<< Previous Appendix AS, ED, IP X12-837 Input / IP Output / OP Output Next Appendix >>

Appendix W-Edited Outpatient Output File Conversion Source

FILE NAME:  EDITED INPATIENT DATE:  01/01/2000
DATA SET NAME:  
     P015B.MASTSTPE.I40210.CYyy (0)
     -(Master File)
     PO15B.MASTSTPE.I40210.INCOM.PLETE.CYyy
     -(Incomplete File)		 SOURCE OF DATA:  
     DDA Master File
     UBF Master File
     Matched File
     Interim Bill File
RECORD LENGTH:  2000 BLOCK SIZE:  32000
FLD FIELD POSITION CONVERSION SOURCE (see Data Element 4)
NO LABEL FROM TO MASTER FILE OR INCOMPELETE FILE (MATMIS) INCOMPLETE FILE (DDAUNM) INCOMPLETE FILE (UBFALL OR UBFMIS)
1 REGION 1 2 DDA DDA UBF
2 PFI 3 7 DDA DDA UBF
3 PATIENT CT NO 8 27 DDA DDA UBF
4 MED REC NO 28 44 DDA DDA UBF
5 ADMIT DATE 45 52 DDA DDA UBF
DISCH DATE 53 60 DDA DDA UBF
6 DISCH YEAR 53 56 DDA DDA UBF
7 DISCH MODA 57 60 DDA DDA UBF
8 RECORD SEQ 61 62 NEW
9 SEQUENCE CT 63 64 NEW
10 PATIENT SEX 65 65 DDA DDA UBF
11 PATIENT DOB 66 73 DDA/UBF DDA UBF
12 ADMIT TYPE 74 74 DDA DDA
13 ADMIT SOURCE 75 75 DDA DDA
14 ADMIT HOUR 76 77 DDA DDA
15 CLAIM FROM 78 85 UBF UBF
16 CLAIM THRU 86 96 UBF UBF
17 DISCH HOUR 94 95 DDA DDA
ALT CARE DATA 96 108 DDA DDA
18 ALT CARE TYPE 96 96 DDA DDA
19 ALT CARE DATE 97 104 DDA DDA
20 TOTAL AC DAYS 105 108 DDA DDA
21 NEO BIRTH WT 109 112 DDA DDA
22 PATIENT DISP 113 114 DDA/UBF DDA UBF
23 NEO M MR NO 115 131 DDA DDA
24 PCR NUMBER 132 139 DDA DDA
25 PATIENT RACE 140 141 DDA DDA
26 PATIENT ETHN 142 142 DDA DDA
27 SCHED ADM IND 143 143 DDA DDA
28 PRIN REIMB 144 145 DDA DDA
29 OTHER REIMB 1 146 147 DDA DDA
30 OTHER REIMB 2 148 149 NEW
31 PATIENT ADDRESS LINE 1 150 167 UBF UBF
32 PATIENT ADDRESS LINE 2 168 185 UBF UBF
33 PATIENT CITY 186 200 UBF UBF
34 PATIENT COUNTY 201 202 UBF DDA UBF
35 PATIENT STATE 203 209 UBF UBF
36 PATIENT ZIP 205 209 UBF DDA UBF
37 PATIENTZIP + 4 210 213 NEW
PAYER DATA 214 279 UBF UBF
38 PAYMENT SOURCE 214 214 UBF UBF
39 POLICY NUMBER 215 233 UBF UBF
40 PAYER ID 234 238 UBF UBF
FILLER 239 250 UBF UBF
41 COVERED DAYS 251 254 UBF UBF
42 NON COVERED DAYS 255 258 NEW
43 PROVIDER ID NO 259 271 UBF UBF
44 ALT CARE DAYS 272 275 NEW
45 LOA DAYS 276 279 NEW
46 TOTAL LOA DAYS 610 613 DDA DDA
47 BILL TYPE 614 616 NEW
48 TRANS CODE 617 617 DDA DDA UBF
49 ACCDNT TYPE 618 619 UBF UBF
50 ACCDNT DATE 620 627 NEW
51 SP PRGRM DIS 628 628 UBF UBF
52 SP PRGRM FP 629 629 UBF UBF
53 SP PRGRM PHC 630 630 UBF UBF
54 SP PRGRM SFP 631 631 UBF UBF
55 WC NF IND 632 633 UBF UBF
56 WC INC AMOUNT 634 642 NEW
57 MD INC CODE 643 643 UBF UBF
58 MD INC AMOUNT 644 652 UBF UBF
59 BLOOD FRNSHD 653 661 UBF UBF
ACCOM DATA 662 846 UBF UBF
ACCOM INFO 662 698 UBF UBF
60 ACCOM RATE 662 670 UBF UBF
61 ACCOM DAYS 671 674 UBF UBF
62 ACCOM CHARGE 675 684 UBF UBF
63 ACCOM NC CHARGE 685 694 UBF UBF
64 ACCOM CODE 695 698 UBF UBF
ANCIL DATA 847 1326 UBF UBF
ANCIL INFO 847 870 UBF UBF
65 ANCIL CODE 847 850 UBF UBF
66 ANCIL CHARGE 851 860 UBF UBF
67 ANCIL NC CHARGE 861 870 UBF UBF
68 PRIN DX CODE 1327 1332 DDA DDA UBF in 92
OTHER DX DATA 1333 1444 DDA DDA UBF in 92
OTHER DX INFO 1333 1444 DDA DDA UBF in 92
69 OTHER DX CODE 1333 1338 DDA DDA UBF in 92
70 EMER IND 1339 1339 DDA DDA
71 ANESTH IND 1340 1340 NEW
PRINC PR INFO 1445 1459 DDA DDA UBF in 92
72 PRINC PR CODE 1445 1451 DDA DDA UBF in 92
73 PRINC PR DATE 1452 1459 DDA DDA UBF in 92
OTHER PR DATA 1460 1669 DDA DDA UBF in 92
OTHER PR INFO 1460 1479 DDA DDA UBF in 92
74 OTHER PR CODE 1460 1466 DDA DDA UBF in 92
75 OTHER PR DATE 1467 1474 DDA DDA UBF in 92
76 ADMIT DX CODE 1670 1675 DDA DDA UBF in 92
77 CAUSE E CODE 1676 1681 DDA DDA UBF in 92
78 PLACE E CODE 1682 1687 DDA DDA
79 CODING METHOD 1688 1688 DDA DDA
80 ANESTH METHOD 1689 1690 NEW
81 EXEMPT UNIT IN 1691 1693 DDA DDA
82 BED PLACE IND 1694 1696 NEW
83 ACUTE CR DAYS 1697 1700 DDA DDA
84 ATTENDING PHYS 1701 1708 DDA DDA
85 OPERATING PHYS 1709 1716 DDA DDA
86 OTHER PHYS 1717 1724 DDA DDA
87 ACC TOTAL CHARGES 1725 1734 UBF UBF
88 ACC NC CHARGES 1735 1744 UBF UBF
89 ANCIL TOTAL CHARGES 1745 1754 UBF UBF
90 ANCIL NC CHARGES 1755 1764 UBF UBF
91 TOTAL CHARGES 1765 1776 UBF UBF
92 TOTAL NC CHARGES 1777 1788 UBF UBF
93 LOS 1789 1792 DDA DDA
94 AGE 1793 1795 DDA DDA
95 CUR FED DRG 1796 1798 DDA DDA
96 CUR FED MDC 1799 1800 DDA DDA
97 CUR STATE DRG 1801 1803 DDA DDA
98 CUR STATE MDC 1804 1805 DDA DDA
99 PRIOR FED DRG 1806 1808 DDA DDA
100 PRIOR FED MDC 1809 1810 DDA DDA
101 PRIOR STATE DRG 1811 1813 DDA DDA
102 PRIOR STATE MDC 1814 1815 DDA DDA
103 NEW FED DRG 1816 1818 DDA DDA
104 NEW FED MDC 1819 1820 DDA DDA
105 NEW STATE DRG 1821 1823 DDA DDA
106 NEW STATE MDC 1824 1825 DDA DDA
107 DATE PROCESSED 1826 1833 DDA DDA UBF
108 LOG NUMBER 1834 1839 DDA DDA UBF
109 DATA COLLECTOR 1840 1842 DDA DDA UBF
110 DRG BILLED 1843 1846 NEW
111 UNIQUE PERS ID 1847 1856 NEW
112 AGE WARNING 1857 1857 NEW
113 DNR INDICATOR 1858 1858 NEW
114 RESIDENCE IND 1859 1859 NEW
NAC INFO 1860 1913 NEW
115 NAC TYPE 1860 1861 NEW
116 NAC FROM DATE 1862 1869 NEW
117 NAC THRU DATE 1870 1877 NEW
118 PROC DT WARN 1914 1914 NEW
SP ACC INFO 1915 1934 NEW
119 SP ACC CODE 1915 1918 NEW
120 FILLER 1935 2000

Revised 1/2000

<< Previous Appendix AS, ED, IP X12-837 Input / IP Output / OP Output Next Appendix >>