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 |