedure date.
             Start: 12/02/2004
      N304 = Missing/incomplete/invalid dispensed
             date.
             Start: 12/02/2004
      N305 = Missing/incomplete/invalid accident
             date.
             Start: 12/02/2004
      N306 = Missing/incomplete/invalid acute
             manifestation date.
             Start: 12/02/2004
      N307 = Missing/incomplete/invalid adjudication
             or payment date.
             Start: 12/02/2004
      N308 = Missing/incomplete/invalid appliance
             placement date.
             Start: 12/02/2004
      N309 = Missing/incomplete/invalid assessment
             date.
             Start: 12/02/2004
      N310 = Missing/incomplete/invalid assumed or
             relinquished care date.
             Start: 12/02/2004
      N311 = Missing/incomplete/invalid authorized
             to return to work date.
             Start: 12/02/2004
      N312 = Missing/incomplete/invalid begin
             therapy date.
             Start: 12/02/2004
      N313 = Missing/incomplete/invalid
             certification revision date.
             Start: 12/02/2004
      N314 = Missing/incomplete/invalid diagnosis
             date.
             Start: 12/02/2004
      N315 = Missing/incomplete/invalid disability
             from date.
             Start: 12/02/2004
      N316 = Missing/incomplete/invalid disability
             to date.
             Start: 12/02/2004
      N317 = Missing/incomplete/invalid discharge
             hour.
             Start: 12/02/2004
      N318 = Missing/incomplete/invalid discharge or
             end of care date.
             Start: 12/02/2004
      N319 = Missing/incomplete/invalid hearing or
             vision prescription date.
             Start: 12/02/2004
      N320 = Missing/incomplete/invalid Home Health
             Certification Period.
             Start: 12/02/2004
      N321 = Missing/incomplete/invalid last
             admission period.
             Start: 12/02/2004
      N322 = Missing/incomplete/invalid last
             certification date.
             Start: 12/02/2004
      N323 = Missing/incomplete/invalid last contact
             date.
             Start: 12/02/2004
      N324 = Missing/incomplete/invalid last
             seen/visit date.
             Start: 12/02/2004
      N325 = Missing/incomplete/invalid last worked
             date.
             Start: 12/02/2004
      N326 = Missing/incomplete/invalid last x-ray
             date.
             Start: 12/02/2004
      N327 = Missing/incomplete/invalid other insured
             birth date.
             Start: 12/02/2004
      N328 = Missing/incomplete/invalid Oxygen
             Saturation Test date.
             Start: 12/02/2004
      N329 = Missing/incomplete/invalid patient
             birth date
             Start: 12/02/2004
      N330 = Missing/incomplete/invalid patient
             death date.
             Start: 12/02/2004
      N331 = Missing/incomplete/invalid physician
             order date.
             Start: 12/02/2004
      N332 = Missing/incomplete/invalid prior
             hospital discharge date.
             Start: 12/02/2004
      N333 = Missing/incomplete/invalid prior
             placement date.
             Start: 12/02/2004
      N334 = Missing/incomplete/invalid re-  evaluation
             date
             Start: 12/02/2004
      N335 = Missing/incomplete/invalid referral
             date.
             Start: 12/02/2004
      N336 = Missing/incomplete/invalid replacement
             date.
             Start: 12/02/2004
      N337 = Missing/incomplete/invalid secondary
             diagnosis date.
             Start: 12/02/2004
      N338 = Missing/incomplete/invalid shipped  date.
             Start: 12/02/2004
      N339 = Missing/incomplete/invalid similar
             illness or symptom date.
             Start: 12/02/2004
      N340 = Missing/incomplete/invalid subscriber
             birth date.
             Start: 12/02/2004
      N341 = Missing/incomplete/invalid surgery date.
             Start: 12/02/2004
      N342 = Missing/incomplete/invalid test
             performed date.
             Start: 12/02/2004
      N343 = Missing/incomplete/invalid
             Transcutaneous Electrical Nerve
             Stimulator (TENS) trial start date.
             Start: 12/02/2004
      N344 = Missing/incomplete/invalid
             Transcutaneous Electrical Nerve
             Stimulator (TENS) trial end date.
             Start: 12/02/2004
      N345 = Date range not valid with units
             submitted.
             Start: 03/30/2005
      N346 = Missing/incomplete/invalid oral cavity
             designation code.
             Start: 03/30/2005
      N347 = Your claim for a referred or purchased
             service cannot be paid because payment
             has already been made for this same
             service to another provider by a payment
             contractor representing the payer.
             Start: 03/30/2005
      N348 = You chose that this service/supply/drug
             would be rendered/supplied and billed by
             a different practitioner/supplier.
             Start: 08/01/2005
      N349 = The administration method and drug must
             be reported to adjudicate this service.
             Start: 08/01/2005
      N350 = Missing/incomplete/invalid description
             of service for a Not Otherwise Classified
             (NOC) code or for an Unlisted/By Report
             procedure.
             Start: 08/01/2005
      N351 = Service date outside of the approved
             treatment plan service dates.
             Start: 08/01/2005
      N352 = Alert: There are no scheduled payments
             for this service. Submit a claim for
             each patient visit.
             Start: 08/01/2005
      N353 = Alert: Benefits have been estimated,
             when the actual services have been
             rendered, additional payment will be
             considered based on the submitted claim.
             Start: 08/01/2005
      N354 = Incomplete/invalid invoice
             Start: 08/01/2005
            "Alert: The law permits exceptions to
             the refund requirement in two cases: -
             If you did not know, and could not have
             reasonably been expected to know, that
             we would not pay for this service; or -
             If you notified the patient in writing
             before providing the service that you
             believed that we were likely to deny the
             service, and the patient signed a
             statement agreeing to pay for the
             service.
             If you come within either exception, or
             if you believe the carrier was wrong in
             its determination that we do not pay for
             this service, you should request appeal
             of this determination within 30 days of
             the date of this notice. Your request
             for review should include any additional
             information necessary to support your
             position.
             If you request an appeal within 30 days
             of receiving this notice, you may delay
             refunding the amount to the patient
             until you receive the results of the
             review. If the review decision is
             favorable to you, you do not need to
             make any refund. If, however, the review
             is unfavorable, the law specifies that
             you must make the refund within 15 days
             of receiving the unfavorable review
             decision.
             The law also permits you to request an
             appeal at any time within 120 days of
             the date you receive this notice.
             However, an appeal request that is
             received more than 30 days after the
             date of this notice, does not permit you
             to delay making the refund. Regardless
             of when a review is requested, the
             patient will be notified that you have
             requested one, and will receive a copy
             of the determination.
             The patient has received a separate
             notice of this denial decision. The
             notice advises that he/she may be
             entitled to a refund of any amounts
             paid, if you should have known that we
             would not pay and did not tell him/her.
             It also instructs the patient to contact
             our office if he/she does not hear
             anything about a refund within 30 days"
             Start: 08/01/2005
      N356 = Not covered when performed with, or
             subsequent to, a non-covered service.
             Start: 08/01/2005
      N357 = Time frame requirements between this
             service/procedure/supply and a related
             service/procedure/supply have not been
             met.
             Start: 11/18/2005
      N358 = Alert: This decision may be reviewed if
             additional documentation as described in
             the contract or plan benefit documents
             is submitted.
             Start: 11/18/2005
      N359 = Missing/incomplete/invalid height.
             Start: 11/18/2005
      N360 = Alert: Coordination of benefits has not
             been calculated when estimating benefits
             for this pre-determination. Submit
             payment information from the primary
             payer with the secondary claim.
             Start: 11/18/2005
      N361 = Payment adjusted based on multiple
             diagnostic imaging procedure rules
             Start: 11/18/2005
             Stop: 10/01/2007
             Notes: (Modified 12/1/06)
             Consider using Reason Code 59
      N362 = The number of Days or Units of Service
             exceeds our acceptable maximum.
             Start: 11/18/2005
      N363 = Alert: in the near future we are
             implementing new policies/procedures
             that would affect this determination.
             Start: 11/18/2005
      N364 = Alert: According to our agreement, you
             must waive the deductible and/or
             coinsurance amounts.
             Start: 11/18/2005
      N365 = This procedure code is not payable.
             It is for reporting/information purposes
             only.
             Start: 04/01/2006
      N366 = Requested information not provided. The
             claim will be reopened if the
             information previously requested is
             submitted within one year after the date
             of this denial notice.
             Start: 04/01/2006
      N367 = Alert: The claim information has been
             forwarded to a Consumer Spending Account
             processor for review; for example,
             flexible spending account or health
             savings account.
             Start: 04/01/2006
             Last Modified: 07/01/2008
      N368 = You must appeal the determination of
             the previously adjudicated claim.
             Start: 04/01/2006
      N369 = Alert: Although this claim has been
             processed, it is deficient according to
             state legislation/regulation.
             Start: 04/01/2006
      N370 = Billing exceeds the rental months
             covered/approved by the payer.
             Start: 08/01/2006
      N371 = Alert: title of this equipment must be
             transferred to the patient.
             Start: 08/01/2006
      N372 = Only reasonable and necessary
             maintenance/service charges are covered.
             Start: 08/01/2006
      N373 = It has been determined that another
             payer paid the services as primary when
             they were not the primary payer.
             Therefore, we are refunding to the payer
             that paid as primary on your behalf.
             Start: 12/01/2006
      N374 = Primary Medicare Part A insurance has
             been exhausted and a Part B Remittance
             Advice is required.
             Start: 12/01/2006
      N375 = Missing/incomplete/invalid
             questionnaire/information required to
             determine dependent eligibility.
             Start: 12/01/2006
      N376 = Subscriber/patient is assigned to
             active military duty, therefore
             primary coverage may be TRICARE.
             Start: 12/01/2006
      N377 = Payment based on a processed
             replacement claim.
             Start: 12/01/2006
      N378 = Missing/incomplete/invalid prescription
             quantity.
             Start: 12/01/2006
      N379 = Claim level information does not match
             line level information.
             Start: 12/01/2006
      N380 = The original claim has been processed,
             submit a corrected claim.
             Start: 04/01/2007
      N381 = Consult our contractual agreement for
             restrictions/billing/payment information
             related to these charges.
             Start: 04/01/2007
      N382 = Missing/incomplete/invalid patient
             identifier.
             Start: 04/01/2007
      N383 = Not covered when deemed cosmetic.
             Start: 04/01/2007
             Last Modified: 03/08/2011
             Notes: (Modified 3/8/11)
      N384 = Records indicate that the referenced
             body part/tooth has been removed in a
             previous procedure.
             Start: 04/01/2007
      N385 = Notification of admission was not
             timely
             according to published plan procedures.
             Start: 04/01/2007
      N386 = This decision was based on a National
             Coverage Determination (NCD). An NCD
             provides a coverage determination as to
             whether a particular item or service is
             covered. A copy of this policy is
             available at www.cms.gov/mcd/search.asp.
             If you do not have web access, you may
             contact the contractor to request a copy
             of the NCD.
             Start: 04/01/2007
      N387 = Alert: Submit this claim to the
             patient's other insurer for potential
             payment of supplemental benefits. We did
             not forward the claim information.
             Start: 04/01/2007
      N388 = Missing/incomplete/invalid prescription
             number.
             Start: 08/01/2007
      N389 = Duplicate prescription number
             submitted.
             Start: 08/01/2007
      N390 = This service/report cannot be billed
             separately.
             Start: 08/01/2007
      N391 = Missing emergency department records.
             Start: 08/01/2007
      N392 = Incomplete/invalid emergency department
             records.
             Start: 08/01/2007
      N393 = Missing progress notes/report.
             Start: 08/01/2007
      N394 = Incomplete/invalid progress
             notes/report.
             Start: 08/01/2007
      N395 = Missing laboratory report.
             Start: 08/01/2007
      N396 = Incomplete/invalid laboratory report.
             Start: 08/01/2007
      N397 = Benefits are not available for
             incomplete service(s)/undelivered
             item(s).
             Start: 08/01/2007
      N398 = Missing elective consent form.
             Start: 08/01/2007
      N399 = Incomplete/invalid elective consent
             form.
             Start: 08/01/2007
      N400 = Alert: Electronically enabled providers
             should submit claims electronically.
             Start: 08/01/2007
      N401 = Missing periodontal charting.
             Start: 08/01/2007
      N402 = Incomplete/invalid periodontal
             charting.
             Start: 08/01/2007
      N403 = Missing facility certification.
             Start: 08/01/2007
      N404 = Incomplete/invalid facility
             certification.
             Start: 08/01/2007
      N405 = This service is only covered when the
             donor's insurer(s) do not provide
             coverage for the service.
             Start: 08/01/2007
      N406 = This service is only covered when the
             recipient's insurer(s) do not provide
             coverage for the service.
             Start: 08/01/2007
      N407 = You are not an approved submitter for
             this transmission format.
             Start: 08/01/2007
      N408 = This payer does not cover deductibles
             assessed by a previous payer.
             Start: 08/01/2007
      N409 = This service is related to an
             accidental injury and is not covered
             unless provided within a specific time
             frame from the date of the accident.
             Start: 08/01/2007
      N410 = Not covered unless the prescription
             changes.
             Start: 08/01/2007
      N411 = This service is allowed one time in a
             6-month period. (This temporary code
             will be deactivated on 2/1/09. Must be
             used with Reason Code 119.)
             Start: 08/01/2007
             Stop: 02/01/2009
      N412 = This service is allowed 2 times in a
             12-month period. (This temporary code
             will be deactivated on 2/1/09. Must be
             used with Reason Code 119.)
             Start: 08/01/2007
             Stop: 02/01/2009
      N413 = This service is allowed 2 times in a
             benefit year. (This temporary code will
             be deactivated on 2/1/09. Must be used
             with Reason Code 119.)
             Start: 08/01/2007
             Stop: 02/01/2009
      N414 = This service is allowed 4 times in a
             12-month period. (This temporary code
             will be deactivated on 2/1/09. Must be
             used with Reason Code 119.)
             Start: 08/01/2007
             Stop: 02/01/2009
      N415 = This service is allowed 1 time in an
             18-month period. (This temporary code
             will be deactivated on 2/1/09. Must be
             used with Reason Code 119.)
             Start: 08/01/2007
             Stop: 02/01/2009
      N416 = This service is allowed 1 time in a
             3-year period. (This temporary code will
             be deactivated on 2/1/09. Must be used
             with Reason Code 119.)
             Start: 08/01/2007
             Stop: 02/01/2009
      N417 = This service is allowed 1 time in a
             5-year period. (This temporary code will
             be deactivated on 2/1/09. Must be used
             with Reason Code 119.)
             Start: 08/01/2007
             Stop: 02/01/2009
      N418 = Misrouted claim. See the payer's claim
             submission instructions.
             Start: 08/01/2007
      N419 = Claim payment was the result of a
             payer's retroactive adjustment due to a
             retroactive rate change.
             Start: 08/01/2007
      N420 = Claim payment was the result of a
             payer's retroactive adjustment due to a
             Coordination of Benefits or Third Party
             Liability Recovery.
             Start: 08/01/2007
      N421 = Claim payment was the result of a
             payer's retroactive adjustment due to a
             review organization decision.
             Start: 08/01/2007
      N422 = Claim payment was the result of a
             payer's retroactive adjustment due to a
             payer's contract incentive program.
             Start: 08/01/2007
      N423 = Claim payment was the result of a
             payer's retroactive adjustment due to a
             non standard program.
             Start: 08/01/2007
      N424 = Patient does not reside in the
             geographic area required for this type
             of payment.
             Start: 08/01/2007
      N425 = Statutorily excluded service(s).
             Start: 08/01/2007
      N426 = No coverage when self-administered.
             Start: 08/01/2007
      N427 = Payment for eyeglasses or contact
             lenses can be made only after cataract
             surgery.
             Start: 08/01/2007
      N428 = Not covered when performed in this
             place of surgery.
             Start: 08/01/2007
      N429 = Not covered when considered routine.
             Start: 08/01/2007
      N430 = Procedure code is inconsistent with the
             units billed.
             Start: 11/05/2007
      N431 = Not covered with this procedure.
             Start: 11/05/2007
      N432 = Adjustment based on a Recovery Audit.
             Start: 11/05/2007
      N433 = Resubmit this claim using only your
             National Provider Identifier (NPI)
             Start: 02/29/2008
      N434 = Missing/Incomplete/Invalid Present on
             Admission indicator.
             Start: 07/01/2008
      N435 = Exceeds number/frequency approved
             /allowed within time period without
             support documentation.
             Start: 07/01/2008
      N436 = The injury claim has not been accepted
             and a mandatory medical reimbursement
             has been made.
             Start: 07/01/2008
      N437 = Alert: If the injury claim is accepted,
             these charges will be reconsidered.
             Start: 07/01/2008
      N438 = This jurisdiction only accepts paper
             claims
             Start: 07/01/2008
      N439 = Missing anesthesia physical status
             report/indicators.
             Start: 07/01/2008
      N440 = Incomplete/invalid anesthesia physical
             status report/indicators.
             Start: 07/01/2008
      N441 = This missed appointment is not covered.
             Start: 07/01/2008
      N442 = Payment based on an alternate fee
             schedule.
             Start: 07/01/2008
      N443 = Missing/incomplete/invalid total time
             or begin/end time.
             Start: 07/01/2008
      N444 = Alert: This facility has not filed the
             Election for High Cost Outlier form with
             the Division of Workers' Compensation.
             Start: 07/01/2008
      N445 = Missing document for actual cost or
             paid amount.
             Start: 07/01/2008
      N446 = Incomplete/invalid document for actual
             cost or paid amount.
             Start: 07/01/2008
      N447 = Payment is based on a generic
             equivalent
             as required documentation was not
             provided.
             Start: 07/01/2008
      N448 = This drug/service/supply is not
             included
             in the fee schedule or
             contracted/legislated fee arrangement
             Start: 07/01/2008
      N449 = Payment based on a comparable
             drug/service/supply.
             Start: 07/01/2008
      N450 = Covered only when performed by the
             primary treating physician or the
             designee.
             Start: 07/01/2008
      N451 = Missing Admission Summary Report.
             Start: 07/01/2008
      N452 = Incomplete/invalid Admission Summary
             Report.
             Start: 07/01/2008
      N453 = Missing Consultation Report.
             Start: 07/01/2008
      N454 = Incomplete/invalid Consultation Report.
             Start: 07/01/2008
      N455 = Missing Physician Order.
             Start: 07/01/2008
      N456 = Incomplete/invalid Physician Order.
             Start: 07/01/2008
      N457 = Missing Diagnostic Report.
             Start: 07/01/2008
      N458 = Incomplete/invalid Diagnostic Report.
             Start: 07/01/2008
      N459 = Missing Discharge Summary.
             Start: 07/01/2008
      N460 = Incomplete/invalid Discharge Summary.
             Start: 07/01/2008
      N461 = Missing Nursing Notes.
             Start: 07/01/2008
      N462 = Incomplete/invalid Nursing Notes.
             Start: 07/01/2008
      N463 = Missing support data for claim.
             Start: 07/01/2008
      N464 = Incomplete/invalid support data for
             claim.
             Start: 07/01/2008
      N465 = Missing Physical Therapy Notes/Report.
             Start: 07/01/2008
      N466 = Incomplete/invalid Physical Therapy
             Notes/Report.
             Start: 07/01/2008
      N467 = Missing Report of Tests and Analysis
             Report.
             Start: 07/01/2008
      N468 = Incomplete/invalid Report of Tests and
             Analysis Report.
             Start: 07/01/2008
      N469 = Alert: Claim/Service(s) subject to
             appeal process, see section 935 of
             Medicare Prescription Drug, Improvement,
             and Modernization Act of 2003 (MMA).
             Start: 07/01/2008
      N470 = This payment will complete the
             mandatory
             medical reimbursement limit.
             Start: 07/01/2008
      N471 = Missing/incomplete/invalid HIPPS Rate
             Code.
             Start: 07/01/2008
      N472 = Payment for this service has been
             issued
             to another provider.
             Start: 07/01/2008
      N473 = Missing certification.
             Start: 07/01/2008
      N474 = Incomplete/invalid certification
             Start: 07/01/2008
      N475 = Missing completed referral form.
             Start: 07/01/2008
      N476 = Incomplete/invalid completed referral
             form
             Start: 07/01/2008
      N477 = Missing Dental Models.
             Start: 07/01/2008
      N478 = Incomplete/invalid Dental Models
             Start: 07/01/2008
      N479 = Missing Explanation of Benefits
             (Coordination of Benefits or Medicare
             Secondary Payer).
             Start: 07/01/2008
      N480 = Incomplete/invalid Explanation of
             Benefits (Coordination of Benefits or
             Medicare Secondary Payer).
             Start: 07/01/2008
      N481 = Missing Models.
             Start: 07/01/2008
      N482 = Incomplete/invalid Models
             Start: 07/01/2008
      N483 = Missing Periodontal Charts.
             Start: 07/01/2008
      N484 = Incomplete/invalid Periodontal Charts
             Start: 07/01/2008
      N485 = Missing Physical Therapy Certification.
             Start: 07/01/2008
      N486 = Incomplete/invalid Physical Therapy
             Certification.
             Start: 07/01/2008
      N487 = Missing Prosthetics or Orthotics
             Certification.
             Start: 07/01/2008
      N488 = Incomplete/invalid Prosthetics or
             Orthotics Certification
             Start: 07/01/2008
      N489 = Missing referral form.
             Start: 07/01/2008
      N490 = Incomplete/invalid referral form
             Start: 07/01/2008
      N491 = Missing/Incomplete/Invalid Exclusionary
             Rider Condition.
             Start: 07/01/2008
      N492 = Alert: A network provider may bill the
             member for this service if the member
             requested the service and agreed in
             writing, prior to receiving the service,
             to be financially responsible for the
             billed charge.
             Start: 07/01/2008
      N493 = Missing Doctor First Report of Injury.
             Start: 07/01/2008
      N494 = Incomplete/invalid Doctor First Report
             of Injury.
             Start: 07/01/2008
      N495 = Missing Supplemental Medical Report.
             Start: 07/01/2008
      N496 = Incomplete/invalid Supplemental Medical
             Report.
             Start: 07/01/2008
      N497 = Missing Medical Permanent Impairment or
             Disability Report.
             Start: 07/01/2008
      N498 = Incomplete/invalid Medical Permanent
             Impairment or Disability Report.
             Start: 07/01/2008
      N499 = Missing Medical Legal Report.
             Start: 07/01/2008
      N500 = Incomplete/invalid Medical Legal
             Report.
             Start: 07/01/2008
      N501 = Missing Vocational Report.
             Start: 07/01/2008
      N502 = Incomplete/invalid Vocational Report.
             Start: 07/01/2008
      N503 = Missing Work Status Report.
             Start: 07/01/2008
      N504 = Incomplete/invalid Work Status Report.
             Start: 07/01/2008
      N505 = Alert: This response includes only
             services that could be estimated in real
             time. No estimate will be provided for
             the services that could not be estimated
             in real time.
             Start: 11/01/2008
      N506 = Alert: This is an estimate of the
             member's liability based on the
             information available at the time the
             estimate was processed. Actual coverage
             and member liability amounts will be
             determined when the claim is processed.
             This is not a pre-authorization or a
             guarantee of payment.
             Start: 11/01/2008
      N507 = Plan distance requirements have not
             been met.
             Start: 11/01/2008
      N508 = Alert: This real time claim
             adjudication response represents the
             the member responsibility to the
             provider for services reported.  The
             member will receive an Explanation of
             Benefits electronically or in the mail.
             Contact the insurer if there are any
             questions.
             Start: 11/01/2008
      N509 = Alert: A current inquiry shows the
             member's Consumer Spending Account
             contains sufficient funds to cover the
             member liability for this claim/service.
             Actual payment from the Consumer
             Spending Account will depend on the
             availability of funds and determination
             of eligible services at the time of
             payment processing.
             Start: 11/01/2008
      N510 = Alert: A current inquiry shows the
             members Consumer Spending Account does
             not contain sufficient funds to cover
             the member's liability for this
             claim/service. Actual payment from the
             Consumer Spending Account will depend on
             the availability of funds and
             determination of eligible services at
             the time of payment processing.
             Start: 11/01/2008
      N511 = Alert: Information on the availability
             of Consumer Spending Account funds to
             cover the member liability on this
             claim/service is not available at this
             time.
             Start: 11/01/2008
      N512 = Alert: This is the initial remit of a
             non-NCPDP claim originally submitted
             real-time without change to the
             adjudication.
             Start: 11/01/2008
      N513 = Alert: This is the initial remit of a
             non-NCPDP claim originally submitted
             real-time with a change to the
             adjudication.
             Start: 11/01/2008
      N514 = Consult plan benefit
             documents/guidelines for information
             about restrictions for this service.
             Start: 11/01/2008
             Stop: 01/01/2011
             Notes: Consider using N130
      N515 = Alert: Submit this claim to the
             patient's other insurer for potential
             payment of supplemental benefits. We did
             not forward the claim information. (use
             N387 instead)
             Start: 11/01/2008
             Stop: 10/1/2009
      N516 = Records indicate a mismatch between the
             submitted NPI and EIN.
             Start: 03/01/2009
      N517 = Resubmit a new claim with the requested
             information.
             Start: 03/01/2009
      N518 = No separate payment for accessories
             when furnished for use with oxygen
             equipment.
             Start: 03/01/2009
      N519 = Invalid combination of HCPCS modifiers.
             Start: 07/01/2009
      N520 = Alert: Payment made from a Consumer
             Spending Account.
             Start: 07/01/2009
      N521 = Mismatch between the submitted provider
             information and the provider information
             stored in our system.
             Start: 11/01/2009
      N522 = Duplicate of a claim processed, or to
             be processed, as a crossover claim.
             Start: 11/01/2009
      N523 = The limitation on outlier payments
             defined by this payer for this service
             period has been met. The outlier payment
             otherwise applicable to this claim has
             not been paid.
             Start: 03/01/2010
      N524 = Based on policy this payment
             constitutes payment in full.
             Start: 03/01/2010
      N525 = These services are not covered when
             performed within the global period of
             another service.
             Start: 03/01/2010
      N526 = Not qualified for recovery based on
             employer size.
             Start: 03/01/2010
      N527 = We processed this claim as the primary
             payer prior to receiving the recovery
             demand.
             Start: 03/01/2010
      N528 = Patient is entitled to benefits for
             Institutional Services only.
             Start: 03/01/2010
      N529 = Patient is entitled to benefits for
             Professional Services only.
             Start: 03/01/2010
      N530 = Not Qualified for Recovery based on
             enrollment information.
             Start: 03/01/2010 |
      N531 = Not qualified for recovery based on
             direct payment of premium.
             Start: 03/01/2010
      N532 = Not qualified for recovery based on
             disability and working status.
             Start: 03/01/2010
      N533 = Services performed in an Indian Health
             Services facility under a self-insured
             tribal Group Health Plan.
             Start: 07/01/2010
      N534 = This is an individual policy, the
             employer does not participate in plan
             sponsorship.
             Start: 07/01/2010
      N535 = Payment is adjusted when procedure is
             performed in this place of service based
             on the submitted procedure code and
             place of service.
             Start: 07/01/2010
      N536 = We are not changing the prior payer's
             determination of patient responsibility,
             which you may collect, as this service
             is not covered by us.
             Start: 07/01/2010
      N537 = We have examined claims history and no
             records of the services have been found.
             Start: 07/01/2010
      N538 = A facility is responsible for payment
             to outside providers who furnish these
             services/supplies/drugs to its
             patients/residents.
             Start: 07/01/2010
      N539 = Alert: We processed appeals/waiver
             requests on your behalf and that request
             has been denied.
             Start: 07/01/2010
      N540 = Payment adjusted based on the
             interrupted stay policy.
             Start: 11/01/2010
      N541 = Mismatch between the submitted
             insurance type code and the information
             stored in our system.
             Start: 11/01/2010
      N542 = Missing income verification.
             Start: 03/08/2011
      N543 = Incomplete/invalid income verification
             Start: 03/08/2011
      N544 = Alert: Although this was paid, you have
             billed with a referring/ordering
             provider that does not match our system
             record. Unless, corrected, this will not
             be paid in the future.
             Start: 07/01/2011
      N545 = Payment reduced based on status as an
             unsuccessful eprescriber per the
             Electronic Prescribing (eRx) Incentive
             Program.
             Start: 07/01/2011
      N546 = Payment represents a previous reduction
             based on the Electronic Prescribing
             (eRx) Incentive Program.
             Start: 07/01/2011
      N547 = A refund request (Frequency Type Code
             8) was processed previously.
             Start: 03/06/2012
      N548 = Alert: Patient's calendar year
             deductible has been met.
             Start: 03/06/2012
      N549 = Alert: Patient's calendar year out-of-
             pocket maximum has been met.
             Start: 03/06/2012
      N550 = Alert: You have not responded to
             requests to revalidate your
             provider/supplier enrollment
             information. Your failure to revalidate
             your enrollment information will result
             in a payment hold in the near future.
             Start: 03/06/2012
      N551 = Payment adjusted based on the
             Ambulatory
             Surgical Center (ASC) Quality Reporting
             Program.
             Start: 03/06/2012
      N552 = Payment adjusted to reverse a previous
             withhold/bonus amount.
             Start: 03/06/2012
      N553 = Payment adjusted based on a Low Income
             Subsidy (LIS) retroactive coverage or
             status change.
             Start: 03/06/2012
             Stop:  11/1/2012
      N554 = Missing/Incomplete/Invalid Family
             Planning Indicator
             Start: 07/01/2012
      N555 = Missing medication list.
             Start: 07/01/2012
      N556 = Incomplete/invalid medication list.
             Start: 07/01/2012
      N557 = This claim/service is not payable under
             our service area. The claim must be
             filed to the Payer/Plan in whose service
             area the specimen was collected.
             Start: 07/01/2012
      N558 = This claim/service is not payable under
             our service area. The claim must be
             filed to the Payer/Plan in whose service
             area the equipment was received.
             Start: 07/01/2012
      N559 = This claim/service is not payable under
             our service area. The claim must be
             filed to the Payer/Plan in whose service
             area the Ordering Physician is located.
             Start: 07/01/2012
      N560 = The pilot program requires an interim or
             final claim within 60 days of the Notice
             of Admission. A claim was not received.
             Start: 11/01/2012
      N561 = The bundled claim originally submitted
             for this episode of care includes
             related readmissions. You may resubmit
             the original claim to receive a
             corrected payment based on this
             readmission.
             Start: 11/01/2012
      N562 = The provider number of your incoming
             claim does not match the provider number
             on the processed Notice of Admission
             (NOA) for this bundled payment.
             Start: 11/01/2012
      N563 = Missing required provider/supplier
             issuance of advance patient notice of
             non-coverage. The patient is not liable
             for payment for this service.
             Start: 11/01/2012
             Notes: Related to M39
      N564 = Patient did not meet the inclusion
             criteria for the demonstration project
             or pilot program.
             Start: 11/01/2012
      N565 = Alert: This procedure code requires a
             modifier. Future claims containing this
             procedure code must include an
             appropriate modifier for the claim to be
             processed.
             Start: 11/01/2012
      N566 = Alert: This procedure code requires
             functional reporting. Future claims
             containing this procedure code must
             include an applicable non-payable code
             and appropriate modifiers for the claim
             to be processed.
             Start: 11/01/2012



 CMS_PRVDR_SPCLTY_TB                     CMS Provider Specialty Table


      00 = Carrier wide
      01 = General practice
      02 = General surgery
      03 = Allergy/immunology
      04 = Otolaryngology
      05 = Anesthesiology
      06 = Cardiology
      07 = Dermatology
      08 = Family practice
      09 = Interventional Pain Management (IPM) (eff. 4/1/03)
      09 = Gynecology (osteopaths only)
           (discontinued 5/92 use code 16)
      10 = Gastroenterology
      11 = Internal medicine
      12 = Osteopathic manipulative therapy
      13 = Neurology
      14 = Neurosurgery
      15 = Speech Language Pathologists
      15 = Obstetrics (osteopaths only)
           (discontinued 5/92 use code 16)
      16 = Obstetrics/gynecology
      17 = Hospice and Palliative Care
      17 = Ophthalmology, otology, laryngology,
           rhinology (osteopaths only)
           (discontinued 5/92 use codes 18 or 04
           depending on percentage of practice)
      18 = Ophthalmology
      19 = Oral surgery (dentists only)
      20 = Orthopedic surgery
      21 = Cardiac Electrophysiology
      21 = Pathologic anatomy, clinical
           pathology (osteopaths only)
           (discontinued 5/92 use code 22)
      22 = Pathology
      23 = Sports medicine
      23 = Peripheral vascular disease, medical
           or surgical (osteopaths only)
           (discontinued 5/92 use code 76)
      24 = Plastic and reconstructive surgery
      25 = Physical medicine and rehabilitation
      26 = Psychiatry
      27 = Geriatric Psychiatry Colorectal Surgery
      27 = Psychiatry, neurology (osteopaths
           only) (discontinued 5/92 use code 86)
      28 = Colorectal surgery (formerly
           proctology)
      29 = Pulmonary disease
      30 = Diagnostic radiology
      31 = Intensive Cardiac Rehabilitation
      31 = Roentgenology, radiology (osteopaths
           only) (discontinued 5/92 use code 30)
      32 = Anesthesiologist Assistants (eff. 4/1/03--previously
           grouped with Certified Registered Nurse Anesthetists
           (CRNA))
      32 = Radiation therapy (osteopaths only)
           (discontinued 5/92 use code 92)
      33 = Thoracic surgery
      34 = Urology
      35 = Chiropractic
      36 = Nuclear medicine
      37 = Pediatric medicine
      38 = Geriatric medicine
      39 = Nephrology
      40 = Hand surgery
      41 = Optometry (revised 10/93 to
           mean optometrist)
      42 = Certified nurse midwife (eff 1/87)
      43 = CRNA (eff. 1/87) (Anesthesiologist Assistants
           were removed from this specialty 4/1/03)
      44 = Infectious disease
      45 = Mammography screening center
      46 = Endocrinology (eff 5/92)
      47 = Independent Diagnostic Testing Facility
           (IDTF) (eff. 6/98)
      48 = Podiatry
      49 = Ambulatory surgical center
           (formerly miscellaneous)
      50 = Nurse practitioner
      51 = Medical supply company with
           certified orthotist (certified by
           American Board for Certification in
           Prosthetics And Orthotics)
      52 = Medical supply company with
           certified prosthetist
           (certified by American Board for
           Certification In Prosthetics And
           Orthotics)
      53 = Medical supply company with
           certified prosthetist-orthotist
           (certified by American Board for
           Certification in Prosthetics
           and Orthotics)
      54 = Medical supply company not included
           in 51, 52, or 53.  (Revised 10/93
           to mean medical supply company for DMERC)
      55 = Individual certified orthotist
      56 = Individual certified prosthetist
      57 = Individual certified prosthetist-orthotist
      58 = Individuals not included in 55, 56, or 57,
           (revised 10/93  to mean medical supply company
           with registered pharmacist)
      59 = Ambulance service supplier, e.g.,
           private ambulance companies, funeral homes, etc.
      60 = Public health or welfare agencies
           (federal, state, and local)
      61 = Voluntary health or charitable agencies (e.g.
           National Cancer Society, National Heart
           Association, Catholic Charities)
      62 = Psychologist (billing independently)
      63 = Portable X-ray supplier
      64 = Audiologist (billing independently)
      65 = Physical therapist (private practice added 4/1/03)
           (independently practicing removed 4/1/03)
      66 = Rheumatology (eff 5/92)
           Note: during 93/94 DMERC also used this to mean
           medical supply company with
           respiratory therapist
      67 = Occupational therapist (private practice added 4/1/03)
           (independently practicing removed 4/1/03)
      68 = Clinical psychologist
      69 = Clinical laboratory (billing independently)
      70 = Multispecialty clinic or group practice
      71 = Registered Dietician/Nutrition Professional (eff. 1/1/02)
      72 = Pain Management (eff. 1/1/02)
      73 = Mass Immunization Roster Biller (eff. 4/1/03)
      74 = Radiation Therapy Centers (added to differentiate
           them from Independent Diagnostic Testing Facilities
           (IDTF --eff. 4/1/03)
      74 = Occupational therapy (GPPP)
           (not to be assigned after 5/92)
      75 = Slide Preparation Facilities (added to differentiate
           them from Independent Diagnostic Testing Facilites
           (IDTFs -- eff. 4/1/03)
      75 = Other medical care (GPPP) (not to
           assigned after 5/92)
      76 = Peripheral vascular disease
           (eff 5/92)
      77 = Vascular surgery (eff 5/92)
      78 = Cardiac surgery (eff 5/92)
      79 = Addiction medicine (eff 5/92)
      80 = Licensed clinical social worker
      81 = Critical care (intensivists)
           (eff 5/92)
      82 = Hematology (eff 5/92)
      83 = Hematology/oncology (eff 5/92)
      84 = Preventive medicine (eff 5/92)
      85 = Maxillofacial surgery (eff 5/92)
      86 = Neuropsychiatry (eff 5/92)
      87 = All other suppliers (e.g. drug and
           department stores) (note: DMERC used
           87 to mean department store from 10/93
           through 9/94; recoded eff 10/94 to A7;
           NCH cross-walked DMERC reported 87 to A7.
      88 = Unknown supplier/provider specialty
           (note: DMERC used 87 to mean grocery
           store from 10/93 - 9/94; recoded eff
           10/94 to A8; NCH cross-walked DMERC
           reported 88 to A8.
      89 = Certified clinical nurse specialist
      90 = Medical oncology (eff 5/92)
      91 = Surgical oncology (eff 5/92)
      92 = Radiation oncology (eff 5/92)
      93 = Emergency medicine (eff 5/92)
      94 = Interventional radiology (eff 5/92)
      95 = Competative Acquisition Program (CAP)
           Vendor (eff. 07/01/06). Prior to
           07/01/06, known as Independent
           physiological laboratory (eff. 5/92)
      96 = Optician (eff 10/93)
      97 = Physician assistant (eff 5/92)
      98 = Gynecologist/oncologist (eff 10/94)
      99 = Unknown physician specialty
      A0 = Hospital (eff 10/93) (DMERCs only)
      A1 = SNF (eff 10/93) (DMERCs only)
      A2 = Intermediate care nursing facility
           (eff 10/93) (DMERCs only)
      A3 = Nursing facility, other (eff 10/93)
           (DMERCs only)
      A4 = HHA (eff 10/93) (DMERCs only)
      A5 = Pharmacy (eff 10/93) (DMERCs only)
      A6 = Medical supply company with respiratory
           therapist (eff 10/93) (DMERCs only)
      A7 = Department store (for DMERC use:
           eff 10/94, but cross-walked from
           code 87 eff 10/93)
      A8 = Grocery store (for DMERC use:
           eff 10/94, but cross-walked from
           code 88 eff 10/93)
      A9 = Indian Health Service (IHS), tribe and
           tribal organizations (non-hospital or
           non-hospital based facilities.  DMERCs shall
           process claims submitted by IHS, tribe and
           non-tribal organizations for DMEPOS and drugs
           covered by the DMERCs. (eff. 1/2005)
      B1 = Supplier of oxygen and/or oxygen related
           equipment (eff. 10/2/07)
      B2 = Pedorthic Personnel (eff. 10/2/07)
      B3 = Medical Supply Company with Pedorthic Personnel
           (eff. 10/2/07)
      B4 = Rehabilitation Agency (eff. 10/2/07)
      B5 = Ocularist
      C0 = Sleep medicine
      C1 = Centralized Flu
      C4 = Non-Provider Convener Participants in the BPCI Advanced
           Model (eff. 7/2019)
      C5 = Dentist (eff. 7/2016)
      D5 = Opiod Treatment Progrm (eff. 1/2020)



 CMS_TYPE_SRVC_TB                        CMS Type of Service Table

      1 = Medical care
      2 = Surgery
      3 = Consultation
      4 = Diagnostic radiology
      5 = Diagnostic laboratory
      6 = Therapeutic radiology
      7 = Anesthesia
      8 = Assistant at surgery
      9 = Other medical items or services
      0 = Whole blood only eff 01/96,
          whole blood or packed red cells before 01/96
      A = Used durable medical equipment (DME)
      B = High risk screening mammography
          (obsolete 1/1/98)
      C = Low risk screening mammography
          (obsolete 1/1/98)
      D = Ambulance (eff 04/95)
      E = Enteral/parenteral nutrients/supplies
          (eff 04/95)
      F = Ambulatory surgical center (facility
          usage for surgical services)
      G = Immunosuppressive drugs
      H = Hospice services (discontinued 01/95)
      I = Purchase of DME (installment basis)
          (discontinued 04/95)
      J = Diabetic shoes (eff 04/95)
      K = Hearing items and services (eff 04/95)
      L = ESRD supplies (eff 04/95)
          (renal supplier in the home before 04/95)
      M = Monthly capitation payment for dialysis
      N = Kidney donor
      P = Lump sum purchase of DME, prosthetics,
          orthotics
      Q = Vision items or services
      R = Rental of DME
      S = Surgical dressings or other medical supplies
          (eff 04/95)
      T = Psychological therapy (term. 12/31/97)
          outpatient mental health limitation (eff. 1/1/98)
      U = Occupational therapy
      V = Pneumococcal/flu vaccine (eff 01/96),
          Pneumococcal/flu/hepatitis B vaccine (eff 04/95-12/95),
          Pneumococcal only before 04/95
      W = Physical therapy
      Y = Second opinion on elective surgery
          (obsoleted 1/97)
      Z = Third opinion on elective surgery
          (obsoleted 1/97)



 CTGRY_EQTBL_BENE_IDENT_TB               Category Equatable Beneficiary Identification Code (BIC) Table

       NCH BIC              SSA Categories
       -------              --------------

       A  = A;J1;J2;J3;J4;M;M1;T;TA
       B  = B;B2;B6;D;D4;D6;E;E1;K1;K2;K3;K4;W;W6;
            TB(F);TD(F);TE(F);TW(F)
       B1 = B1;BR;BY;D1;D5;DC;E4;E5;W1;WR;TB(M)
            TD(M);TE(M);TW(M)
       B3 = B3;B5;B9;D2;D7;D9;E2;E3;K5;K6;K7;K8;W2
            W7;TG(F);TL(F);TR(F);TX(F)
       B4 = B4;BT;BW;D3;DM;DP;E6;E9;W3;WT;TG(M)
            TL(M);TR(M);TX(M)
       B8 = B8;B7;BN;D8;DA;DV;E7;EB;K9;KA;KB;KC;W4
            W8;TH(F);TM(F);TS(F);TY(F)
       BA = BA;BK;BP;DD;DL;DW;E8;EC;KD;KE;KF;KG;W9
            WC;TJ(F);TN(F);TT(F);TZ(F)
       BD = BD;BL;BQ;DG;DN;DY;EA;ED;KH;KJ;KL;KM;WF
            WJ;TK(F);TP(F);TU(F);TV(F)
       BG = BG;DH;DQ;DS;EF;EJ;W5;TH(M);TM(M);TS(M)
            TY(M)
       BH = BH;DJ;DR;DX;EG;EK;WB;TJ(M);TN(M);TT(M)
            TZ(M)
       BJ = BJ;DK;DT;DZ;EH;EM;WG;TK(M);TP(M);TU(M)
            TV(M)
       C1 = C1;TC
       C2 = C2;T2
       C3 = C3;T3
       C4 = C4;T4
       C5 = C5;T5
       C6 = C6;T6
       C7 = C7;T7
       C8 = C8;T8
       C9 = C9;T9
       F1 = F1;TF
       F2 = F2;TQ
       F3-F8 = Equatable only to itself (e.g., F3 IS
               equatable to F3)
       CA-CZ = Equatable only to itself.  (e.g., CA is
               only equatable to CA)

            ---------------------------------------
                       RRB Categories

       10 = 10
       11 = 11
       13 = 13;17
       14 = 14;16
       15 = 15
       43 = 43
       45 = 45
       46 = 46
       80 = 80
       83 = 83
       84 = 84;86
       85 = 85



 DMERC_CLM_NMO_CBA_IND_TB                Claim National Mail Order (NMO) Competitive Bidding Area (CBA) Indicator Code Table

      20001 = Beneficiary does not reside in a Competitive Bidding Area
              (CBA) and at least one line on the claim is subject to
              the National Mail Order (NMO) program.



 DMERC_LINE_CBA_TB                       Line Competitive Bidding Area (CBA) Code Table

      16740 = Charlotte-Gastonia-Concor, NC-SC -- Non Mail-Order
      16741 = Charlotte-Gastonia-Concor, NC-SC -- Mail-Order
      17140 = Cincinnati-Middletown, OH-KY-IN -- Non Mail-Order
      17141 = Cincinnati-Middletown, OH-KY-IN -- Mail-Order
      17460 = Cleveland-Elyria-Mentor, OH -- Non Mail-Order
      17461 = Cleveland-Elyria-Mentor, OH -- Mail-Order
      19100 = Dallas-Fort Worth-Arlington, TX -- Non Mail-Order
      19101 = Dallas-Fort Worth-Arlington, TX -- Mail-Order
      28140 = Kansas City, MS-KS -- Non Mail-Order
      28141 = Kansas City, MS-KS -- Mail-Order
      33100 = Miami-Fort Lauderdale-Pompano Beach, FL - Non Mail-Order
      33101 = Miami-Fort Lauderdale-Pompano Beach, FL - Mail-Order
      36740 = Orlando-Kissimmee, FL -- Non Mail-Order
      36741 = Orlando-Kissimmee, FL -- Mail-Order
      38300 = Pittsburgh, PA -- Non Mail-Order
      38301 = Pittsburgh, PA -- Mail-Order
      40140 = Riverside-San Bernardino, CA -- Non Mail-Order
      40141 = Riverside-San Bernardino, CA -- Mail-Order



 DMERC_LINE_DCSN_IND_TB                  DMERC Line Decision Indicator Table

      O = Original MR determination
      R = MR determination after reversal
      of original decision



 DMERC_LINE_FRGN_ADR_IND_TB              DMERC Line Foreign Address Indicator Table

       EX = Expatriate Beneficiary



 DMERC_LINE_MTUS_IND_TB                  DMERC Line Miles/Time/Units Indicator Table

      0 = Values reported as zero
      3 = Number of services
      4 = Oxygen volume units
      6 = Drug dosage -- since early 1994 this value has
          incorrectly been placed on DMERC claims. The DMERCs
          were overriding the MTUS indicator with a '6' if the
          claim was submitted with an NDC code.
          NOTE:  It was recently discovered that this problem
          has been corrected -- no date on when the correction
          became effective.



 DMERC_LINE_RRB_EXCLSN_IND_TB            DMERC Line RRB Exclusion Indicator Table

      Y = Exclude RRB beneficiary services from the prior authorization
          program
      Blank = Subject RRB beneficiary services to prior authorization



 DMERC_LINE_SCRN_RSLT_IND_TB             DMERC Line Screen Result Indicator Table

      A = Denied for lack of medical necessity;
          highest level of review was automated
          level I review
      B = Reduced (partially denied) for lack
          of medical necessity; highest level
          of review was automated level I review
      C = Denied as statutorily noncovered;
          highest level of review was automated
          level I review
      D = Reserved for future use
      E = Paid after automated level I review
      F = Denied for lack of medical necessity;
          highest level of review was manual
          level I review
      G = Reduced (partially denied) for lack
          of medical necessity; highest level
          of review was manual level I review
      H = Denied as statutorily noncovered;
          highest level of review was manual
          level I review
      I = Denied for coding/unbundling reasons;
          highest level of review was manual
          level I review
      J = Paid after manual level I review
      K = Denied for lack of medical necessity;
          highest level of review was manual
          level II review
      L = Reduced (partially denied) for lack
          of medical necessity; highest level
          of review was manual level II review
      M = Denied as statutorily noncovered;
          highest level of review was manual
          level II review
      N = Denied for coding/unbundling reasons;
          highest level of review was manual
          level II review
      O = Paid after manual level II review
      P = Denied for lack of medical necessity;
          highest level of review was manual
          level III review
      Q = Reduced (partially denied) for lack
          of medical necessity; highest level
          of review was manual level III review
      R = Denied as statutorily noncovered;
          highest level of review was manual
          level III review
      S = Denied for coding/unbundling reasons;
          highest level of review was manual
          level III review
      T = Paid after manual level III review



 DMERC_LINE_SCRN_SUSPNSN_IND_TB          DMERC Line Screen Suspension Indicator Table

      MUXX = Mandated unbundling screens
      UXXX = Local unbundling screens
      CXXX = Statutorily noncovered screens
      M1XX = Mandate CAT I screens
      1XXX = Local CAT I screens
      M2XX = Mandate CAT II screens
      2XXX = Local CAT II screens
      M3XX = Mandate CAT III screens
      3XXX = Local CAT III screens



 DMERC_LINE_SUPLR_TYPE_TB                DMERC Line Supplier Type Table

      0 = Clinics, groups, associations, Intervention,
          or other entities for which the carrier's own
          ID number has been assigned.
      1 = Physicians or suppliers billing as solo
          practitioners for whom SS numbers are shown
          in the physician ID code field.
      2 = Physicians or suppliers billing as
          solo practitioners for the carrier's
          own physician ID code is shown.
      3 = Suppliers (other than sole)
      4 = Suppliers (other than sole proprietorship)
          for whom the carrier's own code has been
          shown.
      5 = Institutional providers and
          independent laboratories for whom EI
          numbers are used in coding the ID field.
      6 = Institutional providers and
          independent laboratories for whom the
          carrier's own ID number is shown.
      7 = Clinics, groups, associations, or
          partnerships for whom EI numbers
          are used in coding the ID field.
      8 = Other entities for whom EI numbers
          are used in coding the ID field.



 END_REC_TB                              End of Record Code Table

      EOR = End of record/segment
      EOC = End of claim



 GEO_STATE_TB                            Geographic State Table

      01 = Alabama
      02 = Alaska
      03 = Arizona
      04 = Arkansas
      05 = California
      06 = Colorado
      07 = Connecticut
      08 = Delaware
      09 = District of Columbia
      10 = Florida
      11 = Georgia
      12 = Hawaii
      13 = Idaho
      14 = Illinois
      15 = Indiana
      16 = Iowa
      17 = Kansas
      18 = Kentucky
      19 = Louisiana
      20 = Maine
      21 = Maryland
      22 = Massachusetts
      23 = Michigan
      24 = Minnesota
      25 = Mississippi
      26 = Missouri
      27 = Montana
      28 = Nebraska
      29 = Nevada
      30 = New Hampshire
      31 = New Jersey
      32 = New Mexico
      33 = New York
      34 = North Carolina
      35 = North Dakota
      36 = Ohio
      37 = Oklahoma
      38 = Oregon
      39 = Pennsylvania
      40 = Puerto Rico
      41 = Rhode Island
      42 = South Carolina
      43 = South Dakota
      44 = Tennessee
      45 = Texas
      46 = Utah
      47 = Vermont
      48 = Virgin Islands
      49 = Virginia
      50 = Washington
      51 = West Virginia
      52 = Wisconsin
      53 = Wyoming
      54 = Africa
      55 = Asia
      56 = Canada
      57 = Central America and West Indies
      58 = Europe
      59 = Mexico
      60 = Oceania
      61 = Philippines
      62 = South America
      63 = U.S. Possessions
      64 = American Samoa
      65 = Guam
      97 = Northern Marianas
      98 = Guam
      99 = Unknown or American Samoa



 LINE_ADDTNL_CLM_DCMTN_IND_TB            Line Additional Claim Documentation Indicator Table

      0 = No additional documentation
      1 = Additional documentation submitted for
          non-DME EMC claim
      2 = CMN/prescription/other documentation submitted
          which justifies medical necessity
      3 = Prior authorization obtained and approved
      4 = Prior authorization requested but not approved
      5 = CMN/prescription/other documentation submitted
          but did not justify medical necessity
      6 = CMN/prescription/other documentation submitted
          and approved after prior authorization rejected
      7 = Recertification CMN/prescription/other
          documentation



 LINE_CNSLDTD_BLG_TB                     Line Consolidated Billing Indicator Table

      1 = Home Health Consolidated Billing Override Code
      2 = SNF Consolidated Billing Override Code



 LINE_DGNS_VRSN_TB                       Line Diagnosis Version Code Table

      Valid Values:
      9 = ICD-9
      0 = ICD-10



 LINE_DUP_CLM_CHK_IND_TB                 Line Duplicate Claim Check Indicator Table

       1= Suspect duplicate review performed



 LINE_HCT_HGB_TYPE_TB                    Line Hematocrit/Hemoglobin Test Type Code

      R1 = Hemoglobin Test
      R2 = Hematocrit Test



 LINE_OTHR_APLD_IND_CD_TB                Line Other Applied Indicator Code Table

          Single byte codes - Prior to January 2021
      A = Gramm-Rudman reduction required for services
          (03/03/1986-09/30/1986)
      B = Interest addition
      C = Positive rounding adjustment (due to line item
          distribution from total claim reimbursement
          amount)
      D = Negative rounding adjustment (due to line item
          distribution from total claim reimbursement
          amount)
      E = Primary Payer allowed charge
      F = Good cause
      G = PMD Demonstration Reduction
      H = Sequestration Reduction Amount
      I = eRX Negative Adjustment Reduction Amount
      J = ACO Payment Adjustment Amount (Pioneer reduction) -
          the amount that would have been paid if not for the
          Pioneer reduction. (eff. 1/2014)
      K = ASC Quality Reporting Payment Reduction (eff. 1/2014)
      L = ACO Payment Adjustment Amount (Pioneer reduction) -
          the actual amount of the Pioneer reduction.
          (eff. 1/2014)
      M = PQRS Negative Payment Adjustment (eff. 1/2015)
      N = None (no amount to apply)
      O = VBM Negative Payment Adjustment (eff. 1/2015)
      P = VBM Positive Payment Adjustment
      Q = EHR Incentive (eff. 1/2015)
      R = Part B Drug Payment Model
      S = Prior Authorization Reduction (eff. October 2016)
      T = Comprehensive Primary Care Plus (CPC+) Payment
          Adjustment (eff. 4/2017)
      U = Maryland Primary Care Program (MDPCP) -
          (eff. 1/2019)
      V = MIPS Positive Amount for Quality Payment Program (QPP)
          payment adjustment (eff. 1/2019)
      W = MIPS Negative Amount for Quality Payment Program (QPP)
          payment adjustment (eff. 1/2019)
      X = The amount by which each line was adjusted for the ET3 15%
          bonus payment. (eff. 1/2020)
      Y = Oncology Care Model Plus (OCM+) Population Based Payment
          Claims Reductions (eff. 1/2020)
      Z = ESRD Treatment Choices (ETC) Model: Home Dialysis Payment
          Adjustment (eff. 7/2020)

          Two-byte codes -- effective January 2021

      A2 = Flat Visit Reduction Amount (PCF Model)
      A3 = Flat Visit Fee Increased Amount (PCF Model)
      A4 = KCF Model Reduction Amount
      A5 = CKCC Model Reduction Amount



 LINE_PLC_SRVC_TB                        Line Place Of Service Table

      01 = Pharmacy (eff. 10/1/05)
      03 = School (eff. 1/1/03
      04 = Homeless Shelter (eff. 1/1/03)
      09 = Prison/correctional facility setting
           (eff. 10/2006)
      11 = Office
      12 = Home
      13 = Assisted Living Facility (eff. 10/1/2003)
      14 = Group Home (eff. 10/1/2003)
      15 = Mobile Unit (eff. 1/1/03)
      18 = Place of Employment/Worksite
      20 = Urgent Care Facility (eff. 1/1/03)
      21 = Inpatient hospital
      22 = Outpatient hospital
      23 = Emergency room - hospital
      24 = Ambulatory surgical center
      25 = Birthing center
      26 = Military treatment facility
      31 = Skilled nursing facility
      32 = Nursing facility
      33 = Custodial care facility
      34 = Hospice
      35 = Adult living care facilities (ALCF)
           (eff. NYD - added 12/3/97)
      41 = Ambulance - land
      42 = Ambulance - air or water
      49 = Independent Care (eff. 10/1/2003)
      50 = Federally qualified health centers
           (eff. 10/1/93)
      51 = Inpatient psychiatric facility
      52 = Psychiatric facility partial hospitalization
      53 = Community mental health center
      54 = Intermediate care facility/mentally
           retarded
      55 = Residential substance abuse treatment
           facility
      56 = Psychiatric residential treatment
           center
      57 = Non-residential substance abuse treatment
           facility (eff. 10/1/2003)
      58 = Non-residential OPIOD treatment facility
           (eff. 1/2020)
      60 = Mass immunizations center (eff. 9/1/97)
      61 = Comprehensive inpatient rehabilitation
           facility
      62 = Comprehensive outpatient rehabilitation
           facility
      65 = End stage renal disease treatment facility
      71 = State or local public health clinic
      72 = Rural health clinic
      81 = Independent laboratory
      99 = Other unlisted facility



 LINE_PMT_80_100_TB                      Line Payment 80%/100% Table

      0 = 80%
      1 = 100%
      3 = 100% Limitation of liability only
      4 = 75% Reimbursement



 LINE_PRCSG_IND_TB                       Line Processing Indicator Table

      A = Allowed
      B = Benefits exhausted
      C = Noncovered care
      D = Denied (existed prior to 1991; from
          BMAD)
      E = MSP Cost Avoided - First Claim Development
      F = MSP Cost Avoided - Trauma Code Development
      G = MSP Cost Avoided - Secondary Claims Investigation
      H = MSP Cost Avoided - Self Reports
      I = Invalid data
      J = MSP Cost Avoided - 411.25
      K = MSP Cost Avoided - Insurer Voluntary Reporting
      L = CLIA (eff 9/92)
      M = Multiple submittal--duplicate line item
      N = Medically unnecessary
      O = Other
      P = Physician ownership denial (eff 3/92)
      Q = MSP cost avoided (contractor #88888) -
          voluntary agreement (eff. 1/98)
      R = Reprocessed--adjustments based on
          subsequent reprocessing of claim
      S = Secondary payer
      T = MSP cost avoided - IEQ contractor
          (eff. 7/76)
      U = MSP cost avoided - HMO rate cell
          adjustment (eff. 7/96)
      V = MSP cost avoided - litigation
          settlement (eff. 7/96)
      X = MSP cost avoided - generic
      Y = MSP cost avoided - IRS/SSA data
          match project
      Z = Bundled test, no payment
          (eff. 1/1/98)
      00 = MSP cost avoided - COB Contractor
      12 = MSP cost avoided - BC/BS Voluntary Agreements
      13 = MSP cost avoided - Office of Personnel Management
      14 = MSP cost avoided - Workman's Compensation (WC) Datamatch
      15 = MSP cost avoided - Workman's Compensation Insurer Voluntary
          Data Sharing Agreements (WC VDSA) (eff. 4/2006)
      16 = MSP cost avoided - Liability Insurer VDSA (eff.4/2006)
      17 = MSP cost avoided - No-Fault Insurer VDSA  (eff.4/2006)
      18 = MSP cost avoided - Pharmacy Benefit Manager Data Sharing
          Agreement (eff.4/2006)
      19 = MSP cost avoided - Worker's Compensation Set Aside
      21 = MSP cost avoided - MIR Group Health Plan (eff.1/2009)
      22 = MSP cost avoided - MIR non-Group Health Plan (eff.1/2009)
      25 = MSP cost avoided - Recovery Audit Contractor - California
          (eff.10/2005)
      26 = MSP cost avoided - Recovery Audit Contractor - Florida
          (eff.10/2005)
      39 = MSP cost avoided - Group Health Plan Recovery
      41 = MSP cost avoided - Next Generation Desktop
      42 = MSP cost avoided - Non Group Health Plan ORM
      43 = MSP cost avoided - COBC Medicare Part C/Medicare Advantage

       NOTE: Effective 4/1/02, the Line Processing Indicator
       code was expanded to a 2-byte field.  The NCH instituted
       a crosswalk from the 2-byte code to a 1-byte character
       code. Below are the character codes (found in NCH &
       NMUD). At some point, NMUD will carry the 2-byte code
       but NCH will continue to have the 1-byte character
       code.

       ! = MSP cost avoided - COB Contractor ('00' 2-byte code)
       @ = MSP cost avoided - BC/BS Voluntary Agreements
           ('12' 2-byte code)
       # = MSP cost avoided - Office of Personnel Management
           ('13' 2-byte code)
       $ = MSP cost avoided - Workman's Compensation (WC) Datamatch
           ('14' 2-byte code)
       * = MSP cost avoided - Workman's Compensation Insurer
           Voluntary Data Sharing Agreements (WC VDSA)
           ('15' 2-byte code) (eff. 4/2006)
       ( = MSP cost avoided - Liability Insurer VDSA
           ('16' 2-byte code) (eff. 4/2006)
       ) = MSP cost avoided - No-Fault Insurer VDSA
           ('17' 2-byte code) (eff. 4/2006)
       + = MSP cost avoided - Pharmacy Benefit Manager Data
           Sharing Agreement ('18' 2 -byte code) (eff. 4/2006)
       < = MSP cost avoided - MIR Group Health Plan
           ('21' 2-byte code) (eff. 1/2009)
       > = MSP cost avoided - MIR non-Group Health Plan
           ('22' 2-byte code) (eff. 1/2009)
       % = MSP cost avoided - Recovery Audit Contractor -
           - California ('25' 2-byte code) (eff. 10/2005)
       & = MSP cost avoided - Recovery Audit Contractor -
           Florida ('26' 2-byte code) (eff. 10/2005)



 LINE_PRIOR_AUTHRZTN_TB                  Line Prior Authorization Indicator Table

      A = Part A
      B = Part B
      D = DME
      H = Home Health and Hospice
      + 3 digit number



 LINE_PRVDR_PRTCPTG_IND_TB               Line Provider Participating Indicator Table

      1 = Participating
      2 = All or some covered and allowed
          expenses applied to deductible Participating
      3 = Assignment accepted/non-participating
      4 = Assignment not accepted/non-participating
      5 = Assignment accepted but all or some
          covered and allowed expenses applied
          to deductible Non-participating.
      6 = Assignment not accepted and all covered
          and allowed expenses applied to deductible
          non-participating.
      7 = Participating provider not accepting
          assignment.



 LINE_PWK_TB                             Line Paperwork Code Table


      P1 = one iteration is present
      P2 = two iterations are present
      P3 = three iterations are present
      P4 = four iterations are present
      P5 = five iterations are present
      P6 = six iterations are present
      P7 = seven iterations are present
      P8 = eight iterations are present
      P9 = nine iterations are present
      P0 = ten iterations are present



 LINE_SRVC_DDCTBL_IND_TB                 Line Service Deductible Indicator Switch Code Table

      0 = SERVICE SUBJECT TO DEDUCTIBLE
      1 = SERVICE NOT SUBJECT TO DEDUCTIBLE



 LINE_VLNTRY_SRVC_IND_TB                 Line Voluntary Service Indicator Table

      V = A voluntary procedure code
      Blank = A required procedure code



 LINE_WC_IND_TB                          Workers' Compensation Indicator Code

      Y = The diagnosis codes on the claims are related to the diagnosis
          codes on the MSP auxiliary file in CWF.

      Spaces




 MCO_OPTN_TB                             MCO Option Table

      *****For lock-in beneficiaries****
      A = HCFA to process all provider bills
      B = MCO to process only in-plan
      C = MCO to process all Part A and Part B bills

      ***** For non-lock-in beneficiaries*****
      1 = HCFA to process all provider bills
      2 = MCO to process only in-plan Part A and
          Part B bills
      4 = Cost Plan-Chronic Care Organizations (eff. 10/2005)



 NCH_CLM_BIC_MDFY_TB                     NCH Claim BIC Modify H Code Table

      H = BIC submitted by CWF = HA, HB or HC
      blank = No HA, HB or HC BIC present



 NCH_CLM_TYPE_TB                         NCH Claim Type Table

       10 = HHA claim
       20 = Non swing bed SNF claim
       30 = Swing bed SNF claim
       40 = Outpatient claim
       50 = Hospice claim
       60 = Inpatient claim
       61 = Inpatient 'Full-Encounter' claim
       62 = Medicare Advantage IME/GME Claims
       63 = Medicare Advantage (no-pay) claims
       64 = Medicare Advantage (paid as FFS) claims
       71 = RIC O local carrier non-DMEPOS claim
       72 = RIC O local carrier DMEPOS claim
       81 = RIC M DMERC non-DMEPOS claim
       82 = RIC M DMERC DMEPOS claim

      NOTE:  In the data element NCH_CLM_TYPE_CD
      (derivation rules) the numbers for these claim
      types need to be changed - dictionary reflects
      61 for all three.



 NCH_DEMO_TRLR_IND_TB                    NCH Demonstration Trailer Indicator Table

      D = Demo trailer present



 NCH_DGNS_TRLR_IND_TB                    NCH Diagnosis Trailer Indicator Table

      Y = Diagnosis code trailer present



 NCH_EDIT_DISP_TB                        NCH Edit Disposition Table

       00 = No MQA errors
       10 = Possible duplicate
       20 = Utilization error
       30 = Consistency error
       40 = Entitlement error
       50 = Identification error
       60 = Logical duplicate
       70 = Systems duplicate



 NCH_EDIT_TB                             NCH EDIT TABLE

      A0X1 = (C) PHYSICIAN-SUPPLIER ZIP CODE
      A000 = (C) REIMB > $100,000 OR UNITS > 150
      A002 = (C) CLAIM IDENTIFIER (CAN)
      A003 = (C) BENEFICIARY IDENTIFICATION (BIC)
      A004 = (C) PATIENT SURNAME BLANK
      A005 = (C) PATIENT 1ST INITIAL NOT-ALPHABETIC
      A006 = (C) DATE OF BIRTH IS NOT NUMERIC
      A007 = (C) INVALID GENDER (0, 1, 2)
      A008 = (C) INVALID QUERY-CODE (WAS CORRECTED)
      A009 = (C) TYPE OF BILL RECEIVED IS 41A, 41B, OR 41D
      A010 = (C) DISPOSITION CODE VS. ACTION/ENTRY CODE
      A023 = (C) PORTABLE X-RAY WITHOUT MODIFIER
      A025 = (C) FOR OV 4, TOB MUST = 13,83,85,73
      A031 = (C) HOSPITAL CLAIMS--CLAIM SHOWS SERVICES WERE PAID
                 BY AN HMO AND CODITION CODE '04' IS NOT PRESENT.
                 (TOB '11' & '12')
      A041 = (C) HHA CLAIMS--TOB 32X OR 33X WITH >4 VISITS; DATE
                 OF SERVICE > 9/30/00 AND LUPA IND IS PRESENT.
                 BYPASS FOR NON-PAYMENT CODE B, C, Q, T-Y.
      A1X1 = (C) PERCENT ALLOWED INDICATOR
      A1X2 = (C) DT>97273,DG1=7611,DG<>103,163,1589
      A1X3 = (C) DT>96365,DIAG=V725
      A1X4 = (C) INVALID DIAGNOSTIC CODES
      C050 = (U) HOSPICE - SPELL VALUE INVALID
      D102 = (C) DME DATE OF BIRTH INVALID
      D2X2 = (C) DME SCREEN SAVINGS INVALID
      D2X3 = (C) DME SCREEN RESULT INVALID
      D2X4 = (C) DME DECISION IND INVALID
      D2X5 = (C) DME WAIVER OF PROV LIAB INVALID
      D3X1 = (C) DME NATIONAL DRUG CODE INVALID
      D4X1 = (C) DME BENE RESIDNC STATE CODE INVALID
      D4X2 = (C) DME OUT OF DMERC SERVICE AREA
      D4X3 = (C) DME STATE CODE INVALID
      D5X1 = (C) TOS INVALID FOR DME HCPCS
      D5X2 = (C) DME HCPCS NOC & NOC DESCRIP MISSING
      D5X3 = (C) DME INVALID USE OF MS MODIFIER
      D5X4 = (C) TOS9 NDC REQD WHEN HCPCS OMITTED
      D5X5 = (C) TOS9 NDC REQD FOR Q0127-130 HCPCS
      D5X6 = (C) TOS9 NDC/DIAGNOSIS CODE INVALID
      D5X7 = (C) ANTI-EMETIC/ANTI-CANCER DRUG W/0 CANCER
                 DIAGNOSIS
      D5X8 = (C) TWO ANTI-EMETIC DRUGS PRESENT ON SAME CLAIM
                 WITH IDENTICAL DATES OF SERVICE.
      D6X1 = (C) DME SUPPLIER NUMBER MISSING
      D7X1 = (C) DME PURCHASE ALLOWABLE INVALID
      D919 = (C) CAPPED/PEN PUMPS,NUM OF SRVCS > 1
      D921 = (C) SHOE HCPC W/O MOD RT,LT REQ U=2/4/6
      D922 = (C) THERAPEUTIC SHOE CODES 'A5505-A5501'
                 W/MODIFIER 'LT' OR 'RT' MUST HAVE
                 UNITS = '001'
      XXXX = (D) SYS DUPL: HOST/BATCH/QUERY-CODE
      Y001 = (C) HCPCS R0075/UNITS>1/SERVICES=1
      Y002 = (C) HCPCS R0075/UNITS=1/SERVICES>1
      Y003 = (C) HCPCS R0075/UNITS=SERVICES
      Y010 = (C) TOB=13X/14X AND T.C.>$7,500
      Y011 = (C) INP CLAIM/REIM > $350,000
      Z001 = (C) RVNU 820-859 REQ COND CODE 71-76
      Z002 = (C) CC M2 PRESENT/REIMB > $150,000
      Z003 = (C) CC M2 PRESENT/UNITS > 150
      Z004 = (C) CC M2 PRESENT/UNITS & REIM < MAX
      Z005 = (C) REIMB>99999 AND REIMB<150000
      Z006 = (C) UNITS>99 AND UNITS<150
      Z007 = (C) TOB VS TOTAL CHARGE
      Z008 = (C) TOB VS TOTAL CHARGE W/O 20/21
                 CONDITION CODE
      Z237 = (E) HOSPICE OVERLAP - DATE ZERO
      0011 = (C) ACTION CODE INVALID
      0012 = (C) IME/GME CLAIM -- '04' OR '69'
                 CONDITION CODE
      0013 = (C) CABG/PCOE/MPPD AND INVALID ADMIT DATE
      0014 = (C) DEMO NUM INVALID
      0015 = (C) ESRD PLAN VS DEMO NUM
      0016 = (C) INVALID VA CLAIM
      0017 = (C) DEMO=38 W/O CONTRACTOR #80881/80882
      0018 = (C) DEMO=31,ACT CD<>1/5 OR ENT CD<>1/5
      0019 = (C) DEMO 07/08 WITH CONDITION CODE B1
      0020 = (C) CANCEL ONLY CODE INVALID
      0021 = (C) DEMO COUNT > 1
      0022 = (C) TOB '32X' OR '33X' W/DATES OF SERVICE >9/30/00
                 AND HAS CANCEL ONLY CODE OTHER THAN A,B,E,F
      0023 = (C) DEMO '46' AND HCPCS INCONSISTENT
      0301 = (C) INVALID HI CLAIM NUMBER
      0302 = (C) BENE IDEN CDE (BIC) INVAL OR BLK
      04A1 = (C) PATIENT SURNAME BLANK (PHYS/SUP)
      04B1 = (C) PATIENT 1ST INITIAL NOT-ALPHABETIC
      0401 = (C) BILL TYPE/PROVIDER INVALID
      0402 = (C) BILL TYPE/REV CODE/PROVR RANGE
      0403 = (C) TOB '41X'/PRVDR # 1990-1999) OR TOB '51X'/
                 PRVDR #6990-6999, TRANS CODE SHOULD BE
                 '0' OR '3'
      0406 = (C) MAMMOGRAPHY WITH NO HCPCS 76092 OR SEX NOT F
      0407 = (C) RESPITE CARE BILL TYPE NOT 34X,NO REV 66
      0408 = (C) REV CODE 403 /TYPE 71X/ PROV3800-974
      041A = (C) TOB '11A' OR '11D' AND DEMO #'07' OR '08'
                 NOT PRESENT
      0410 = (C) IMMUNO DRUG OCCR-36,NO REV-25 OR 636
      0412 = (C) BILL TYPE XX5 HAS ACCOM. REV. CODES
      0413 = (C) CABG/PCOE BUT TOB = HHA,OUT,HOS
      0414 = (C) VALU CD 61,MSA AMOUNT MISSING
      0415 = (C) HOME HEALTH INCORRECT ALPHA RIC
      0416 = (C) REVENUE CENTER '0022', TOB MUST BE
                 '18X' OR '21X'
      0417 = (C) REVENUE CENTER '0023', TOB MUST BE '32X'
                 OR '33X'
      0418 = (C) HHA--TOB '3X5' AND DATES OF SERVICE
                 >9/30/00
      0419 = (C) HHA--RIC 'W' MUST HAVE VALUE CODE '63'/
                 RIC 'V' MUST HAVE VALUE CODE '62' AND
                 RIC 'U' MUST HAVE VALUE CODES '62' AND
                 '63' PRESENT FOR DATES OF SERVICE >
                 9/30/00.
      0420 = (C) HHA W/O REVENUE CODE '0023'
      0421 = (C) START DATE MISSING
      0422 = (C) COB VS. OVERRIDE CODE
      05X4 = (C) UPIN REQUIRED FOR TYPE-OF-SERVICE
      05X5 = (C) UPIN REQUIRED FOR DME
      0501 = (C) REFFERING UPIN REQUIRED FOR CLINICAL LAB
      0502 = (C) REFERRING UPIN INVALID
      0601 = (C) GENDER INVALID
      0701 = (C) CONTRACTOR/POS 1-2 PROVIDER NUM INVALID
      0702 = (C) PROVIDER NUMBER VS. TOB
      0703 = (C) MAMMOGRAPHY FOR NOT FEMALE
      0704 = (C) INVALID CONT FOR CABG DEMO
      0705 = (C) INVALID CONT FOR PCOE DEMO
      0706 = (C) REVENUE CENTER CODE MAMMOGRAPHY AND
                 BENEFICIARY <35
      0901 = (C) INVALID DISP CODE OF 02
      0902 = (C) INVALID DISP CODE OF SPACES
      0903 = (C) INVALID DISP CODE
      1001 = (C) PROF REVIEW/ACT CODE/BILL TYPE
      13X2 = (C) MULTIPLE ITEMS FOR SAME SERVICE
      1301 = (C) LINE COUNT NOT NUMERIC OR > 13
      1302 = (C) RECORD LENGTH INVALID
      1401 = (C) INVALID MEDICARE STATUS CODE
      1501 = (C) ADMIT DATE/START DATE/ENTRY CODE INVALID
      1502 = (C) ADMIT DATE/START CARE DATE > STAY FROM DATE
      1503 = (C) ADMIT DATE INVALID WITH THRU DATE
      1504 = (C) ADM/FROM/THRU DATE > TODAYS DATE
      1505 = (C) HCPCS W SERVICE DATES > 09-30-94
      1601 = (C) INVESTIGATION IND INVALID
      1701 = (C) SPLIT IND INVALID
      1801 = (C) PAY-DENY CODE INVALID
      1802 = (C) HEADER AMT/LINE ITEMS DENIED
      1803 = (C) MSP COST AVD/ALL MSP LI NOT SAME
      1901 = (C) AB CROSSOVER IND INVALID
      2001 = (C) HOSPICE OVERRIDE INVALID
      2101 = (C) HMO-OVERRIDE/PATIENT-STAT INVALID
      2102 = (C) PATIENT STATUS VS. TOB
      2103 = (C) HIPPS RATE/CMG CODE VS. PATIENT STATUS
      2201 = (C) FROM DATE/HCPCS YR INVALID
      2202 = (C) STAY-FROM DATE > THRU-DATE
      2203 = (C) THRU DATE INVALID
      2204 = (C) FROM DATE BEFORE EFFECTIVE DATE
      2205 = (C) DATE YEARS DIFFERENT ON OUTPAT
      2207 = (C) MAMMOGRAPHY BEFORE 1991
      2208 = (C) TOB '21X', REV CODE 0022 FROM DATE
                 < 06-03-98
      2209 = (C) HHA WITH OVERLAPPING DATES JUNE/JULY,
                 SEPT/OCT
      2210 = (C) TOB 41X, SERVICE DATES 6/30/00,
                 EXCEP/NONEXCEP IND = 1,2
      2212 = (C) TOB 51X WITH SERVICE DATES >6/30/00
      2213 = (C) TOB 32X OR 33X, SERVICE >9/30/00 DAYS
                 CAN NOT = 60
      2215 = (C) DEMO 37 WITH VALUE CODES 'A2', 'B2', 'C2'
      2216 = (C) DEMO 37 OR CONDITION CODE 78 AND CHARGES
                 SUB TO DED > 0
      2301 = (C) DOCUMENT CNTL OR UTIL DYS INVALID
      2302 = (C) COVERED DAYS INVALID OR INCONSIST
      2303 = (C) COST REPORT DAYS > ACCOMIDATION
      2304 = (C) UTIL DAYS = ZERO ON PATIENT BILL
      2305 = (C) LATE CHARGE BILL WITH DATA FIELD PRESENT
      2306 = (C) UTIL DYS/NOPAY/REIMB INCONSISTENT
      2307 = (C) COND=40,UTL DYS >0/VAL CDE A1,08,09
      2308 = (C) NOPAY = R WHEN UTIL DAYS = ZERO
      2401 = (C) NON-UTIL DAYS INVALID
      2501 = (C) CLAIM RCV DT OR COINSURANCE INVAL
      2502 = (C) COIN+LR>UTIL DAYS/RCPT DTE>CUR DTE
      2503 = (C) COIN/TR TYP/UTIL DYS/RCPT DTE>PD/DEN
      2504 = (C) COINSURANCE AMOUNT EXCESSIVE
      2505 = (C) COINSURANCE RATE > ALLOWED AMOUNT
      2506 = (C) COINSURANCE DAYS/AMOUNT INCONSIST
      2507 = (C) COIN+LR DAYS > TOTAL DAYS FOR YR
      2508 = (C) COINSURANCE DAYS INVALID FOR TRAN
      2601 = (C) CLAIM PAID DT INVALID OR LIFE RES
      2602 = (C) LR-DAYS, NO VAL 08,10/PD/DEN>CUR+27
      2603 = (C) LIFE RESERVE > RATE FOR CAL YEAR
      2604 = (C) PPS BILL, NO DAY OUTLIER
      2605 = (C) LIFE RESERVE RATE > DAILY RATE AVR.
      28XA = (C) UTIL DAYS > FROM TO BENEF EXH
      28XB = (C) BENEFITS EXH DATE > FROM DATE
      28XC = (C) BENEFITS EXH DATE/INVALID TRANS TYPE
      28XD = (C) OCCUR 23 WITH SPAN 70 ON INPAT HOSP
      28XE = (C) MULTI BENE EXH DATE (OCCR A3,B3,C3)
      28XF = (C) ACE DATE ON SNF (NOPAY =B, C, N, W)
      28XG = (C) SPAN CD 70+4+6+9 NOT = NONUTIL DAYS
      28XM = (C) OCC CD 42 DATE NOT = SRVCE THRU DTE
      28XN = (C) INVALID OCC CODE
      28XO = (C) AN 'N' NO-PAY CODE IS PRESENT AND OCCURRENCE
                 CODE '23' OR '42' IS NOT PRESENT AND THE
                 DATE ASSOCIATED WITH CODE IS MISSING OR NOT
                 EQUAL TO THRU DATE.
      28XP = (C) THE OCCURRENCE CODE 23 DATE DOES NOT EQUAL THE
                 THRU DATE
      28X0 = (C) BENE EXH DATE OUTSIDE SERVICE DATES
      28X1 = (C) OCCUR DATE INVALID
      28X2 = (C) OCCUR = 20 AND TRANS = 4
      28X3 = (C) OCCUR 20 DATE < ADMIT DATE
      28X4 = (C) OCCUR 20 DATE > ADMIT + 12
      28X5 = (C) OCCUR 20 AND ADMIT NOT = FROM
      28X6 = (C) OCCUR 20 DATE < BENE EXH DATE
      28X7 = (C) OCCUR 20 DATE+UTIL-COIN>COVERAGE
      28X8 = (C) OCCUR 22 DATE < FROM OR > THRU
      28X9 = (C) UTIL > FROM - THRU LESS NCOV
      33X1 = (C) QUAL STAY DATES INVALID (SPAN=70)
      33X2 = (C) QS FROM DATE NOT < THRU (SPAN=70)
      33X3 = (C) QS DAYS/ADMISSION ARE INVALID
      33X4 = (C) QS THRU DATE > ADMIT DATE (SPAN=70)
      33X5 = (C) SPAN 70 INVALID FOR DATE OF SERVICE
      33X6 = (C) TOB=18/21/28/51,COND=WO,HMO<>90091
      33X7 = (C) TOB<>18/21/28/51,COND=WO
      33X8 = (C) TOB=18/21/28/51,CO=WO,ADM DT<97001
      33X9 = (C) TOB=32X SPAN 70 OR OCCR BO PRESENT
      33#A = (C) MULTIPLE PET SCANS
      33#B = (C) MULITIPLE PET SCANS W/O MODIFIER 26
                 OR TC
      3401 = (C) DEMO ID = 04 AND RIC NOT = 1 OR 2
      34X2 = (C) DEMO ID = 04 AND COND WO NOT SHOWN
      34#3 = (C) CONDITION CODE = W0 AND DEMO NOT = 04
      35X1 = (C) 60, 61, 66 & NON-PPS / 65 & PPS
      35X2 = (C) COND = 60 OR 61 AND NO VALU 17
      35X3 = (C) PRO APPROVAL COND C3,C7 REQ SPAN M0
      35#3 = (C) (SECOND CONDITION) CONDITION CODE = C3
                 REQUIRES SPAN CODE 76 OR 77
      35#4 = (C) CONDITION CODE = 69 AND TOB NOT 11X
      36X1 = (C) SURG DATE < STAY FROM/ > STAY THRU
      36#1 = (C) SURGICAL DATE = ZEROES OR < FROM OR >
                 THRU DATES
      3701 = (C) ASSIGN CODE INVALID
      3705 = (C) 1ST CHAR OF IDE# IS NOT ALPHA
      3706 = (C) INVALID IDE NUMBER-NOT IN FILE
      3710 = (C) NUM OF IDE# > REV 0624
      3715 = (C) NUM OF IDE# < REV 0624
      3720 = (C) IDE AND LINE ITEM NUMBER > 2
      3801 = (C) AMT BENE PD INVALID
      3XA/ = (C) COLORECTAL/PROSTATE SCREENING BILLED
                 MULTIPLE TIMES
      4001 = (C) BLOOD PINTS FURNISHED INVALID
      4002 = (C) BLOOD FURNISHED/REPLACED INVALID
      4003 = (C) BLOOD FURNISHED/VERIFIED/DEDUCT
      4201 = (C) BLOOD PINTS UNREPLACED INVALID
      4202 = (C) BLOOD PINTS UNREPLACED/BLOOD DED
      4203 = (C) INVALID CPO PROVIDER NUMBER
      4301 = (C) BLOOD DEDUCTABLE INVALID
      4302 = (C) BLOOD DEDUCT/FURNISHED PINTS
      4303 = (C) BLOOD DEDUCT > UNREPLACED BLOOD
      4304 = (C) BLOOD DEDUCT > 3 - REPLACED
      4501 = (C) PRIMARY DIAGNOSIS INVALID
      4502 = (C) SERVICE DATES > CURRENT DATE
      46#A = (C) MSP VET AND VET AT MEDICARE
      46#B = (C) MULTIPLE COIN VALU CODES (A2,B2,C2)
      46#C = (C) COIN VALUE (A2,B2,C2) ON INP/SNF
      46#G = (C) VALU CODE 20 INVALID
      46#L = (C) BLOOD FURNISHED < BLOOD REPLACED
      46#N = (C) VALUE CODE 37,38,39 INVALID
      46#O = (C) VALUE CDE 37,38,39 AMOUNT NOT > 00
      46#P = (C) BLD UNREP VS REV CDS AND/OR UNITS
      46#Q = (C) VALUE CDE 37=39 AND 38 IS PRESENT
      46#R = (C) BLD FIELDS VS REV CDE 380,381,382
      46#S = (C) VALU CODE 39, AND 37 IS NOT PRESENT
      46#T = (C) CABG/PCOE/MPPD,VC<>Y1,Y2,Y3,Y4,VA NOT>0
      46#U = (C) MSP VALUES ON CABG/PCOE/MPPD (INP)
                 TOB '32X'/'33X' MUST HAVE VALUE 62/64
                 OR 63/65 (HHA)
      46#V = (C) TOB '32X'/'33X' VISITS IN 62/63 NOT =
                 REVENUE CODE 42X-44X, 55X-57X
      46#W = (C) CONDITION CODE =30/78 AND WITH VALUE
                 CODE = A1, B1, C1
      46#1 = (C) VALUE AMOUNT INVALID
      46#2 = (C) VALU 06 AND BLD-DED-PTS IS ZERO
      46#3 = (C) VALU 06 AND TTL-CHGS=NC-CHGS(001)
      46#4 = (C) VALU (A1,B1,C1): AMT > DEDUCT
      46#5 = (C) DEDUCT VALUE (A1,B1,C1) ON SNF BILL
      46#6 = (C) VALU 17 AND NO COND CODE 60 OR 61
      46#7 = (C) OUTLIER(VAL 17) > REIMB + VAL6-16
      46#8 = (C) MULTI CASH DED VALU CODES (A1,B1,C1)
      46X9 = (C) DEMO ID=03,REQUIRED HCPCS NOT SHOWN
      4600 = (C) CAPITAL TOTAL NOT = CAP VALUES
      4601 = (C) CABG/PCOE, MSP CODE PRESENT
      4603 = (C) DEMO ID = 03 AND RIC NOT=6,7
      4604 = (C) DEMO = 03 WITH DATES OF SERVICE
                 > 09/31/01
      4901 = (C) PCOE/CABG,DEN CD NOT D
      4902 = (C) PCOE/CABG BUT DME
      50#1 = (C) RVCD=54,TOB<>13,23,32,33,34,83,85
      50#2 = (C) REV CD=054X,MOD NOT = QM,QN
      5051 = (E) EDB: NOMATCH ON 3 CHARACTERISTICS
      5052 = (E) EDB: NOMATCH ON MASTER-ID RECORD
      5053 = (E) EDB: NOMATCH ON CLAIM-NUMBER
      51#A = (C) HCPCS EYEWARE & REV CODE NOT 274
      51#C = (C) HCPCS REQUIRES DIAG CODE OF CANCER
      51#D = (C) HCPCS REQUIRES UNITS > ZERO
      51#E = (C) HCPCS REQUIRES REVENUE CODE 636/294
      51#F = (C) INV BILL TYP/ANTI-CAN DRUG HCPCS
      51#G = (C) HCPCS REQUIRES DIAG OF HEMOPHILL1A
      51#H = (C) TOB 21X/P82=2/3/4;REV CD<9001,>9044
      51#I = (C) TOB 21X/P82<>2/3/4:REV CD>8999<9045
      51#J = (C) TOB 21X/REV CD: SVC-FROM DT INVALID
      51#K = (C) TOB 21X/P82=2/3/4,REV CD = NNX
      51#L = (C) REV 0762/UNT>48,TOB NOT=12,13,85,83
      51#M = (C) 21X,RC>9041/<9045,RC<>4/234
      51#N = (C) 21X,RC>9032/<9042,RC<>4/234
      51#O = (C) TWO ANTI-EMETIC/ANTI-CANCER DRUGS
                 ON SAME CLAIM
      51#P = (C) HHA/OUTPATIENT RC DATE OF SRVC MISSING
      51#Q = (C) NO RC 0636 OR DTE INVALID
      51#R = (C) DEMO ID=01,RIC NOT=2
      51#S = (C) DEMO ID=01,RUGS<>2,3,4 OR BILL<>21
      51#V = (C) TOB 72X W HCPCS 'J1955' MISSING REVENUE
                 CENTER 636
      51#W = (C) TOB 12X, 13X, 22X, 23X, 34X, 74X, 75X,
                 83X, HCPCS '97504', '97116', PRESENT
                 ON SAME DAY
      51#X = (C) TOB '32X-34X' REQUIRE HCPCS FOR REVENUE
                 CODE '29X', '60X', '636'
      51X0 = (C) REV CENTER CODE INVALID
      51X1 = (C) REV CODE CHECK
      51X2 = (C) REV CODE INCOMPATIBLE BILL TYPE
      51X3 = (C) UNITS MUST BE > 0
      51X4 = (C) INP:CHGS/YR-RATE,ETC; OUTP:PSYCH>YR
      51X5 = (C) REVENUE NON-COVERED > TOTAL CHRGE
      51X6 = (C) REV TOTAL CHARGES EQUAL ZERO
      51X7 = (C) REV CDE 403 WTH NO BILL 14 23 71 85
      51X8 = (C) MAMMOGRAPHY SUBMISSION INVALID
      51X9 = (C) HCPCS/REV CODE/BILL TYPE
      5100 = (U) TRANSITION SPELL / SNF
      5160 = (U) LATE CHG HSP BILL STAY DAYS > 0
      5166 = (U) PROVIDER NE TO 1ST WORK PRVDR
      5167 = (U) PROVIDER 1 NE 2: FROM DT < START DT
      5168 = (E) CLAIM IN HOSPICE WITH 2ND START DATE
                 PRESENT
      5169 = (U) PROVIDER NE TO WORK PROVIDER
      5170 = (E) OCCURRENCE CODE = 42 AND < DOLBA
      5177 = (U) PROVIDER NE TO WORK PROVIDER
      5178 = (U) HOSPICE BILL THRU < DOLBA
      5181 = (U) HOSP BILL OCCR 27 DISCREPANCY
      5200 = (E) ENTITLEMENT EFFECTIVE DATE
      5201 = (U) HOSP DATE DIFFERENCE NE 60 OR 90
      5202 = (E) ENTITLEMENT HOSPICE EFFECTIVE DATE
      5202 = (U) HOSPICE TRAILER ERROR
      5203 = (E) ENTITLEMENT HOSPICE PERIODS
      5203 = (U) HOSPICE START DATE ERROR
      5204 = (U) HOSPICE DATE DIFFERENCE NE 90
      5205 = (U) HOSPICE DATE DISCREPANCY
      5206 = (U) HOSPICE DATE DISCREPANCY
      5207 = (U) HOSPICE THRU > TERM DATE 2ND
      5208 = (U) HOSPICE PERIOD NUMBER BLANK
      5209 = (U) HOSPICE DATE DISCREPANCY
      5210 = (E) ENTITLEMENT FRM/TRU/END DATES
      5211 = (E) ENTITLEMENT DATE DEATH/THRU
      5212 = (E) ENTITLEMENT DATE DEATH/THRU
      5213 = (E) ENTITLEMENT DATE DEATH MBR
      5220 = (E) ENTITLEMENT FROM/EFF DATES
      5225 = (E) ENT INP PPS SPAN 70 DATES
      5232 = (E) ENTL HMO NO HMO OVERRIDE CDE
      5233 = (E) ENTITLEMENT HMO PERIODS
      5234 = (E) ENTITLEMENT HMO NUMBER NEEDED
      5235 = (E) ENTITLEMENT HMO HOSP+NO CC07
      5236 = (E) ENTITLEMENT HMO HOSP + CC07
      5237 = (E) ENTITLEMENT HOSP OVERLAP
      5238 = (U) HOSPICE CLAIM OVERLAP > 90
      5239 = (U) HOSPICE CLAIM OVERLAP > 60
      524Z = (E) HOSP OVERLAP NO OVD NO DEMO
      5240 = (U) HOSPICE DAYS STAY+USED > 90
      5241 = (U) HOSPICE DAYS STAY+USED > 60
      5242 = (C) INVALID CARRIER FOR RRB
      5243 = (C) HMO=90091,INVALID SERVICE DTE
      5244 = (E) DEMO CABG/PCOE MISSING ENTL
      5245 = (C) INVALID CARRIER FOR NON RRB
      525Z = (E) HMO/HOSP 6/7 NO OVD NO DEMO
      5250 = (U) HOSPICE DOEBA/DOLBA
      5255 = (U) HOSPICE DAYS USED
      5256 = (U) HOSPICE DAYS USED > 999
      526Y = (E) HMO/HOSP DEMO 5/15 REIMB > 0
      526Z = (E) HMO/HOSP DEMO 5/15 REIMB = 0
      5270 = (C) CONDITION CODE = 30 AND HMO REQUIRES
                 MODIFIER = 'QV' OR 'KZ'/DED IND
      5271 = (C) RISK HMO NOT PRESENT AND MOD 'KZ'/
                 OR CONDITION CODE 78 PRESENT
      527Y = (E) HMO/HOSP DEMO OVD=1 REIMB > 0
      527Z = (E) HMO/HOSP DEMO OVD=1 REIMB = 0
      5299 = (U) HOSPICE PERIOD NUMBER ERROR
      52#K = (C) HCPCS VS DIAGNOSIS
      52#L = (C) HCPCS VS MODIFIER
      52#M = (C) HCPCS VS DATES OF SERVICE
      52#N = (C) TOB '71X' OR '73X' WITH REVENUE
                 CENTER CODE 0403 MISSING REVENUE
                 CENTER CODE 0521
      52#O = (C) REVENUE CENTER CODE 0022/0024 WITH
                 CHARGES >0
      52#P = (C) REVENUE CENTER CODE 010X-021X MINUS
                 18X <> 0022
      52#Q = (C) REVENUE CENTER CODE 0022 AND HIPPS
                 MISSING
      52#R = (C) REVENUE CENTER CODE 0022 MISSING DATE
                 OF SERVICE
      52#T = (C) REVENUE CENTER CODE 0022 MISSING REVENUE
                 CENTER CODE 042X-044X
      5320 = (U) BILL > DOEBA AND IND-1 = 2
      5350 = (U) HOSPICE DOEBA/DOLBA SECONDARY
      5355 = (U) HOSPICE DAYS USED SECONDARY
      5362 = (C) MAMMOGRAPHY AND BENE <35
      5378 = (C) SERVICE DATE < AGE 50
      5379 = (C) HCPCS 'G0160' PRESENT MORE THAN
                 ONCE
      5381 = (C) HCPCS 'G0161' PRESENT MORE THAN
                 ONCE
      5382 = (C) HCPCS 'G0102-03' AND BENE <50
      538Q = (C) SERVICE DATES WITHIN ALIEN RECORD
      5397 = (C) DEMO '37' AND NOT CAT 74
      5398 = (C) HCPCS 'G9001-G9005 & G9009-G9011 >1
                 OR 2 ARE PRESENT
      5399 = (U) HOSPICE PERIOD NUM MATCH
      539A = (C) HCPCS 'G9008' PRESENT MORE THAN ONCE
      539C = (C) HCPCS 'G9013-G9015' PRESENT MORE THAN
                 ONCE OR 2 PRESENT
      5410 = (U) INPAT DEDUCTABLE
      5425 = (U) PART B DEDUCTABLE CHECK
      5430 = (U) PART B DEDUCTABLE CHECK
      5450 = (U) PART B COMPARE MED EXPENSE
      5460 = (U) PART B COMPARE MED EXPENSE
      5499 = (U) MED EXPENSE TRAILER MISSING
      5500 = (U) FULL DAYS/SNF-HOSP FULL DAYS
      5510 = (U) COIN DAYS/SNF COIN DAYS
      5515 = (U) FULL DAYS/COIN DAYS
      5516 = (U) SNF FULL DAYS/SNF COIN DAYS
      5520 = (U) LIFE RESERVE DAYS
      5530 = (U) UTIL DAYS/LIFE PSYCH DAYS
      5540 = (U) HH VISITS NE AFT PT B TRLR
      5550 = (E) SNF LESS THAN PT A EFF DATE
      5600 = (D) LOGICAL DUPE, COVERED
      5601 = (D) LOGICAL DUPE, QRY-CDE, RIC 123
      5602 = (D) LOGICAL DUPE, PANDE C, E OR I
      5603 = (D) LOGICAL DUPE, COVERED
      5604 = (D) LOGICAL DUPE, DATES
      5605 = (D) POSS DUPE, OUTPAT REIMB
      5606 = (D) POSS DUPE, HOME HEALTH COVERED U
      5623 = (U) NON-PAY CODE IS P
      57X1 = (C) PROVIDER SPECIALITY CODE INVALID
      57X2 = (C) PHYS THERAPY/PROVIDER SPEC INVAL
      57X3 = (C) PLACE/TYPE/SPECIALTY/REIMB IND
      57X4 = (C) SPECIALTY CODE VS. HCPCS INVALID
      57X5 = (C) HCPCS 98940-2 MODIFIER NOT = 'AT'
      5700 = (U) LINKED TO THREE SPELLS
      5701 = (C) DEMO ID=02,RIC NOT = 5
      5702 = (C) DEMO ID=02,INVALID PROVIDER NUM
      58X1 = (C) PROVIDER TYPE INVALID
      58X9 = (C) TYPE OF SERVICE INVALID
      5802 = (C) REIMB > $150,000
      5803 = (C) UNITS/VISITS > 150
      5804 = (C) UNITS/VISITS > 99
      5805 = (C) OUTPATIENT CHARGE > $150,000
      5806 = (C) REVENUE CENTER CODE '042X-044X'
                 WITHOUT MODIFIER 'GN-GP'
      58#4 = (C) REVENUE CENTER CODE MISSING REQUIRED
                 HCPCS OR MODIFIER
      59XA = (C) PROST ORTH HCPCS/FROM DATE
      59XB = (C) HCPCS/FROM DATE/TYPE P OR I
      59XC = (C) HCPCS Q0036,37,42,43,46/FROM DATE
      59XD = (C) HCPCS Q0038-41/FROM DATE/TYPE
      59XE = (C) HCPCS/MAMMOGRAPHY-RISK/ DIAGNOSIS
      59XG = (C) INVALID TOS FOR DME
      59XH = (C) HCPCS E0620/TYPE/DATE
      59XI = (C) HCPCS E0627-9/ DATE < 1991
      59XJ = (C) GLOBAL HCPCS TOS MUST = 2
      59XK = (C) HCPCS PEN PUMP AND TOS <>9
      59XL = (C) HCPCS 00104 - TOS/POS
      59X1 = (C) INVALID HCPCS/TOS COMBINATION
      59X2 = (C) ASC IND/TYPE OF SERVICE INVALID
      59X3 = (C) TOS INVALID TO MODIFIER
      59X4 = (C) KIDNEY DONOR/TYPE/PLACE/REIMB
      59X5 = (C) MAMMOGRAPHY FOR MALE
      59X6 = (C) DRUG AND NON DRUG BILL LINE ITEMS
      59X7 = (C) CAPPED-HCPCS/FROM DATE
      59X8 = (C) FREQUENTLY MAINTAINED HCPCS
      59X9 = (C) HCPCS E1220/FROM DATE/TYPE IS R
      5901 = (U) ERROR CODE OF Q
      5A#1 = (C) DEMO=37, UNITS >1 FOR 'G9001-05'
                 'G9007-11', G9013-G9015'
      60X1 = (C) ASSIGN IND INVALID
      6000 = (U) ADJUSTMENT BILL SPELL DATA
      6020 = (U) CURRENT SPELL DOEBA < 1990
      6030 = (U) ADJUSTMENT BILL SPELL DATA
      6035 = (U) ADJUSTMENT BILL THRU DTE/DOLBA
      61X1 = (C) PAY PROCESS IND INVALID
      61X2 = (C) DENIED CLAIM/NO DENIED LINE
      61X3 = (C) PAY PROCESS IND/ALLOWED CHARGES
      61X4 = (C) RATE MISSING OR NON-NUMERIC
      61#E = (C) PROVIDER PAYMENT INCONSISTENCIES
      61#F = (C) BENEFICIARY PAYMENT INCONSISTENCIES
      61#G = (C) PATIENT RESPONSIBILITY INCONSISTENCIES
      61#H = (C) MEDICARE PAYMENT INCONSISTENCIES
      61#I = (C) LINE DATE OF SERVICE < FROM DATE
                 > THRU DATE
      61#J = (C) DUPLICATE HCPCS CODE '55873'
      61#K = (C) HCPCS 'G0117-8' >2 OR BOTH PRESENT
      61#L = (C) REVENUE CENTER CODE 0024 > 2
      61#M = (C) REVENUE CENTER CODE 0024 VS PROVIDER
                 NUMBER
      61#N = (C) REVENUE CENTER CODE 0024 REQUIRES
                 VALID HIPPS RATE CMG CODE
      61#R = (C) HCPCS/TOB/REVENUE CENTER CODE
      61#S = (C) HCPCS 'G0247' REQUIRES 'G0245-6' TO
                 BE COVERED
      61#T = (C) HCPCS CODE '0245-0246' PRESENT MULTIPLE
                 TIMES
      61#0 = (C) REVENUE CENTER CODE VS SPAN CODE '74'
      61#6 = (C) PAYMENT METHOD INVALID
      61#7 = (C) ANSI CODE MISSING
      61#8 = (C) BLOOD CASH DEDUCTIBLE INCONSISTENCIES
      61#9 = (C) CASH DEDUCTIBLE INCONSISTENCIES
      6100 = (C) REV 0001 NOT PRESENT ON CLAIM
      6101 = (C) REV COMPUTED CHARGES NOT=TOTAL
      6102 = (C) REV COMPUTED NON-COVERED/NON-COV
      6103 = (C) REV TOTAL CHARGES < PRIMARY PAYER
      6105 = (C) REVE CODE 0001 > 1
      6106 = TOB 3X2 REVENUE CENTER CODE 0023 NOT =
                 TOTAL CHARGE
      6109 = (C) REIMBURSEMENT > 4 OR 6 TIMES
      62XA = (C) PSYC OT PT/REIM/TYPE
      62XC = (C) DEMO 37 WITH REIMBURSEMENT/DED IND
                 <>1
      62X1 = (C) DME/DATE/100% OR INVAL REIMB IND
      62X6 = (C) RAD PATH/PLACE/TYPE/DATE/DED
      62X8 = (C) KIDNEY DONO/TYPE/100%
      62X9 = (C) PNEUM VACCINE/TYPE/100%
      6201 = (C) TOTAL DEDUCT > CHARGES/NON-COV
      6203 = (U) HOSPICE ADJUSTMENT PERIOD/DATE
      6204 = (U) HOSPICE ADJUSTMENT THRU>DOLBA
      6260 = (U) HOSPICE ADJUSTMENT STAY DAYS
      6261 = (U) HOSPICE ADJUSTMENT DAYS USED
      6265 = (U) HOSPICE ADJUSTMENT DAYS USED
      6269 = (U) HOSPICE ADJUSTMENT PERIOD# (MAIN)
      63X1 = (C) DEDUCT IND INVALID
      63X2 = (C) DED/HCFA COINS IN PCOE/CABG
      6365 = (U) HOSPICE ADJUSTMENT SECONDARY DAYS
      6369 = (U) HOSPICE ADJUSTMENT PERIOD# (SECOND)
      64X1 = (C) PROVIDER IND INVALID
      6430 = (U) PART B DEDUCTABLE CHECK
      65X1 = (C) PAYSCREEN IND INVALID
      66?? = (D) POSS DUPE, CR/DB, DOC-ID
      66XX = (D) POSS DUPE, CR/DB, DOC-ID
      66X1 = (C) UNITS AMOUNT INVALID
      66X2 = (C) UNITS IND > 0; AMT NOT VALID
      66X3 = (C) UNITS IND = 0; AMT > 0
      66X4 = (C) MT INDICATOR/AMOUNT
      66X7 = (C) DEMO 37/HCPCS/UNITS
      6600 = (U) ADJUSTMENT BILL FULL DAYS
      6610 = (U) ADJUSTMENT BILL COIN DAYS
      6620 = (U) ADJUSTMENT BILL LIFE RESERVE
      6630 = (U) ADJUSTMENT BILL LIFE PSYCH DYS
      67X1 = (C) UNITS INDICATOR INVALID
      67X2 = (C) CHG ALLOWED > 0; UNITS IND = 0
      67X3 = (C) TOS/HCPCS=ANEST, MTU IND NOT = 2
      67X4 = (C) HCPCS = AMBULANCE, MTU IND NOT = 1
      67X6 = (C) INVALID PROC FOR MT IND 2, ANEST
      67X7 = (C) INVALID UNITS IND WITH TOS OF BLOOD
      67X8 = (C) INVALID PROC FOR MT IND 4, OXYGEN
      6700 = (U) ADJUSTMENT BILL FULL/SNF DAYS
      6710 = (U) ADJUSTMENT BILL COIN/SNF DAYS
      68XA = (C) HCPCS G0117-8 >1 OR BOTH PRESENT
      68XB = (C) HCPCS CODE G0245-46 > 1
      68X1 = (C) INVALID HCPCS CODE
      68X2 = (C) MAMMOGRAPY/DATE/PROC NOT 76092
      68X3 = (C) TYPE OF SERVICE = G /PROC CODE
      68X4 = (C) HCPCS NOT VALID FOR SERVICE DATE
      68X5 = (C) MODIFIER NOT VALID FOR HCPCS, ETC
      68X6 = (C) TYPE SERVICE INVALID FOR HCPCS, ETC
      68X7 = (C) ZX MOD REQ FOR THER SHOES/INS/MOD.
      68X8 = (C) ANTI-EMETIC WITHOUT ANTI-CANCER DRUG
      6812 = (C) DEMO 37 WITH PRIMARY PAYER CODE
      69XA = (C) MODIFIER NOT VALID FOR HCPCS/GLOBAL
      69XB = (C) HCPCS CODE 97504/97116 PRESENT ON
                 SAME DAY
      69XC = (C) HCPCS CODE VS PAY PROCESS INDICATOR
      69X3 = (C) PROC CODE MOD = LL / TYPE = R
      69X6 = (C) PROC CODE MOD/NOT CAPPED
      69X8 = (C) SPEC CODE NURSE PRACT, MOD INVAL
      69X9 = (C) NURSE PRACTITIONER, MOD INVALID
      6901 = (C) KRON IND AND UTIL DYS EQUALS ZERO
      6902 = (C) KRON IND AND NO-PAY CODE B OR N
      6903 = (C) KRON IND AND INPATIENT DEDUCT = 0
      6904 = (C) KRON IND AND TRANS CODE IS 4
      6910 = (C) REV CODES ON HOME HEALTH
      6911 = (C) REV CODE 274 ON OUTPAT AND HH ONLY
      6912 = (C) REV CODE INVAL FOR PROSTH AND ORTHO
      6913 = (C) REV CODE INVAL FOR OXYGEN
      6914 = (C) REV CODE INVAL FOR DME
      6915 = (C) PURCHASE OF RENT DME INVAL ON DATES
      6916 = (C) PURCHASE OF RENT DME INVAL ON DATES
      6917 = (C) PURCHASE OF LIFT CHAIR INVAL > 91000
      6918 = (C) HCPCS INVALID ON DATE RANGES
      6919 = (C) DME OXYGEN ON HH INVAL BEFORE 7/1/89
      6920 = (C) HCPCS INVAL ON REV 270/BILL 32-33
      6921 = (C) HCPCS ON REV CODE 272 BILL TYPE 83X
      6922 = (C) HCPCS ON BILL TYPE 83X -NOT REV 274
      6923 = (C) RENTAL OF DME CUSTOMIZE AND REV 291
      6924 = (C) INVAL MODIFIER FOR CAPPED RENTAL
      6925 = (C) HCPCS ALLOWED ON BILL TYPES 32X-34X
      6929 = (U) ADJUSTMENT BILL LIFE RESERVE
      6930 = (U) ADJUSTMENT BILL LIFE PSYCH DYS
      7000 = (U) INVALID DOEBA/DOLBA
      7002 = (U) LESS THAN 60/61 BETWEEN SPELLS
      7010 = (E) TOB 85X/ELECTN PRD: COND CD 07 REQD
      71X1 = (C) SUBMITTED CHARGES INVALID
      71X2 = (C) MAMMOGRPY/PROC CODE MOD TC,26/CHG
      71X3 = (C) HCPCS 76092 PAY INDICATOR <> A,R,S
                 & 76085 PAY INDICATOR A,R,S
      72X1 = (C) ALLOWED CHGS INVALID
      72X2 = (C) ALLOWED/SUBMITTED CHARGES/TYPE
      72X3 = (C) DENIED LINE/ALLOWED CHARGES
      7230 = (C) FRAMES >1, LENSES >2
      73X1 = (C) SS NUMBER INVALID
      73X2 = (C) CARRIER ASSIGNED PROV NUM MISSING
      74X1 = (C) LOCALITY CODE INVAL FOR CONTRACT
      76X1 = (C) PL OF SER INVAL ON MAMMOGRAPHY BILL
      77X1 = (C) PLACE OF SERVICE INVALID
      77X2 = (C) PHYS THERAPY/PLACE
      77X3 = (C) PHYS THERAPY/SPECIALTY/TYPE
      77X4 = (C) ASC/TYPE/PLACE/REIMB IND/DED IND
      77X6 = (C) TOS=F, PL OF SER NOT = 24
      7701 = (C) INCORRECT MODIFIER
      7777 = (D) POSS DUPE, PART B DOC-ID
      78XA = (C) MAMMOGRAPHY BEFORE 1991
      78XB = (C) ANTI-CANCER BEFORE 01/01/1998
      78X1 = (C) FROM DATE IMPOSSIBLE
      78X2 = (C) FROM DATE > CURRENT DATE OR
                 < 07/01/1966
      78X3 = (C) FROM DATE GREATER THAN THRU DATE
      78X4 = (C) FROM DATE > RCVD DATE/PAY-DENY
      78X5 = (C) FROM DATE > PAID DATE/TYPE/100%
      78X7 = (C) LAB EDIT/TYPE/100%/FROM DATE
      79X1 = (C) THRU DATE IMPOSSIBLE
      79X2 = (C) THRU DATE > CURRENT DATE
      79X3 = (C) THRU DATE>RECD DATE/NOT DENIED
      79X4 = (C) THRU DATE>PAID DATE/NOT DENIED
      8000 = (U) MAIN & 2NDARY DOEBA < 01/01/90
      8028 = (E) NO ENTITLEMENT
      8029 = (U) HH BEFORE PERIOD NOT PRESENT
      8030 = (U) HH BILL VISITS > PT A REMAINING
      8031 = (U) HH PT A REMAINING > 0
      8032 = (U) HH DOLBA+59 NOT GT FROM-DATE
      8050 = (U) HH QUALIFYING INDICATOR = 1
      8051 = (U) HH # VISITS NE AFT PT B APPLIED
      8052 = (U) HH # VISITS NE AFT TRAILER
      8053 = (U) HH BENEFIT PERIOD NOT PRESENT
      8054 = (U) HH DOEBA/DOLBA NOT > 0
      8060 = (U) HH QUALIFYING INDICATOR NE 1
      8061 = (U) HH DATE NE DOLBA IN AFT TRLR
      8062 = (U) HH NE PT-A VISITS REMAINING
      81X1 = (C) NUM OF SERVICES INVALID
      83X1 = (C) DIAGNOSIS INVALID
      8301 = (C) HCPCS/GENDER DIAGNOSIS
      8302 = (C) HCPCS G0101 V-CODE/SEX CODE
      8303 = (C) HCPCS/GENDER
      8304 = (C) BILL TYPE INVALID FOR G0123/4
      8305 = (C) HCPCS/SERVICE DATES/GENDER
      84X1 = (C) PAP SMEAR/DIAGNOSIS/GENDER/PROC
      84X2 = (C) INVALID DME START DATE
      84X3 = (C) INVALID DME START DATE W/HCPCS
      84X4 = (C) HCPCS G0101 V-CODE/SEX CODE
      84X5 = (C) HCPCS CODE WITH INV DIAG CODE
      84X6 = (C) HCPCS/GENDER
      84X7 = (C) HCPCS/SERVICE DATES/GENDER
      84X8 = (C) DUPLICATE HCPCS
      86X1 = (C) CLINICAL LAB HCPCS W/O CLINICAL
                 LAB ID
      86X2 = (C) NON-WAIVER HCPCS/PAY DENIAL CODE/
                 MODIFIER
      86X8 = (C) CLIA REQUIRES NON-WAIVER HCPCS
      88XX = (D) POSS DUPE, DOC-ID,UNITS,ENT,ALWD
      9000 = (U) DOEBA/DOLBA CALC
      9005 = (U) FULL/COINS HOSP DAYS CALC
      9010 = (U) FULL/COINS SNF DAYS CALC
      9015 = (U) LIFE RESERVE DAYS CALC
      9020 = (U) LIFE PSYCH DAYS CALC
      9030 = (U) INPAT DEDUCTABLE CALC
      9040 = (U) DATA INDICATOR 1 SET
      9050 = (U) DATA INDICATOR 2 SET
      91X1 = (C) PATIENT REIMB/PAY-DENY CODE
      92X1 = (C) PATIENT REIMB INVALID
      92X2 = (C) PROVIDER REIMB INVALID
      92X3 = (C) LINE DENIED/PATIENT-PROV REIMB
      92X4 = (C) MSP CODE/AMT/DATE/ALLOWED CHARGES
      92X5 = (C) CHARGES/REIMB AMT NOT CONSISTANT
      92X7 = (C) REIMB/PAY-DENY INCONSISTANT
      9201 = (C) UPIN REF NAME OR INITIAL MISSING
      9202 = (C) UPIN REF FIRST 3 CHAR INVALID
      9203 = (C) UPIN REF LAST 3 CHAR NOT NUMERIC
      93X1 = (C) CASH DEDUCTABLE INVALID
      93X2 = (C) DEDUCT INDICATOR/CASH DEDUCTIBLE
      93X3 = (C) DENIED LINE/CASH DEDUCTIBLE
      93X4 = (C) FROM DATE/CASH DEDUCTIBLE
      93X5 = (C) TYPE/CASH DEDUCTIBLE/ALLOWED CHGS
      9300 = (C) UPIN OTHER, NOT PRESENT
      9301 = (C) UPIN NME MIS/DED TOT LI>0 FR DEN CLM
      9302 = (C) UPIN OPERATING, FIRST 3 NOT NUMERIC
      9303 = (C) UPIN L 3 CH NT NUM/DED TOT LI>YR DED
      9351 = (C) OTHER UPIN PRESENT/MISSING OTHER FIELDS
      9352 = (C) OTHER UPIN INVALID
      9353 = (C) OTHER UPIN INVALID
      94A1 = (C) NON-COVERED FROM DATE INVALID
      94A2 = (C) NON-COVERED FROM > THRU DATE
      94A3 = (C) NON-COVERED THRU DATE INVALID
      94A4 = (C) NON-COVERED THRU DATE > ADMIT
      94A5 = (C) NON-COVERED THRU DATE/ADMIT DATE
      94C1 = (C) PR-PSYCH DAYS INVALID
      94C3 = (C) PR-PSYCH DAYS > PROVIDER LIMIT
      94F1 = (C) REIMBURSEMENT AMOUNT INVALID
      94F2 = (C) REIMBURSE AMT NOT 0 FOR HMO PAID
      94G1 = (C) NO-PAY CODE INVALID
      94G2 = (C) NO-PAY CODE SPACE/NON-COVERD=TOTL
      94G3 = (C) NO-PAY/PROVIDER INCONSISTANT
      94G4 = (C) NO PAY CODE = R & REIMB PRESENT
      94X1 = (C) BLOOD LIMIT INVALID
      94X2 = (C) TYPE/BLOOD DEDUCTIBLE
      94X3 = (C) TYPE/DATE/LIMIT AMOUNT
      94X4 = (C) BLOOD DED/TYPE/NUMBER OF SERVICES
      94X5 = (C) BLOOD/MSP CODE/COMPUTED LINE MAX
      9401 = (C) BLOOD DEDUCTIBLE AMT > 3
      9402 = (C) BLOOD FURNISHED > DEDUCTIBLE
      9403 = (C) DATE OF BIRTH MISSING ON PRO-PAY
      9404 = (C) INVALID GENDER CODE ON PRO-PAY
      9407 = (C) INVALID DIAGNOSIS
      9408 = (C) INVALID DRG NUMBER (GLOBAL)
      9409 = (C) HCFA DRG<>DRG ON BILL
      940X = (C) INVALID DRG
      9410 = (C) CABG/PCOE,INVALID DRG
      95X1 = (C) MSP CODE G/DATE BEFORE 1/1/87
      95X2 = (C) MSP AMOUNT APPLIED INVALID
      95X3 = (C) MSP AMOUNT APPLIED > SUB CHARGES
      95X4 = (C) MSP PRIMARY PAY/AMOUNT/CODE/DATE
      95X5 = (C) MSP CODE = G/DATE BEFORE 1987
      95X6 = (C) MSP CODE = X AND NOT AVOIDED
      95X7 = (C) MSP CODE VALID, CABG/PCOE
      96X1 = (C) OTHER AMOUNTS INVALID
      96X2 = (C) OTHER AMOUNTS > PAT-PROV REIMB
      97X1 = (C) OTHER AMOUNTS INDICATOR INVALID
      97X2 = (C) GRUDMAN SW/GRUDMAN AMT NOT > 0
      98X1 = (C) COINSURANCE INVALID
      98X3 = (C) MSP CODE/TYPE/COIN AMT/ALLOW/CSH
      98X4 = (C) DATE/MSP/TYPE/CASH DED/ALLOW/COI
      98X5 = (C) DATE/ALLOW/CASH DED/REIMB/MSP/TYP
      9801 = (C) REV CENTER CODE 0910 WITH SERVICE
                 DATE > 10/15/2004
      99XX = (D) POSS DUPE, PART B DOC-ID
      9901 = (C) REV CODE INVALID OR TRAILER CNT=0
      9902 = (C) ACCOMMODATION DAYS/FROM/THRU DATE
      9903 = (C) NO CLINIC VISITS FOR RHC
      9904 = (C) INCOMPATIBLE DATES/CLAIM TYPE
      991X = (C) NO DATE OF SERVICE
      9910 = (C) BLOOD DEDUCTIBLE NON NUMERIC
      9911 = (C) BLOOD DEDUCTIBLE PRESENT WITHOUT
                 BLOOD FURNISHED
      9920 = (C) CASH DEDUCTIBLE INVALID
      9930 = (C) COINSURANCE INVALID
      9931 = (C) OUTPAT COINSURANCE VALUES
      9933 = (C) RATE EXCEDES MAMMOGRAPHY LIMIT
      9934 = (C) HCPCS 76092 NON COVERED/76085 COVERED
      9940 = (C) PROVIDER PAYMENT INVALID
      9941 = (C) REIMBURSEMENT AMOUNT/COND/NON-PAYMENT/
                 PRIMARY PAYER
      9942 = (C) PATIENT DISTRIBUTION INVALID
      9944 = (C) STAY FROM>97273,DIAG<>V103,163,7612
      9945 = (C) HCPCS INVALID FOR SERVICE DATES
      9946 = (C) TOB INVALID FOR HCPCS
      9947 = (C) INVALID DATE FOR HCPCS
      9948 = (C) STAY FROM>96365,DIAG=V725
      9960 = (C) MED CHOICE BUT HMO DATA MISSING
      9965 = (C) HMO PRESENT BUT MED CHOICE MISSING
      9968 = (C) MED CHOICE NOT= HMO PLAN NUMBER
      9999 = (U) MAIN SPELL TRAILER NUMBER DOES NOT MATCH SPELL



 NCH_EDIT_TRLR_IND_TB                    NCH Edit Trailer Indicator Table

      E = Edit code trailer present



 NCH_LINE_TRLR_IND_TB                    NCH Line Item Trailer Indicator Table

      L = Line Item trailer present
      Blank = No trailer present



 NCH_MCO_TRLR_IND_TB                     NCH Managed Care Organization (MCO) Trailer Indicator Table

      M = MCO trailer present



 NCH_MQA_RIC_TB                          NCH MQA Record Identification Code Table

       1 = Inpatient
       2 = SNF
       3 = Hospice
       4 = Outpatient
       5 = Home Health Agency
       6 = Physician/Supplier
       7 = Durable Medical Equipment



 NCH_NEAR_LINE_REC_VRSN_TB               NCH Near Line Record Version Table

       A = Record format as of January 1991
       B = Record format as of April 1991
       C = Record format as of May 1991
       D = Record format as of January 1992
       E = Record format as of March 1992
       F = Record format as of May 1992
       G = Record format as of October 1993
       H = Record format as of September 1998
       I = Record format as of July 2000
       J = Record format as of January 2011
       K = Record format as of April 2013
       L = Record format as of January 2021



 NCH_NEAR_LINE_RIC_TB                    NCH Near-Line Record Identification Code Table

       O = Part B physician/supplier claim
           record (processed by local carriers;
           can include DMEPOS services)
       V = Part A institutional claim record
           (inpatient (IP), skilled nursing
           facility (SNF), christian science
           (CS), home health agency (HHA), or
           hospice)
       W = Part B institutional claim record
           (outpatient (OP), HHA)
       U = Both Part A and B institutional home
           health agency (HHA) claim records --
           due to HHPPS and HHA A/B split.
           (effective 10/00)
       M = Part B DMEPOS claim record (processed
           by DME Regional Carrier) (effective 10/93)



 NCH_PATCH_TB                            NCH Patch Table

      01 = RRB Category Equatable BIC - changed (all
           claim types) -- applied during the Nearline
           'G' conversion to claims with NCH weekly
           process date before 3/91.   Prior to Version
           'H', patch indicator stored in redefined Claim
           Edit Group, 3rd occurrence, position 2.
      02 = Claim Transaction Code made consistent with
           NCH payment/edit RIC code (OP and HHA) --
           effective 3/94, CWFMQA began patch.  During
           'H' conversion, patch applied to claims with
           NCH weekly process date prior to 3/94.  Prior
           to version 'H', patch indicator stored in
           redefined Claim Edit Group, 4th occurrence,
           position 1.
      03 = Garbage/nonnumeric Claim Total Charge Amount
           set to zeroes (Instnl) --  during the Version
           'G' conversion, error occurred in the deriva-
           tion of this field where the claim was missing
           revenue center code = '0001'.   In 1994, patch
           was applied to the OP and HHA SAFs only. (This
           SAF patch indicator was stored in the redefined
           Claim Edit Group, 4th occurrence, position 2).
           During the 'H' ocnversion, patch applied to
           Nearline claims where garbage or nonnumeric
           values.
      04 = Incorrect bene residence SSA standard county
           code '999' changed (all claim types) --
           applied during the Nearline 'G' conversion and
           ongoing through 4/21/94, calling EQSTZIP
           routine to claims with NCH weekly process
           date prior to 4/22/94.  Prior to Version 'H'
           patch indicator stored in redefined Claim
           Edit Group, 3rd occurrence, position 4.
      05 = Wrong century bene birth date corrected (all
           claim types) -- applied during Nearline 'H'
           conversion to all history where century
           greater than 1700 and less than 1850; if
           century less than 1700, zeroes moved.
      06 = Inconsistent CWF bene medicare status code
           made consistent with age (all claim types) --
           applied during Nearline 'H' conversion to all
           history and patched ongoing.  Bene age is
           calculated to determine the correct value;
           if greater than 64, 1st position MSC ='1';
           if less than 65, 1st position MSC = '2'.
      07 = Missing CWF bene medicare status code derived
           (all claim types) -- applied during Nearline
           'H' conversion to all history and patched
           ongoing, except claims with unknown DOB and/
           or Claim From Date='0' (left blank).   Bene
           age is calculated to determine missing value;
           if greater than 64, MSC='10'; if less than
           65, MSC = '20'.
      08 = Invalid NCH primary payer code set to blanks
           (Instnl) -- applied during Version 'H' con-
           version to claims with NCH weekly process
           date 10/1/93-10/30/95, where MSP values =
           invalid '0', '1', '2', '3' or '4' (caused
           by erroneous logic in HCFA program code,
           which was corrected on 11/1/95).
      09 = Zero CWF claim accretion date replaced with
           NCH weekly process date (all claim types)
           -- applied during Version 'H' conversion to
           Instnl and DMERC claims; applied during
           Version 'G' conversion to non-institutional
           (non-DMERC) claims.  Prior to Version 'H',
           patch indicator stored in redefined claim
           edit group, 3rd occurrence, position 1.
      10 = Multiple Revenue Center 0001 (Outpatient,
           HHA and Hospice) -- patch applied to 1998 &
           1999 Nearline and SAFs to delete any revenue
           codes that followed the first '0001' revenue
           center code.   The edit was applied across all
           institutional claim types, including Inpatient/
           SNF (the problem was only found with OP/HHA/
           Hospice claims).  The problem was corrected
           6/25/99.
      11 = Truncated claim total charge amount in the
           fixed portion replaced with the total charge
           amount in the revenue center 0001 amount field
           -- service years 1998 & 1999 patched during
           quarterly merge.  The 1998 & 1999 SAFs were
           corrected when finalized in 7/99.  The patch
           was done for records with NCH Daily Process
           Date 1/4/99 - 5/14/99.
      12 = Missing claim-level HHA Total Visit Count --
           service years 1998, 1999 & 2000 patch applied
           during Version 'I' conversion of both the
           Nearline and SAFs.   Problem occurs in those
           claims recovered during the missing claims
           effort.
      13 = Inconsistent Claim MCO Paid Switch made consistent
           with criteria used to identify an inpatient
           encounter claim -- if MCO paid switch equal to blank
           or '0' and ALL conditions are met to indicate an
           inpatient encounter claim (bene enrolled in a risk
           MCO during the service period), change the switch to
           a '1'.  The patch was applied during the Version 'I'
           conversion, for claims back to 7/1/97 service thru date.

      14 = SNF claims incorrectly identified as Inpatient
           Encounter claims -- SNF claims matching the Inpatient
           encounter data criteria were incorrectly identified
           as Inpatient encounter claims (claim type code = '61'
           instead of '20' or '30').   NOTE:  if the SNF claims
           were identified the MCO paid switch was set to '1'.
           The patch was applied to correctly identify these
           claims as a '20' or '30'.  The MCO paid switch will
           be set to '0' as there is no way to recover the original
           value.  The problem occurred in claims with an NCH
           Weekly Process Date ranging from 7/7/2000 - 1/26/2001.
           The patch applied date is 03/30/2001.

      15 = HHA Part A claims with overlaid revenue center lines -
           During the Version 'I' conversion, NCH made each
           segment of a claim contains a maximum of 45 revenue
           lines.  During the month of June 2000 our CWFMQA had
           to be ready to except the new expanded format, but the
           NCH was not ready.  CWFMQA converted these 'I' claims
           back to Version 'H', a typo in the code caused the
           additional revenue lines to overlay some of the
           revenue lines on the base/initial record/segment.
           The problem occurred in claims with NCH Weekly Process
           dates from 6/16/00, 6/23/00, 6/30/00 and 7/7/00
           (both Version 'H' & 'I' files).

           In the Version 'I' files, the annual service year
           2000 files, service year 1999 and 1998 trickles were
           patched.  The 18-month service year 1999 was also
           patched (the service year 2000 SAF was created after
           the fix was applied).

           The patch applied date is 06/29/2001.



 NCH_PATCH_TRLR_IND_TB                   NCH Patch Trailer Indicator Table

      P = Patch code trailer present



 NCH_STATE_SGMT_TB                       NCH State Segment Table

      NCH State Segment     State Codes
      -----------------     -----------------------
      B =                   01;02;03;04;06;07;08;09;
                            12;13;16;17;19;20;21;25;
                            27;28;29;30;32;35;37;38;
                            40;41;42;43;44;46;47;48;
                            50;51;53-99

      C =                   11;14;15;18;24;26;49;52

      D =                   11;14;15;18;24;26;31;34;
                            45;49;52

      E =                   22;23;31;34;36;45

      F =                   10;22;23;31;34;36;45

      G =                   10;22;23;36;39

      H =                   05;10;22;23;39

      I =                   05;10;39

      J =                   05;10;33;39

      K =                   05;33;39

      L =                   05;33;39

      M =                   05;33

      N =                   05;33

      O =                   33

      P =                   33

      Q =                   33

      R =                   33



 RP_IND_TB                               Claim Representative Payee (RP) Indicator Code Table

      R = bypass representative payee
      Space



 RSDL_PMT_IND_TB                         Claim Residual Payment Indicator Code Table

      X = Residual Payment
      Space



 YES_NO_TB                               Yes/No Table

       Y = Yes
       N = No



                                                           QUERY: RIFQQ11, RIFQQ21 ON DB2T
                                   *******END OF TOC APPENDIX FOR RECORD: DMERC_CLM_REC********


1
 LIMITATIONS APPENDIX FOR RECORD: DMERC_CLM_REC,  STATUS: PROD, VERSION: 21006
  PRINTED: 10/19/2021,  USER: F43D,  DATA SOURCE: CA REPOSITORY ON DB2T


  CHOICES_DEMO_LIM
                                   FULL NAME: Choices Demonstration Limitation
                                   DESCRIPTION :
                                     A programming error created an 'INVALID' indication
                                     in the demo text field for CHOICES claims.
                                   BACKGROUND    :
                                     In 6/00, the CWFMQA front-end editing revealed that some
                                     CHOICES demo claims were coming in with a valid 'H'
                                     number in the fixed portion of the claims, but in the
                                     first occurrence MCO trailer a numeric packed field
                                     (value hex '0100000C') was moved to the MCO Contract
                                     Number/Option Code fields.   This created an invalid
                                     period check of number/code to MCO effective date,
                                     resulting in an INVALID indication in the demo info
                                     text field.
                                   CORRECTIVE ACTION :
                                     The problem was forwarded to the CWF BSOG staff
                                     for further investigation.
                                   SOURCE:
                                     CONTACT         :  OIS/EDG/DMUDD
  CLM_ACNT_NUM_LIM
                                   FULL NAME: Beneficiary Claim Account Number Limitation
                                   DESCRIPTION :
                                     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.
                                   SOURCE:
  NCH_CLM_TYPE_CD_LIM
                                   FULL NAME: NCH Claim Type Code Limitation
                                   DESCRIPTION :
                                     As of the implementation of Version 'J', the NCH claim
                                     type codes '62' and '64' were not correctly being set.
                                   BACKGROUND    :
                                     With the implementation of Version'J', we added three
                                     new claim type codes ('62', '63' and '64') to identify
                                     Medicare Advantage claims.

                                     It appears that the conversion code we used to convert
                                     all of our history files (claims prior to start of Version
                                     'J') set the 62 and 64 correctly but that same code was not
                                     used in our normal monthly claims processing (claims
                                     received January 1, 2011 and after).  The error was with
                                     the MCO-PD-SW logic used to derive the claim type code.
                                   CORRECTIVE ACTION :
                                     This anamoly was handled in two phases:

                                     Phase 1 -- a fix was put into the NCH code to use
                                     the correct MCO-PD-SW logic.  The fix was imple-
                                     mented prior to our October 2012 NCH monthly
                                     load.  This fix corrected the claims received
                                     October 1st and forward.

                                     Phase 2 -- History files (January 1, 2011 thru
                                     September 28, 2012) were corrected during our
                                     NCH Version 'K' conversion, which was implemented
                                     April 2013.
                                   SOURCE:
                                   ADMINISTRATIVE DATA:
                                     START DATE      : 01/01/2011
                                     END DATE        : 10/01/2012
  NCH_DAILY_PROC_DT_LIM
                                   FULL NAME: NCH Daily Process Date Limitation
                                   DESCRIPTION :
                                     The NCH Daily Process Date was mistakenly changed on
                                     all Version 'J' claims during the history conversion
                                     process.
                                   BACKGROUND    :
                                     It was discovered during the process of modifying the
                                     conversion code used during Version 'J' processing that
                                     the NCH Daily Process Date was mistakenly changed in the
                                     Version 'J' conversion code.  When preparing the specs for
                                     the Version 'J' conversion code, we were told to change the
                                     NCH Daily Process Date to reflect the date the history files
                                     were converted.

                                     This change impacts the linkage of Part A claims that have
                                     multiple segments (claims with more than 45 revenue center
                                     lines) on the Version 'J' claim files.  The NCH Daily
                                     Process Date is used in conjuction with the NCH Segment
                                     Link Number to keep records/segments belonging to a
                                     specific claim together.

                                     There is the possibility that two different claims could
                                     now have the same NCH Daily Process Date and NCH Segment
                                     Link Number.  This could cause users of the data to
                                     match claim records/segments together that should not
                                     be paired.   We believe the chances of this occurring to
                                     be minimal.
                                   CORRECTIVE ACTION :
                                     Because the Version 'I' files were converted and the
                                     date changed, we have no way of going back and retrieving
                                     the original NCH Daily Process Date so no fix/patch
                                     will be applied.
                                   SOURCE:
                                     CONTACT         :  OIS/EDG/DDOM
  PMT_AMT_EXCEDG_CHRG_AMT_LIM
                                   FULL NAME: Claim Payment Amount Exceeding Total Charge Amount Limitation
                                   DESCRIPTION :
                                     Approximately 75 Inpatient claims had a reimbursement
                                     amount exceed $500,000 which was at least 25 times
                                     the total charge amount.  There were also claims where
                                     the reimbursement was less than $500,000 but greater
                                     than the total charges.

                                     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.
                                     SQL_INFO:       NUMBER(11,2)
                                   BACKGROUND    :
                                     In November of 1999, it was brought to the attention
                                     of the HDUG that large reimbursement amounts were
                                     being paid in Pennsylvania.  There were 75 inpatient
                                     claims provided where the reimbursement amount was
                                     over $500,000 and at least 25 times the total charge
                                     amount.  These claims were processed between 9/29/98
                                     and 10/1/98.  There were also claims identified with
                                     reimbursement less than $500,000 but greater than
                                     total charge.  It was later discovered that the
                                     source of the problem was an error in entering an
                                     MSA; the decimal point was off by 2 positions.

                                     Because there were no changes in utilization, the
                                     claims were corrected and the correct payments dis-
                                     tributed, but the new payment amounts were never
                                     sent to CWF (not in NCH).  There is currently
                                     no requirement that FIs and carriers update CWF with
                                     final payment information by submitting payment only
                                     adjustments. It was noted that there is no expectation
                                     that CWF wll have final payment information for claims.
                                   CORRECTIVE ACTION :
                                     According to Veritus (FI), the problem was caught
                                     in their system using a pre-payment edit prior to
                                     sending out the payments.  The erroneous MSA value
                                     was corrected and the claims were then sent to
                                     PRICER again and paid correctly.

                                     The claims were corrected and correct payments were
                                     made but these new payment amounts were never sent
                                     to CWF and are not reflected in the NCH.
                                   SOURCE:
                                     CONTACT         :  OIS/EDG/DMUDD


                                                           QUERY: RIFQQ41 ON DB2T
                        *******END OF LIMITATION APPENDIX FOR RECORD: DMERC_CLM_REC*******


