Stop-Loss Import File Specifications

Format Specifications:

  • File format should be submitted as tab-delimited text
  • First row must contain field names
  • Please include ALL columns in layout whether or not they are to be used
  • DO NOT submit IP, MH, or RHCF claims in the same file
Field Name Field Type Field Length Field Description Values Required Required Claim Type
ClmType Text 4 Value Indicating NYSDOH Stop Loss Form Rate Type Based on Admission Date (IP) or Rate (MH, SNP, or RHCF). IMPORTANT: Please include only 1 benefit year per file for IP and SNP claim types. For MH and RHCF claim types; benefit years may be mixed only if there are 20 or fewer claims within the file. IP08: (1/1/08 - 12/31/08) Rate: 2296/2299, IP09 : (1/1/09 - 12/31/09) Rate: 2296/2299, IP10 : (1/1/10 - 12/31/10),Rate: 2296/2299, IP11 : (1/1/11 - 12/31/11), IP12: (1/1/12 - 12/31/12), Rate: 2296/2299, MH Rate: 2295, SNP Rate: 2296, RHCF Rate: 2297 Yes All
Date Date 8 Date of file submission m/d/yyyy Yes All
Plan Name Text 55 Plan Name Yes All
Plan ID Text 8 Plan Medicaid Identification Number (MMIS) Yes All
Contact Name Text 55 Plan Contact Name Yes All
Contact Phone Text 15 Plan Contact Phone (999)999-9999 Yes All
Email Text 55 Plan Contact E-mail Yes All
Patient Name Text 55 Enrollee Name Last, First Yes All
CIN Text 8 Enrollee Client Identification Number Yes All
TCN Text 16 Transaction Control Number (If submitting an adjustment) Yes, if applicable All
Benefit Year Text 4 Year (YYYY) of Claim based on Date of Admission i.e. 2008, 2009, 2010,2011 Yes All
Ttl Stays Integer or Long 1 Count of Stay 1 Yes All
Stop Loss Threshold Double 15 Stop Loss Dollar/Day Threshold $50,000, $100,000, $250,000, $300,000, 30, 60 Yes All
Amt Over Threshold Double 15 Dollar/Day Amount Over Threshold Yes All
Plan Liability Double 15 Dollar Amount of Plan Liability Yes, if applicable All
Liability Type Text 40 Specify Any Applicable Dollar Liability Type e.g. Copay, Third Party Payment Yes, if applicable All
Net Amt Due Double 15 Net Dollar Amount Due Yes All
HCO Boolean or Integer 1 True if Claim includes stays to be reviewed as High Cost Outlier 1 = True, 0 = False Yes IP08, IP09, IP10, IP11, IP12, SNP
HCO Stays Integer 1 Count of HCO Stay 1 Yes, if applicable IP08, IP09, IP10, IP11, IP12, SNP
HCO Date From1 Date 8 Date Span Admit Date 1 m/d/yyyy Yes, if applicable IP08, IP09, IP10, IP11, IP12, SNP
HCO Date To1 Date 8 Date Span Discharge Date 1 m/d/yyyy Yes, if applicable IP08, IP09, IP10, IP11, IP12, SNP
HCO Date From2 Date 8 Date Span Admit Date 2 m/d/yyyy Yes, if applicable IP08, IP09, IP10, IP11, IP12, SNP
HCO Date To2 Date 8 Date Span Discharge Date 2 m/d/yyyy Yes, if applicable IP08, IP09, IP10, IP11, IP12, SNP
HCO Date From3 Date 8 Date Span Admit Date 3 m/d/yyyy Yes, if applicable IP08, IP09, IP10, IP11, IP12, SNP
HCO Date To3 Date 8 Date Span Discharge Date 3 m/d/yyyy Yes, if applicable IP08, IP09, IP10, IP11, IP12, SNP
HCO Date From4 Date 8 Date Span Admit Date 4 m/d/yyyy Yes, if applicable IP08, IP09, IP10, IP11, IP12, SNP
HCO Date To4 Date 8 Date Span Discharge Date 4 m/d/yyyy Yes, if applicable IP08, IP09, IP10, IP11, IP12, SNP
HCO Date From5 Date 8 Date Span Admit Date 5 m/d/yyyy Yes, if applicable IP08, IP09, IP10, IP11, IP12, SNP
HCO Date To5 Date 8 Date Span Discharge Date 5 m/d/yyyy Yes, if applicable IP08, IP09, IP10, IP11, IP12, SNP
HCO Date From6 Date 8 Date Span Admit Date 6 m/d/yyyy Yes, if applicable IP08, IP09, IP10, IP11, IP12, SNP
HCO Date To6 Date 8 Date Span Discharge Date 6 m/d/yyyy Yes, if applicable IP08, IP09, IP10, IP11, IP12, SNP
HCO Date From7 Date 8 Date Span Admit Date 7 m/d/yyyy Yes, if applicable IP08, IP09, IP10, IP11, IP12, SNP
HCO Date To7 Date 8 Date Span Discharge Date 7 m/d/yyyy Yes, if applicable IP08, IP09, IP10, IP11, IP12, SNP
HCO Date From8 Date 8 Date Span Admit Date 8 m/d/yyyy Yes, if applicable IP08, IP09, IP10, IP11, IP12, SNP
HCO Date To8 Date 8 Date Span Discharge Date 8 m/d/yyyy Yes, if applicable IP08, IP09, IP10, IP11, IP12, SNP
HCO Date From9 Date 8 Date Span Admit Date 9 m/d/yyyy Yes, if applicable IP08, IP09, IP10, IP11, IP12, SNP
HCO Date To9 Date 8 Date Span Discharge Date 9 m/d/yyyy Yes, if applicable IP08, IP09, IP10, IP11, IP12, SNP
HCO Date From10 Date 8 Date Span Admit Date 10 m/d/yyyy Yes, if applicable IP08, IP09, IP10, IP11, IP12, SNP
HCO Date To10 Date 8 Date Span Discharge Date 10 m/d/yyyy Yes, if applicable IP08, IP09, IP10, IP11, IP12, SNP
HCO Date From11 Date 8 Date Span Admit Date 11 m/d/yyyy Yes, if applicable IP08, IP09, IP10, IP11, IP12, SNP
HCO Date To11 Date 8 Date Span Discharge Date 11 m/d/yyyy Yes, if applicable IP08, IP09, IP10, IP11, IP12, SNP
Hospital Name Text 55 Hospital Name Yes All
Out Of State Boolean or Integer 1 True if Out of State Hospital 1 = True, 0 = False Yes All
Out of State Address Text 55 Out of State Address for Hospital Facility Yes, if applicable All
MMIS ID Text 8 Hospital Medcaid MMIS ID # Yes All
NPI Text 10 National Provider Identification Number Yes, if MMIS ID is Unavailable All
Admit Date Date 8 Admission Date m/d/yyyy Yes All
Discharge Date Date 8 Discharge Date m/d/yyyy Yes All
LOS Long 4 Length of Stay (Number of Days in Stay) Yes All
Acute Care Days Long 4 Total Number of Acute Care Days Yes IP08, IP09, IP10, IP11, IP12, SNP
ALC Days Long 4 Total Number of Alternate Level of Care Days Yes, if applicable IP08, IP09, IP10, IP11, IP12, SNP, MH
DOB Date 8 Date of Birth m/d/yyyy Yes All
Age Long 3 Age at Time of Discharge Yes All
Sex Text 1 Sex (Gender) M, F Yes All
Birth Wgt Long 4 Birth Weight (Must be included for newborns up to 28 days old) In grams Yes, if applicable IP08, IP09, IP10, IP11, IP12, SNP
Disposition Text 2 Disposition (Status) 01, 02, 03, 04, 05, 06, 07, 08, 09, 10, 13, 20, 21, 30, 40, 41, 42, 43, 50, 51, 61, 62, 63, 64, 65, 66, 70 Yes All
Admitting Dx Text 6 Admitting Diagnosis ICD9 Diagnosis Code : NO DECIMAL Yes All
Ttl Hospital Charges Double 15 Total Hospital Charges Yes All
Plan Per Diem Rate Double 15 Plan Per Diem Rate Yes, if applicable MH, RHCF
RHCF Per Diem Rate Double 15 RHCF Per Diem Rate Yes, if applicable RHCF
Principal DX Text 6 Principal Diagnosis ICD9 Diagnosis Code : NO DECIMAL Yes, if applicable IP08, IP09, IP10, IP11, IP12, SNP, MH
POAP Boolean or Integer 1 True if Present on Admission: Principle Diagnosis 1 = True, 0 = False Yes, if applicable IP08, IP09, IP10, IP11, IP12, SNP
Other DX1 Text 6 Other Diagnosis 1 ICD9 Diagnosis Code : NO DECIMAL Yes, if applicable IP08, IP09, IP10, IP11, IP12, SNP, MH
POA1 Boolean or Integer 1 True if Present on Admission: Diagnosis 1 1 = True, 0 = False Yes, if applicable IP08, IP09, IP10, IP11, IP12, SNP
Other DX2 Text 6 Other Diagnosis 2 ICD9 Diagnosis Code : NO DECIMAL Yes, if applicable IP08, IP09, IP10, IP11, IP12, SNP, MH
POA2 Boolean or Integer 1 True if Present on Admission: Diagnosis 2 1 = True, 0 = False Yes, if applicable IP08, IP09, IP10, IP11, IP12, SNP
Other DX3 Text 6 Other Diagnosis 3 ICD9 Diagnosis Code : NO DECIMAL Yes, if applicable IP08, IP09, IP10, IP11, IP12, SNP, MH
POA3 Boolean or Integer 1 True if Present on Admission: Diagnosis 3 1 = True, 0 = False Yes, if applicable IP08, IP09, IP10, IP11, IP12, SNP
Other DX4 Text 6 Other Diagnosis 4 ICD9 Diagnosis Code : NO DECIMAL Yes, if applicable IP08, IP09, IP10, IP11, IP12, SNP, MH
POA4 Boolean or Integer 1 True if Present on Admission: Diagnosis 4 1 = True, 0 = False Yes, if applicable IP08, IP09, IP10, IP11, IP12, SNP
Other DX5 Text 6 Other Diagnosis 5 ICD9 Diagnosis Code : NO DECIMAL Yes, if applicable IP08, IP09, IP10, IP11, IP12, SNP, MH
POA5 Boolean or Integer 1 True if Present on Admission: Diagnosis 5 1 = True, 0 = False Yes, if applicable IP08, IP09, IP10, IP11, IP12, SNP
Other DX6 Text 6 Other Diagnosis 6 ICD9 Diagnosis Code : NO DECIMAL Yes, if applicable IP08, IP09, IP10, IP11, IP12, SNP, MH
POA6 Boolean or Integer 1 True if Present on Admission: Diagnosis 6 1 = True, 0 = False Yes, if applicable IP08, IP09, IP10, IP11, IP12, SNP
Other DX7 Text 6 Other Diagnosis 7 ICD9 Diagnosis Code : NO DECIMAL Yes, if applicable IP08, IP09, IP10, IP11, IP12, SNP, MH
POA7 Boolean or Integer 1 True if Present on Admission: Diagnosis 7 1 = True, 0 = False Yes, if applicable IP08, IP09, IP10, IP11, IP12, SNP
Other DX8 Text 6 Other Diagnosis 8 ICD9 Diagnosis Code : NO DECIMAL Yes, if applicable IP08, IP09, IP10, IP11, IP12, SNP
POA8 Boolean or Integer 1 True if Present on Admission: Diagnosis 8 1 = True, 0 = False Yes, if applicable IP08, IP09, IP10, IP11, IP12, SNP
Other DX9 Text 6 Other Diagnosis 9 ICD9 Diagnosis Code : NO DECIMAL Yes, if applicable IP08, IP09, IP10, IP11, IP12, SNP
POA9 Boolean or Integer 1 True if Present on Admission: Diagnosis 9 1 = True, 0 = False Yes, if applicable IP08, IP09, IP10, IP11, IP12, SNP
Other DX10 Text 6 Other Diagnosis 10 ICD9 Diagnosis Code : NO DECIMAL Yes, if applicable IP08, IP09, IP10, IP11, IP12, SNP
POA10 Boolean or Integer 1 True if Present on Admission: Diagnosis 10 1 = True, 0 = False Yes, if applicable IP08, IP09, IP10, IP11, IP12, SNP
Other DX11 Text 6 Other Diagnosis 11 ICD9 Diagnosis Code : NO DECIMAL Yes, if applicable IP08, IP09, IP10, IP11, IP12, SNP
POA11 Boolean or Integer 1 True if Present on Admission: Diagnosis 11 1 = True, 0 = False Yes, if applicable IP08, IP09, IP10, IP11, IP12, SNP
Other DX12 Text 6 Other Diagnosis 12 ICD9 Diagnosis Code : NO DECIMAL Yes, if applicable IP08, IP09, IP10, IP11, IP12, SNP
POA12 Boolean or Integer 1 True if Present on Admission: Diagnosis 12 1 = True, 0 = False Yes, if applicable IP08, IP09, IP10, IP11, IP12, SNP
Other DX13 Text 6 Other Diagnosis 13 ICD9 Diagnosis Code : NO DECIMAL Yes, if applicable IP08, IP09, IP10, IP11, IP12, SNP
POA13 Boolean or Integer 1 True if Present on Admission: Diagnosis 13 1 = True, 0 = False Yes, if applicable IP08, IP09, IP10, IP11, IP12, SNP
Other DX14 Text 6 Other Diagnosis 14 ICD9 Diagnosis Code : NO DECIMAL Yes, if applicable IP08, IP09, IP10, IP11, IP12, SNP
POA14 Boolean or Integer 1 True if Present on Admission: Diagnosis 14 1 = True, 0 = False Yes, if applicable IP08, IP09, IP10, IP11, IP12, SNP
Other DX15 Text 6 Other Diagnosis 15 ICD9 Diagnosis Code : NO DECIMAL Yes, if applicable IP08, IP09, IP10, IP11, IP12, SNP
POA15 Boolean or Integer 1 True if Present on Admission: Diagnosis 15 1 = True, 0 = False Yes, if applicable IP08, IP09, IP10, IP11, IP12, SNP
Other DX16 Text 6 Other Diagnosis 16 ICD9 Diagnosis Code : NO DECIMAL Yes, if applicable IP08, IP09, IP10, IP11, IP12, SNP
POA16 Boolean or Integer 1 True if Present on Admission: Diagnosis 16 1 = True, 0 = False Yes, if applicable IP08, IP09, IP10, IP11, IP12, SNP
Other DX17 Text 6 Other Diagnosis 17 ICD9 Diagnosis Code : NO DECIMAL Yes, if applicable IP08, IP09, IP10, IP11, IP12, SNP
POA17 Boolean or Integer 1 True if Present on Admission: Diagnosis 17 1 = True, 0 = False Yes, if applicable IP08, IP09, IP10, IP11, IP12, SNP
Other DX18 Text 6 Other Diagnosis 18 ICD9 Diagnosis Code : NO DECIMAL Yes, if applicable IP08, IP09, IP10, IP11, IP12, SNP
POA18 Boolean or Integer 1 True if Present on Admission: Diagnosis 18 1 = True, 0 = False Yes, if applicable IP08, IP09, IP10, IP11, IP12, SNP
Other DX19 Text 6 Other Diagnosis 19 ICD9 Diagnosis Code : NO DECIMAL Yes, if applicable IP08, IP09, IP10, IP11, IP12, SNP
POA19 Boolean or Integer 1 True if Present on Admission: Diagnosis 19 1 = True, 0 = False Yes, if applicable IP08, IP09, IP10, IP11, IP12, SNP
Other DX20 Text 6 Other Diagnosis 20 ICD9 Diagnosis Code : NO DECIMAL Yes, if applicable IP08, IP09, IP10, IP11, IP12, SNP
POA20 Boolean or Integer 1 True if Present on Admission: Diagnosis 20 1 = True, 0 = False Yes, if applicable IP08, IP09, IP10, IP11, IP12, SNP
Other DX21 Text 6 Other Diagnosis 21 ICD9 Diagnosis Code : NO DECIMAL Yes, if applicable IP08, IP09, IP10, IP11, IP12, SNP
POA21 Boolean or Integer 1 True if Present on Admission: Diagnosis 21 1 = True, 0 = False Yes, if applicable IP08, IP09, IP10, IP11, IP12, SNP
Other DX22 Text 6 Other Diagnosis 22 ICD9 Diagnosis Code : NO DECIMAL Yes, if applicable IP08, IP09, IP10, IP11, IP12, SNP
POA22 Boolean or Integer 1 True if Present on Admission: Diagnosis 22 1 = True, 0 = False Yes, if applicable IP08, IP09, IP10, IP11, IP12, SNP
Other DX23 Text 6 Other Diagnosis 23 ICD9 Diagnosis Code : NO DECIMAL Yes, if applicable IP08, IP09, IP10, IP11, IP12, SNP
POA23 Boolean or Integer 1 True if Present on Admission: Diagnosis 23 1 = True, 0 = False Yes, if applicable IP08, IP09, IP10, IP11, IP12, SNP
Other DX24 Text 6 Other Diagnosis 24 ICD9 Diagnosis Code : NO DECIMAL Yes, if applicable IP08, IP09, IP10, IP11, IP12, SNP
POA24 Boolean or Integer 1 True if Present on Admission: Diagnosis 24 1 = True, 0 = False Yes, if applicable IP08, IP09, IP10, IP11, IP12, SNP
Permanent Boolean or Integer 1 True if Patient's placement status in a Residential Health Care Facility is permanent 1 = True, 0 = False Yes, if applicable RHCF
Temporary Boolean or Integer 1 True if Patient's placement status in a Residential Health Care Facility is temporary 1 = True, 0 = False Yes, if applicable RHCF
Principal Proc Text 6 Principal Procedure ICD9 Procedure Code : NO DECIMAL Yes, if applicable IP08, IP09, IP10, IP11, IP12, SNP, MH
Other Proc1 Text 6 Other Procedure 1 ICD9 Procedure Code : NO DECIMAL Yes, if applicable IP08, IP09, IP10, IP11, IP12, SNP, MH
Other Proc2 Text 6 Other Procedure 2 ICD9 Procedure Code : NO DECIMAL Yes, if applicable IP08, IP09, IP10, IP11, IP12, SNP, MH
Other Proc3 Text 6 Other Procedure 3 ICD9 Procedure Code : NO DECIMAL Yes, if applicable IP08, IP09, IP10, IP11, IP12, SNP, MH
Other Proc4 Text 6 Other Procedure 4 ICD9 Procedure Code : NO DECIMAL Yes, if applicable IP08, IP09, IP10, IP11, IP12, SNP, MH
Other Proc5 Text 6 Other Procedure 5 ICD9 Procedure Code : NO DECIMAL Yes, if applicable IP08, IP09, IP10, IP11, IP12, SNP, MH
Other Proc6 Text 6 Other Procedure 6 ICD9 Procedure Code : NO DECIMAL Yes, if applicable IP08, IP09, IP10, IP11, IP12, SNP, MH
Other Proc7 Text 6 Other Procedure 7 ICD9 Procedure Code : NO DECIMAL Yes, if applicable IP08, IP09, IP10, IP11, IP12, SNP
Other Proc8 Text 6 Other Procedure 8 ICD9 Procedure Code : NO DECIMAL Yes, if applicable IP08, IP09, IP10, IP11, IP12, SNP
Other Proc9 Text 6 Other Procedure 9 ICD9 Procedure Code : NO DECIMAL Yes, if applicable IP08, IP09, IP10, IP11, IP12, SNP
Other Proc10 Text 6 Other Procedure 10 ICD9 Procedure Code : NO DECIMAL Yes, if applicable IP08, IP09, IP10, IP11, IP12, SNP
Other Proc11 Text 6 Other Procedure 11 ICD9 Procedure Code : NO DECIMAL Yes, if applicable IP08, IP09, IP10, IP11, IP12, SNP
Other Proc12 Text 6 Other Procedure 12 ICD9 Procedure Code : NO DECIMAL Yes, if applicable IP08, IP09, IP10, IP11, IP12, SNP
Other Proc13 Text 6 Other Procedure 13 ICD9 Procedure Code : NO DECIMAL Yes, if applicable IP08, IP09, IP10, IP11, IP12, SNP
Other Proc14 Text 6 Other Procedure 14 ICD9 Procedure Code : NO DECIMAL Yes, if applicable IP08, IP09, IP10, IP11, IP12, SNP
Other Proc15 Text 6 Other Procedure 15 ICD9 Procedure Code : NO DECIMAL Yes, if applicable IP08, IP09, IP10, IP11, IP12, SNP
Other Proc16 Text 6 Other Procedure 16 ICD9 Procedure Code : NO DECIMAL Yes, if applicable IP08, IP09, IP10, IP11, IP12, SNP
Other Proc17 Text 6 Other Procedure 17 ICD9 Procedure Code : NO DECIMAL Yes, if applicable IP08, IP09, IP10, IP11, IP12, SNP
Other Proc18 Text 6 Other Procedure 18 ICD9 Procedure Code : NO DECIMAL Yes, if applicable IP08, IP09, IP10, IP11, IP12, SNP
Other Proc19 Text 6 Other Procedure 19 ICD9 Procedure Code : NO DECIMAL Yes, if applicable IP08, IP09, IP10, IP11, IP12, SNP
Other Proc20 Text 6 Other Procedure 20 ICD9 Procedure Code : NO DECIMAL Yes, if applicable IP08, IP09, IP10, IP11, IP12, SNP
Other Proc21 Text 6 Other Procedure 21 ICD9 Procedure Code : NO DECIMAL Yes, if applicable IP08, IP09, IP10, IP11, IP12, SNP
Other Proc22 Text 6 Other Procedure 22 ICD9 Procedure Code : NO DECIMAL Yes, if applicable IP08, IP09, IP10, IP11, IP12, SNP
Other Proc23 Text 6 Other Procedure 23 ICD9 Procedure Code : NO DECIMAL Yes, if applicable IP08, IP09, IP10, IP11, IP12, SNP
Other Proc24 Text 6 Other Procedure 24 ICD9 Procedure Code : NO DECIMAL Yes, if applicable IP08, IP09, IP10, IP11, IP12, SNP
APRDRG Text 6 AP - DRG (claims 1/1/08 - 11/30/09) or APR - DRG (12/1/09 - ) dependent upon the Benefit Year Yes All
SevLevel Text 1 Severity Level 1, 2, 3, 4 Yes, if applicable IP08, IP09, IP10, IP11, IP12, SNP
SIW Double 8 Service Intensity Weight as indicated by APR - DRG Yes IP08, IP09, IP10, IP11, IP12, SNP
Low Long 3 Low Trim Point as indicated by AP - DRG Yes, if applicable IP08, IP09
High Long 3 High Trim Point as indicated by AP - DRG Yes, if applicable IP08, IP09
Upstate ALOS Long 3 Upstate Average Length of Stay as indicated by AP - DRG Yes, if applicable IP08, IP09
Downstate ALOS Long 3 Downstate Average Length of Stay as indicated by AP - DRG Yes, if applicable IP08, IP09
ALOS Long 3 Average Length of Stay (12/1/09 - ) Yes, if applicable IP09, IP10, IP11
APR ExcInc Text 7 Applies to APR rates used on inpatient stays after 7/1/08 and before 1/1/2010: based on whether the plan has a contracted rate: Exclude if Yes, Include if No "Exclude", "Include" (Always "Include" after 1/1/10) Yes IP08, IP09, IP10, IP11, IP12, SNP
Amt Paid Double 15 Amount Paid by Plan Yes All
Detox Code Text 4 Rate Code for IP Chemical Dependency Detox 4800,4801,4802,4803, 4804 Yes, if applicable IP08, IP09, IP10, IP11, IP12, SNP
Blank2 Null For future use
Inlier Boolean or Integer 1 True if stay is calculated as an Inlier 1 = True, 0 = False Yes, if applicable IP08, IP09, IP10, IP11, IP12, SNP
Long Stay Boolean or Integer 1 True if stay is calculated as a Long Stay 1 = True, 0 = False Yes, if applicable IP08, IP09
Short Stay Boolean or Integer 1 True if stay is calculated as a Short Stay 1 = True, 0 = False Yes, if applicable IP08, IP09
Transfer Boolean or Integer 1 True if stay is calculated as a Transfer 1 = True, 0 = False Yes, if applicable IP08, IP09, IP10, IP11, IP12, SNP
Exempt Unit Boolean or Integer 1 True if stay is calculated as an Exempt Unit 1 = True, 0 = False Yes, if applicable IP08, IP09, IP10, IP11, IP12, SNP, MH
Exempt Desc Text 55 Exempt Unit Description Other Exempt, Drug Exempt, Epilepsy Exempt, Aids Exempt, Alcohol Exempt, Medical Rehab, Specialty Hospital, Chemical Dependency Rehab, Critical Access, Psychiatric Exempt, Detox, Medically Managed Detox Yes, if applicable IP08, IP09, IP10, IP11, IP12, SNP, MH
Top 20 DRG Boolean or Integer 1 True if stay is calculated as a Top 20 DRG 1 = True, 0 = False Yes, if applicable IP08, IP09
HCO Boolean or Integer 1 True if stay is calculated as a High Cost Outlier 1 = True, 0 = False Yes, if applicable IP08, IP09, IP10, IP11, IP12, SNP
DRG Boolean or Integer 1 True if stay is calculated as DRG 1 = True, 0 = False Yes, if applicable MH
Per Diem Boolean or Integer 1 True if stay is calculated as Per Diem 1 = True, 0 = False Yes, if applicable MH
Other Boolean or Integer 1 True if stay is calculated as Other 1 = True, 0 = False Yes, if applicable IP08, IP09, IP10, IP11, IP12, SNP
Other Desc Text 55 Other Description Yes, if applicable IP08, IP09, IP10, IP11, IP12, SNP
Respite Days Long 4 Total Number of Respite Days Authorized Yes, if applicable RHCF
Reservation Days Long 4 Total Number of Reservation Days Authorized Yes, if applicable RHCF
Reserve Date From Date (m/d/yy) 8 First Date of Bed Reservation Day Yes, if applicable RHCF
Reserve DateTo Date (m/d/yy) 8 Last Date of Bed Reservation Day Yes, if applicable RHCF
Occupy Rate Percent 5 RHCF Occupancy Rate on Date of First Bed Reservation Day Yes, if applicable RHCF
Reserve Per Diem Double 15 Per Diem Rate Paid to RHCF for Bed Reservation Days Yes, if applicable RHCF
adjust Boolean or Integer 1 True if =Claim Adjustment 1 = True, 0 = False Yes, if applicable All
adjustnbr Long 3 Number of claim adjustments Yes, if applicable All
resubmit Boolean or Integer 1 True if =Claim Resubmission 1 = True, 0 = False Yes, if applicable All
resubmitnbr Long 3 Number of claim resubmissions Yes, if applicable All

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