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Prompt             Description
3RD PTY COPAY      THIRD PARTY COINSURANCE PAYMENT CODE
                   A code that indicates the group paying the Part B
                   premiums for the Beneficiary
                   VALID VALUES
                   0 - No third party involvement
                   1 - State "buy-in"
                   5 - Civil Service
                   7 - Other private third party
AB Crossover       Crossover Override Indicator
                   A code that indicates whether the claim should be
                   cross checked against Part A records for duplicate
                   or incorrect entries, or the A/B crossover edit
                   should be bypassed due to the completion of cross
                   checking.
                   VALID VALUES
                   0 - Investigation
                   1 - Previous A/B crossover reject was investigated
                   and the carrier is bypassing the A/B crossover edit
ABG                CERTIFICATE OF MEDICAL NECESSITY ARTERIAL BLOOD GAS
                   LEVEL:
                   The amount of oxygen and carbon dioxide in the
                   blood, measured in millimeters
ABGD               CERTIFICATE OF MEDICAL NECESSITY ARTERIAL BLOOD
                   GAS1DATE
                   The date that the most recent ABG test was
                   performed, displayed in Gregorian format (MMDDYY).
ACCIDENT           ACCIDENT INDICATOR:
                   A code that indicates the claim resulted from an
                   accident.
                   VALID VALUES:
                   SPACE - Not applicable
                   A - Auto
                   O - Other
ACT CD             ACTION CODE:
                   A code that indicates the type of action requested
                   by the intermediary to be taken on an institutional
                   claim. The code determines the path that the
                   adjusted claim will follow through the claim
                   processing system.
                   VALID VALUES:
                   1 - Original debit action (includes non-adjustment
                       RTI correction items)
                   2 - Cancel by credit adjustment (BDMS only
                   3 - Secondary debit adjustment
                   4 - Cancel only adjustment
                   5 - Secondary debit adjustment
                   6 - Cancel only adjustment
                   7 - Accrete Outpatient claim history only
                   8 - Benefits refused (for Inpatient claims, an "R"
                       nonpayment code must be present)
                   9 - Payment requested
ADM DIAG           INPATIENT ADMITTING DIAGNOSIS CODE:
                   A code that indicates the patient's diagnosis at the
                   time of admission. Diagnosis codes may be found in
                   the International Classification of Diseases, 9th
                   Revision, Clinical Modification Manual.
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ADM DIAG           INPATIENT ADMITTING DIAGNOSIS CODE:
                   A code that indicates the patient's diagnosis at the
                   time of admission. Diagnosis codes may be found in
                   the International Classification of Diseases, 9th
                   Revision, Clinical Modification Manual.
ADM DTE            INPATIENT ADMISSION1DATE:
                   The date on which the Beneficiary was admitted to a
                   hospital or a SNF. The date is displayed in
                   Gregorian format (MM/DD/YY).
ADM SRCE           INPATIENT SOURCE OF ADMISSION:
                   A code that indicates the source of the
                   Beneficiary's admittance to the Inpatient health
                   care facility.
                   VALID VALUES:
                   1 - Physician referral
                   2 - Clinic referral
                   3 - GHO referral
                   4 - Transfer from hospital
                   5 - Transfer from SNF
                   6 - Transfer from another health care facility
                   7 - Emergency room
                   8 - Court/law enforcement
                   9 - Information not available
                   A - SNF qualifying stay is RPCH
                   OR
                   A code that indicates the admission source for
                   newborns.
                   NEWBORN VALUES:
                   1 - Normal delivery
                   2 - Premature delivery
                   3 - Sick baby
                   4 - Extra mural birth
                   9 - Information not available
ADM TYPE           INPATIENT TYPE OF ADMISSION:
                   A code that indicates the type and priority of this
                   Inpatient admission associated with the service
                   performed.
                   VALID VALUES:
                   1 - Emergency
                   2 - Urgent
                   3 - Elective
                   4 - Newborn
                   9 - Information not available
ALLOW              ALLOWABLE CHARGES:
                   The portion of the submitted charges that is
                   considered to be an allowable charge according to
                   the usual and customary reasonable fee associated
                   with the provider's geographic location.
AMT PAID BY BENE   AMOUNT PAID BY BENEFICIARY:
                   The amount of the total claim charge paid by the
                   Beneficiary to the provider of service.
APPROVED DTE       DATE APPROVED:
                   The date an initial claim was approved by the
                   intermediary or, for adjustment claims, the date the
                   adjustment was processed. The date is displayed in
                   Gregorian format (MM/DD/YY).
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ARCHIVED           ARCHIVED POINTER CLAIM ARCHIVED1DATE:
                   The date that the history record was archived. The
                   date is displayed in Gregorian format (MM/DD/YY).
ARCHIVED RECS      ARCHIVED POINTER NUMBER OF RECORDS:
                   The number of records that are stored on the
                   Archived History files for all claims for that
                   Beneficiary.
ASIS 1             BENEFICIARY "AS IS" BILL PROCESSING DATA INDICATOR:
                   1: A code that indicates a claim has a KRON spell.
                       Refer to the definition for INPATIENT KRON
                       INDICATOR. Prior to CWF, HCFA BDMS used the
                       "as is" method to accommodate the random
                       submission of claims, that is multiple
                       providers submitting claims at different times
                       rather than chronological service date order.
                       The "as is" indicator was used when the benefit
                       information at HCFA BDMS conflicted with the
                       information on an incoming claim. Once the
                       interim claim was processed at HCFA BDMS, the
                       indicator was reset. Since the implementation
                       of CWF, this field is only used to indicate
                       that a claim has a KRON spell.
                   VALID VALUES:
                   0 - Not used
                   A - Inpatient benefits exhausted
                   B - SNF benefits exhausted
                   C - Both A and B
                   D - KRON spell
                   E - Both A and D
                   F - Both B and D
                   G - A, B and D
ASIS 2             BENEFICIARY "AS IS" BILL PROCESSING DATA INDICATOR
                   2:
                   This field is obsolete, it is not used in the CWF
                   processing system. This field may be displayed on
                   claims processed in the batch system used prior to
                   CWF. For those instances it is defined as: the
                   second "as is" bill processing indicator is an
                   extension of the first "as is" bill processing
                   indicator, and is used to indicate additional
                   Beneficiary benefit information as of the last claim
                   processed. Refer to the definition for BENEFICIARY
                   "AS IS" BILL PROCESSING DATA INDICATOR 1.
                   VALID VALUES:
                   0 - Not used
                   A - Blood pints furnished
                   B - Life reserve days used
                   C - Both A and B
ASSIGNMENT         ASSIGNMENT INDICATOR:
                   A code, assigned by HCFA BPO, that indicates whether
                   or not the provider of service accepts the Medicare
                   program's payment as payment in full except for
                   specific coinsurance and deductible amounts required
                   of the patient.
                   VALID VALUES:
                   P - Provider accepts assignment
                   N - Provider does not accept assignment
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ASSOC ADJ CODE     ASSOCIATION ADJUSTMENT CODE:
                   A two position code that is used to associate
                   debit/credit adjustments. An association adjustment
                   code is mandatory for all adjustment claims. Refer
                   to the Intermediary Manual S3885.2.
                   VALID VALUES:
                   1         A - J
                   2         1 - 9
ATTD PHYS          ATTENDING PHYSICIAN IDENTIFIER CODE:
                   The name and/or number of the licensed physician who
                   would normally be expected to certify and recertify
                   the medical necessity of the services rendered,
                   and/or who has primary responsibility for the
                   patient's medical care and treatment.
AUTO ADJ           AUTOMATIC ADJUSTMENT:
                   A code that indicates an automatic claim payment
                   adjustment. Claim data was received from an
                   intermediary or carrier processing facility for
                   payment, and the claim was adjusted by CWF during
                   utilization processing due to the most current
                   information on file.
                   VALID VALUES:
                   0 - Not applicable
                   1 - Overmet Inpatient deductible adjusted
                   2 - Overmet blood deductible adjusted
                   3 - Undermet blood deductible adjusted
                   4 - Full days adjusted and coinsurance rate
                   unchanged
                   5 - Full days adjusted and coinsurance rate
                   increased
                   6 - Full days adjusted and coinsurance rate
                   decreased
                   7 - Lifetime reserve days adjusted and coinsurance
                        rate unchanged.
                   8 - Lifetime reserve days adjusted and coinsurance
                   rate increased
                   9 - Lifetime reserve days adjusted and coinsurance
                   rate decreased
                   A - Part A Home Health visits adjusted to Part B.
                   B - Home Health thru and/or discharge date changed.
                   C - Home Health thru and/or discharge date adjusted
                      to agree with the master death date
                   D - Home Health claim adjusted from Part A to Part B
                      or from Part B to Part A
                   E - Condition C and D are both present
                   F - Hospice provider number in claim not equal to
                      Hospice Master record
                   G - Undermet Inpatient deductible adjusted
                   X - As is under-utilization
                   Y - CWF multiple adjustments
BEN EXH IND        INPATIENT BENEFITS EXHAUSTED INDICATOR:
                   A code that indicates the Beneficiary has exhausted
                   all Medicare Part A benefits for this claim.
                   VALID VALUES:
                   0 - Not applicable
                   1 - Benefits exhausted date or non-payment code
                        present
                   2 - Corrected from date
                   3 - Both conditions apply
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BEN PAY IND         INPATIENT BENEFITS PAID INDICATOR:
                    A code that indicates whether the intermediary has
                    denied payment for technical reasons or requested
                    payment due to the reversal of the technical denial
                    of payment.
                    VALID VALUES:
                    0 - Not applicable
                    1 - Payment refused
                    2 - Payment requested
BENE DIED           BENEFICIARY DIED INDICATOR:
                    A code that indicates the Beneficiary is deceased.
                    VALID VALUES:
                    SPACE - Beneficiary is not deceased
                    D - Beneficiary is deceased
BILL                TYPE OF BILL:
                    A code reported by the provider that indicates the
                    specific type of claim (Inpatient, Outpatient,
                    adjustments, voids, etc.). Refer to the
                    Intermediary Manual S3800.
BLD DED REMAINING   BENEFICIARY REMAINING BLOOD DEDUCTIBLE PINT
                    QUANTITY:
                    The remaining quantity of whole pints of blood which
                    must be paid for, or replaced by the Beneficiary
                    before the blood deductible is satisfied.
BLOCKED             BENEFICIARY BLOCK CODE:
                    A code used to indicate that a Beneficiary has
                    become "blocked", that is, claims cannot process
                    either due to merge, review or clerical
                    modifications at HCFA BPO.
                    VALID VALUES:
                    B - Blocked
                    C - Temporarily blocked by HCFA BPO initiating a
                        merge HICR HCDL transaction
                    D - Logically deleted by HCFA BDMS
                    L - Logically deleted due to a merge of Beneficiary
                        data where the Beneficiary data is now located
                        under a different HIC or at another host This
                        code used prior to implementation of XREF Phase
                        II project.
                    M - Logically deleted due to a merge of Beneficiary
                        data where the Beneficiary data is now located
                        under a different HIC or at another host This
                        code now used with implementation of XREF Phase
                        II project.
                    N - Not blocked
                    X - Temporarily blocked by HCFA BDMS initiating a
                        merge HIDL transaction
                    Y - Temporarily blocked due to a request for
                        clerical update
BTCH                LAST BATCH ACTIVITY1DATE:
                    A date that indicates the last maintenance completed
                    for a particular Beneficiary. This date could be
                    either the date in the maintenance records that were
                    received from HCFA BDMS or the date that the CWF
                    host executed a maintenance cycle to apply data from
                    HCFA BDMS or HCFA BPO to a Beneficiary record. The
                    date is displayed in Gregorian format (MM/DD/YY).
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CAL/DAY            CMN MILLILITERS PER DAY:
                   The number of milliliters per day prescribed for
                   parenteral nutrition therapy.
CAL/DAY            CERTIFICATE OF MEDICAL NECESSITY ENTERAL NUTRITION
                   CALORIES:
                   The number of enteral nutrition calories that the
                   Beneficiary receives per day.
CAL/DAY            CMN MILLILITERS PER DAY. THE NUMBER OF MILLILITERS
                   PER DAY PRESCRIBED FOR PARENTERAL NUTRITION THERAPY
CAL/DAY            CMN milliliters per day. the number of milliliters
                   per day prescribed for parenteral nutrition therapy.
CAL/DAY            CMN milliliters per day the number of milliliters
                   per day prescribed for parenteral nutrition therapy.
CAL/DAY            CMN milliliters per day the number of milliliters
                   per day prescribed for parenteral nutrition therapy.
CANC               CANCELLATION1DATE:
                   The date that the previously processed corresponding
                   claim was canceled. The date is displayed in
                   Gregorian format (MM/DD/YY).
CANC IND           CLAIM CANCEL INDICATOR:
                   A code indicating whether or not the claim has been
                   canceled. Adjustment processing or incorrect claim
                   data may cause claim cancellation.
                   VALID VALUES:
                   N – Non-choices claim not canceled
                   Y – Non-choices claim canceled
                   C – Choices claim not canceled
                   D – Non-choices claim canceled
                   E – Encounter claim not canceled
                   F – Encounter claim canceled
                   CANCEL ONLY ADJUSTMENT CODE:
                   A code that indicates the claim accepted by HCFA
                   BDMS is to be canceled. Adjustment processing or
                   incorrect claim data may cause claim cancellation.
                   VALID VALUES
                   C - Coverage only code
                   P - Plan transfer
                   S - Scramble
                   D - Duplicate billing
                   H - Other
CARRIER            SUBMITTING CARRIER:
                   A code assigned to the satellite carrier that
                   submitted the claim.
CARRIER (ESRD)     END STAGE RENAL DISEASE PRIOR CARRIER:
                   The code assigned to the satellite that submitted a
                   prior ESRD claim for emergency supplies.
CASH DED           VERIFIED PATIENT LIABILITY CASH DEDUCTIBLE:
                   The portion of the total charges for this claim that
                   was applied toward the patient's deductible amount
                   for which the patient is liable for payment to the
                   provider of services.
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CASH DED APPLIED    TOTAL CASH DEDUCTIBLE APPLIED:
                    The portion of the line item charge that was applied
                    toward the patient's deductible amount for which the
                    patient is liable for payment to the provider of
                    service.
CAT                 DME, PROSTHETICS, ORTHOTICS, AND SUPPLIES CATEGORY:
                    A code that indicates the category of Durable
                    Medical Equipment, Prosthetics, Orthotics or
                    Supplies (DMEPOS) certified for the Beneficiary's
                    use.
                    VALID VALUES:
                    1 - Inexpensive/routinely purchased
                    2 - Frequent maintenance
                    3 - Prosthetics/orthotics
                    4 - Capped rental
                    5 - Oxygen
                    6 - Immunosuppressive drugs
                    7 - Parenteral/enteral nutrition
                    8 - Epoetin - a biologically engineered protein
                         which stimulates the bone marrow to make new
                         red blood cells
                    9 - Customized DMEPOS, drugs and vision items
                    A - Repair and replacement
CAT ADJ INDICATOR   BENEFICIARY CATASTROPHIC ADJUSTMENT INDICATOR:
                    A code that indicates whether or not a Beneficiary
                    has received an adjustment on a claim processed for
                    a hospital stay using catastrophic benefits.
                    Catastrophic benefits were effective January 1, 1989
                    thru December 31, 1989. It provided coverage for
                    overwhelming costs related to serious injury or
                    illness.
                    VALID VALUES:
                    0 - No adjustment
                    1 - Downward adjustment
                    2 - Upward adjustment
CAT ADM DTE         BENEFICIARY CATASTROPHIC ADMISSION1DATE:
                    The admission date of the claim to which the
                    Inpatient deductible was applied in 1989. The date
                    is displayed in Gregorian format (MM/DD/YY).
CAT BLD DED RMNG    BENEFICIARY CATASTROPHIC REMAINING BLOOD DEDUCTIBLE:
                    The amount of whole pints of blood that are
                    remaining for use by a Beneficiary receiving
                    catastrophic benefits. This amount is initialized
                    to the value of "3" and decremented through the
                    acceptance of Part A claims.
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CAT CO SNF DAYS     BENEFICIARY CATASTROPHIC COINSURANCE SNF DAYS:
                    The number of Beneficiary coinsurance SNF days
                    remaining for the 1989 catastrophic benefit year.
                    This amount begins at 8 and represents the required
                    number of days a Beneficiary has to pay coinsurance
                    amounts in the 1989 calendar year. If the
                    Beneficiary was treated in a Christian Science SNF,
                    the maximum days allowed is 45. The number is
                    decremented through the acceptance of Part A SNF
                    claims with service dates in 1989.
CAT DEC DED         BENEFICIARY CAT INPATIENT DECEMBER HOSP DEDUCTIBLE
APPLIED             APPLIED:
                    The total deductible amount for a beneficiary
                    receiving catastrophic Inpatient hospital benefits
                    that was applied in December 1988. The maximum
                    amount that can be applied for the 1989 catastrophic
                    benefit year is $560.00; if no deductible is
                    applied, the value of this field will be zeroes.
CAT DED APPLIED     BENEFICIARY CATASTROPHIC DEDUCTIBLE APPLIED:
                    The deductible amount applied to the earliest
                    hospital stay in 1989.
CAT DED             BENEFICIARY CATASTROPHIC DEDUCTIBLE CALCULATED:
CALCULATED          The amount that indicates the deductible calculated
                    for a hospital stay associated with catastrophic
                    benefits.
CAT EARLIEST        BENEFICIARY CATASTROPHIC FROM1DATE:
BILLING             The from date of the earliest billing action
                    associated with the 1989 catastrophic benefit year.
                     This represents the date of earliest billing action
                    for Part A services within the year that
                    catastrophic benefits were in effect. The date is
                    displayed in Gregorian format (MM/DD/YY).
CAT FROM DTE        BENEFICIARY CATASTROPHIC DEDUCTIBLE FROM1DATE:
                    The from date of the Inpatient hospital claim to
                    which the catastrophic deductible was applied. The
                    date is displayed in Gregorian format(MM/DD/YY).
CAT FULL SNF DAYS   BENEFICIARY REMAINING CATASTROPHIC FULL SNF DAYS:
                    The number of full coverage days of SNF services
                    remaining for the 1989 catastrophic benefit year.
                    This amount begins at 142, the number of full days a
                    Beneficiary could receive care in a certified SNF in
                    the 1989 calendar year. The number is decremented
                    through the acceptance of Part A SNF claims with
                    service dates in 1989. If the Beneficiary was
                    treated in a Christian Science SNF, the maximum
                    number of full SNF days allowed is zero.
CAT HCFA DATE       BENEFICIARY CATASTROPHIC HCFA1DATE
                    The date that HCFA BDMS or CWF processed the
                    earliest bill received for a hospital stay
                    associated with catastrophic benefits that satisfies
                    the Inpatient deductible. The date is displayed in
                    Gregorian format (MM/DD/YY).
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CAT INP DED RMNG   BENEFICIARY REMAINING CATASTROPHIC INPATIENT
                   DEDUCTIBLE AMT:
                   The amount of deductible that remains to be met for
                   a Beneficiary receiving 1989 catastrophic benefits.
                    Before the deductible is reduced, the initial
                   amount is equal to the maximum allowable amount
                   ($560.00) for the 1989 catastrophic benefit year.
CAT INTER          BENEFICIARY CATASTROPHIC INTERMEDIARY NUMBER:
                   The number which identifies the intermediary that
                   processed the claim to which the 1989 Inpatient
                   deductible was applied.
CAT LATEST         BENEFICIARY CATASTROPHIC THRU1DATE:
BILLING            The thru date of the latest billing action
                   associated with the 1989 catastrophic benefit year.
                   This date represents the latest date for Part A
                   services within the year that catastrophic benefits
                   were in effect. The date is displayed in Gregorian
                   format (MM/DD/YY).
CAT THRU DTE       BENEFICIARY CATASTROPHIC DEDUCTIBLE THRU1DATE:
                   The thru date of the earliest hospital claim
                   processed during the year that catastrophic coverage
                   was available to which the Inpatient deductible was
                   applied. The date is displayed in Gregorian format
                   (MM/DD/YY).
CAT TRANS BLD      BENEFICIARY CATASTROPHIC TRANSITION BLOOD DEDUCTIBLE
                   PINTS:
                   The number of blood deductible pints met in a
                   transitional catastrophic benefit period. A
                   transitional period consists of a hospital stay
                   occurring prior to 1989 and continuing into 1989.
CAT TRANSFER       INTERIM BENEFICIARY CATASTROPHIC TRANSFER INDICATOR:
                   A code that indicates the claim, following the claim
                   in which the deductible was applied, is a
                   continuation of the first hospital stay; therefore,
                   charges may not be applied toward any remaining
                   deductible limits.
                   VALID VALUES:
                   0 - Does not apply
                   1 - Beneficiary transferred
                   2 - Beneficiary in still hospitalized at the end of
                       the period
CAT TRLR IND1      BENEFICIARY CATASTROPHIC YEARLY INDICATOR 1:
                   A code used to represent specific catastrophic
                   information related to a paid claim.
                   VALID VALUES:
                   0 - Not used
                   1 - Clerical involvement
                   2 - Christian Science SNF usage
                   3 - Both conditions exist
CAT TRLR IND2      BENEFICIARY CATASTROPHIC YEARLY INDICATOR 2:
                   A second code used to represent specific
                   catastrophic information related to a paid claim.
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                    VALID VALUES:
                    0 - Not used
                    1 - Thru date is interim
                    2 - Indication from a posted Part A claim that an
                        earlier claim contains deductible
                    3 - Both conditions exist
CAT TRLR YR         BENEFICIARY CATASTROPHIC TRAILER YEAR:
                    The year for which the associated trailer
                    information (Inpatient catastrophic claim data
                    stored in CWF) applies. Currently this information
                    can only pertain to 1989.
CCPD AMT            END STAGE RENAL DISEASE LIMITATION CCPD AMOUNT:
                    The monthly payment amount for the designated month
                    for any Continuous Cycling Peritoneal Dialysis
                    (CCPD) services.
CERT TYPE           CLINICAL LABORATORY IMPROVEMENT AMENDMENT
                    CERTIFICATION TYPE:
                    A code that indicates the type of certification
                    assigned to the clinical laboratory. The levels of
                    certification restrict the complexity of testing
                    that will be covered by Medicare.
                    VALID VALUES FOR PHASE II:
                    1 - Regular
                    2 - Waiver
                    3 - Accreditation
                    4 - PPMP
                    5 - Patrial Accredited
                    9 - Registration
CERTIF/N DATE EFF   CLIA CERTIFICATE EFFECTIVE1DATE:
                    A date that indicates the start of the clinical
                    laboratory's certification to perform specific
                    laboratory procedures, based on the type of
                    certification. The date is displayed in Gregorian
                    format (MM/DD/YYYY).
CERTIF/N DATE TRM   CLIA CERTIFICATE TERMINATION1DATE:
                    A date that indicates the termination of the
                    clinical laboratory's certification to perform
                    specific laboratory procedures, based on the type of
                    certification. The date is displayed in Gregorian
                    format (MM/DD/YYYY).
CERTS               CLIA NUMBER OF CERTIFICATES:
                    The number of certification periods in which a
                    clinical laboratory meets the required laboratory
                    testing standards for the specified certificate
                    type. Refer to the definition for CLINICAL
                    LABORATORY
IMPROVEMENT AMENDMENT CERTIFICATION TYPE
CHARGES             FINANCIAL OR REVENUE CHARGES:
                    Total charges pertaining to the related revenue
                    code. Refer to the definition for REVENUE CENTER
                    CODE.
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CLAIM IND           CLAIM HISTORY VALIDATION INPATIENT CLAIM INDICATOR:
                    A code on the claim index that identifies the
                    current status of the claim.
                    VALID VALUES:
                    SPACE - Valid History
                    C - Canceled
                    I - Ignored
                    A - Adjustment
                    R - Replacement
CLAIM RECEIPT DTE   PART B CLAIM RECEIPT1DATE:
                    The date that the carrier received the claim for
                    processing. The date is displayed in Gregorian
                    format (MM/DD/YY).
CLAIM REIM          PART B TOTAL CLAIM REIMBURSEMENT:
                    The amount of reimbursement to the Beneficiary or
                    the provider of service.
CLAIM TYPE          CLAIM HISTORY CLAIM TYPE SELECTION:
                    A code that indicates the type of claims selected
                    for Paid Claim History Inquiry display.
                    VALID VALUES:
                    Space - All claim types
                    I - Inpatient claim
                    O - Outpatient claim
                    B - Carrier claim
                    D - DME claim
CLEAN CLM           CLEAN CLAIM INDICATOR:
                    A clean claim is one that does not require
                    investigation or development that prevents timely
                    Medicare payment.
                    VALID VALUES:
                    X - Clean claim
                    O - Other
CLIA NUMBER         CLINICAL LABORATORY IMPROVEMENT AMENDMENT NUMBER:
                    A unique certificate number assigned by HCFA BDMS,
                    under the Clinical Laboratory Improvement Amendment
                    (CLIA), to identify the certification and ownership
                    data for a clinical laboratory.
CLINICAL LAB AMT    CLINICAL LABORATORY AMOUNT:
                    Clinical laboratory charges associated with this
                    line item service, if applicable.
CLINICAL LAB ID     CLINICAL LABORATORY IDENTIFICATION NUMBER:
                    The identification number of the clinical laboratory
                    that provided services on the line item service, if
                    applicable.
CLM                 CLAIM HISTORY VALIDATION CLAIM TYPE:
                    A code used for duplicate claim checking that
                    indicates the type of claim transaction.
                    VALID VALUES:
                    I - Inpatient claim
                    O - Outpatient claim
                    B - Carrier claim
                    D - DME claim
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CLM FROM           PART B CLAIM FROM1DATE:
                   The earliest date of service on this claim,
                   displayed in Gregorian format (MM/DD/YY).
CLM THRU           PART B CLAIM THRU1DATE:
                   The latest date of service on this claim. The date
                   is displayed in Gregorian format (MM/DD/YY).
CMN IND            BENEFICIARY DURABLE MEDICAL EQUIPMENT AUXILIARY
                   INDICATOR:
                   A code that indicates the existence of auxiliary
                   Certificate of Medical Necessity (CMN) records for
                   Durable Medical Equipment (DME), prosthetics,
                   orthotics and supplies.
                   VALID VALUES:
                   0 - No auxiliary CMN records exist
                   1 - DME claims activity recorded
                   2 - Skeleton CMN on file
                   3 - True CMN on file
CNCR IND           A code that indicates the existence of Cancer
                   Screening Database records
                   Valid Values:
                   0 - No cancer screening data exists
                   1 - Cancer screening data exists
CNTY CD            BENEFICIARY COUNTY CODE:
                   The Social Security Administration standard county
                   code that indicates where a Beneficiary resides.
                   This element is used in conjunction with the state
                   code to determine payment rates for GHO
                   reimbursement and for special studies. County codes
                   are carrier and intermediary specific.
CO                 INPATIENT COINSURANCE DAYS:
                   The number of days of care that the Beneficiary is
                   responsible for a predetermined coinsurance payment.
CO DAYS            BENEFICIARY REMAINING INPATIENT COINSURANCE DAYS:
                   The number of coinsurance days of Inpatient hospital
                   services remaining in a benefit period. The
                   Beneficiary is entitled to up to 30 coinsurance days
                   for each benefit period. Coinsurance days must be
                   exhausted before lifetime reserve days can be used.
                    The number is decremented through the acceptance of
                   Part A claims, by subtraction of the coinsurance
                   covered days.
CO INS             COINSURANCE AMOUNT:
                   The portion of this line item charge that the
                   Beneficiary is responsible for payment, usually 20%
                   of reasonable charges after the carrier annual
                   deductible has been met.
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CO SNF DAYS        BENEFICIARY REMAINING COINSURANCE SNF DAYS:
                   The number of Beneficiary coinsurance SNF days
                   remaining in a benefit period. After a hospital
                   stay of 3 or more days, a Beneficiary is entitled to
                   20 full days of care and 80 coinsurance days in a
                   certified SNF (or 30 coinsurance days in a Christian
                   Science SNF) for each benefit period. The number is
                   decremented through the acceptance of Part A claims.
CO: YR 1           INPATIENT FIRST YEAR COINSURANCE DAYS:
                   The number of coinsurance days involved with the
                   Beneficiary's stay in a facility. For services
                   excluding calendar year 1989 when catastrophic
                   coverage was in effect, the Inpatient Medicare days
                   occurring after the 60th day and before the 91st day
                   in a single spell of illness; for SNF claims,
                   coinsurance days occurring after the 20th day and
                   before the 101st day of a stay in a SNF. If the
                   claim spans two calendar years, this field contains
                   the coinsurance days that occurred in the first
                   calendar year; otherwise, it contains the total
                   coinsurance days for the stay. Coinsurance was not
                   charged for Inpatient hospital care in 1989, due to
                   catastrophic coverage.
CO: YR 2           INPATIENT SECOND YEAR COINSURANCE DAYS:
                   For services excluding calendar year 1989 when
                   catastrophic coverage was in effect, the Inpatient
                   Medicare days occurring after the 60th day and
                   before the 91st day in a single spell of illness;
                   for SNF claims, coinsurance days occurring after the
                   20th day and before the 101st day of a stay in a
                   SNF. If the claim spans two calendar years, this
                   field contains the coinsurance days that occurred in
                   the second calendar year; otherwise, it contains
                   zeroes. Coinsurance was not charged for Inpatient
                   hospital care in 1989, due to catastrophic coverage.

COMBINED A&B DED   BENEFICIARY REMAINING PART A/B BLOOD DEDUCTIBLE
                   PINTS:
                   The number of blood deductible pints taken for both
                   Part A and Part B benefits for the indicated year.
COMBINED A&B YR    BENEFICIARY REMAINING PART A/B BLOOD DEDUCTIBLE
                   YEAR:
                   The year associated with the calculation for
                   remaining Part A and Part B blood deductible pints.
                    The year is displayed as YY or '##' as the default.
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COMP CARRIER       COMPLEMENTARY CARRIER:
                   The name of the Beneficiary's complementary
                   insurance carrier (insurance to cover charges not
                   paid by Medicare) when the complement indicator is
                   "C", or Medicaid identification number when the
                   complement indicator is "M". Refer to the
                   definition for COMPLEMENTARY INSURANCE INDICATOR.
                   For the CHOICES demonstration this filed will
                   contain the CHOICES identifier. The CHOICES
                   identifier is a five character HMO number. See INP-
                   HMO-ID for a full description.
COMP ID NUM        COMPLEMENTARY CARRIER IDENTIFICATION NUMBER:
                   The Beneficiary's complementary insurance carrier
                   identification number if the COMPLEMENTARY INSURANCE
                   INDICATOR is "C", or the Beneficiary's Medicaid
                   identification number if the COMPLEMENTARY INSURANCE
                   INDICATOR is "M". Refer to the definition for
                   COMPLEMENTARY INSURANCE INDICATOR.
COMP IND           COMPLEMENTARY INSURANCE INDICATOR:
                   A code that indicates whether the Beneficiary has
                   additional health insurance coverage, Medicaid
                   coverage, or no additional coverage.
                   VALID VALUES:
                   SPACE - Not applicable
                   M - Medicaid
                   C - Complementary
COND CODE          CONDITION CODE:
                   A code that identifies conditions relating to this
                   claim that may affect payer processing. Refer to the
                   Intermediary Manual S3871.
CORR               BENEFICIARY CORRECT HIC NUMBER:
                   The current active HIC number for a Beneficiary is
                   displayed on the HIMR Inquiry screens as the correct
                   HIC number in external format. HIC numbers are
                   stored internally by HCFA BDMS and CWF in a
                   converted format. Refer to HEALTH INSURANCE CLAIM
                   NUMBER for further information.
CORRUPTED CLAIM    CORRUPTED CLAIM
                   No detail line information present for ICN
CPT INTEREST       CLAIMS PROCESSING TIMELINESS INTEREST:
                   The amount of anticipated interest that was or will
                   be paid on the claim because the carrier was unable
                   to pay the claim within the regulated time frames.
CUM MN             CMN ACCUMULATIVE MEDICAL NECESSITY:
                   The accumulated number of months to date that have
                   been certified by a physician as medically necessary
                   for the use of DME, prosthetics, orthotics or
                   medical supplies. The period includes the initial
                   certification period, as well as any revisions. A
                   value of 99 indicates the item has been determined
                   to be necessary for the patient's lifetime.
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CURRENT A ENT      BENEFICIARY PART A ENTITLEMENT START1DATE:
                   A date that indicates the start of current
                   entitlement to Medicare Part A benefits. The date is
                   displayed in Gregorian format (MM/DD/YY). In
                   general, a Beneficiary is entitled to receive Part A
                   Medicare benefits as follows:
                   -the individual has reached age 65 and also is
                    entitled to Social Security retirement or survivor
                    benefits
                   -the individual is a qualified Railroad Retirement
                    Beneficiary
                   -the individual is under age 65, but is entitled to
                    benefits in the Social Security or Railroad
                    Retirement programs because they are disabled.
                   -the individual qualifies due to ESRD.

                   The date of entitlement begins when a qualified
                   individual reaches the age of 65, but benefits are
                   payable with the first day of the month in which the
                   65th birthday occurs. It is assumed that an
                   individual reaches a given age on the first day of
                   the month of the birth anniversary. A person born
                   on July 31st, for example, could be entitled to
                   benefits as early as July 1st. Individuals
                   receiving disability benefits or ESRD beneficiaries
                   must receive these benefits for at least 30 months
                   before Medicare entitlement begins.

CURRENT A TRM      BENEFICIARY PART A TERMINATION DATE:
                   A date that indicates the termination of current
                   entitlement to Medicare Part A benefits. The date
                   is displayed in Gregorian format (MM/DD/YY). Part A
                   benefits will terminate upon the death of a Social
                   Security or Railroad Retirement recipient. Disabled
                   or ESRD beneficiaries will have their benefits
                   terminated if they no longer qualify under disabled
                   or ESRD entitlements; and for beneficiaries over 65
                   who are not covered by Social Security or Railroad
                   Retirement benefits, but elected to pay for "buy-in"
                   Part A benefits, coverage will terminate upon death
                   or non-payment of premiums.
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CURRENT B ENT      BENEFICIARY PART B ENTITLEMENT START DATE:
                   A date that indicates the start of current
                   entitlement to Medicare Part B benefits. The date
                   is displayed in Gregorian format (MM/DD/YY). Part B
                   Medicare, or Supplemental Medical Insurance (SMI) is
                   a voluntary program financed largely by premium
                   payments from the enrollees. Automatic enrollment
                   in this program is in effect for most individuals
                   entitled to hospital insurance, refer to the
                   definition for BENEFICIARY PART A ENTITLEMENT START
                   DATE, unless the Beneficiary declines coverage.
                   Beneficiaries can only be enrolled in this program
                   during the general enrollment period (January 1 –
                   March 31), or an initial enrollment period. The
                   initial enrollment period, which last for seven
                   months, starts on the first day of the third month
                   prior to the month of eligibility. An individual
                   qualifying for this program based on Part A benefits
                   is entitled to Part B insurance on the same day Part
                   A benefits begin.

                   This program is independent from the Part A or
                   hospital insurance plan. It is possible for an
                   eligible individual to enroll in the program without
                   being entitled to monthly Social Security, Railroad
                   Retirement benefits or to hospital insurance
                   protection. These individuals, or individuals who
                   are re-enrolling in the program, may enroll by
                   application during the designated general enrollment
                   periods.
CURRENT B TRM      BENEFICIARY PART B TERMINATION DATE:
                   A date that indicates the termination of current
                   entitlement to Medicare Part B benefits. The date
                   is displayed in Gregorian format (MM/DD/YY). Since
                   the Part B or SMI benefits are voluntary and require
                   premium a Beneficiary may terminate participation in
                   the program at any time by filing notice.
                   Termination will also occur if premiums are unpaid
                   or the Beneficiary dies.
CURRENT STATUS     ARCHIVED POINTER CURRENT RECORD STATUS:
                   A code that indicates the current status of the
                   Archived History record.
                   VALID VALUES:
                   A-ARCHIVED - The record is not accessible on-line
                       and a retrieval request has not been made
                   P-RETRIEVAL PENDING - The record has an existing
                       retrieval request
                   M-RETRIEVAL MERGE PENDING - The record has an
                       existing merge request
                   R-RETRIEVAL - The record is accessible on-line
                   U-UNRETRIEVABLE - The record is not accessible on-
                       line due to a technical malfunction
                   *DELETED - The record is logically unavailable for
                       retrieval
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CURRENT SYSTEM     CURRENT SYSTEM DATE:
DATE               The current processing date in MM/DD/YY format as
                   assigned by the computer system. This date is
                   displayed on line 24, position 70 in the HIMR
                   Inquiry System.
CUST               CERTIFICATE OF MEDICAL NECESSITY CUSTOMIZED DME
                   INDICATOR:
                   A code that indicates the DMEPOS item has been
                   customized for the Beneficiary.
                   VALID VALUES:
                   Y - Customized
                   N - Not customized
CWF Sector Name    CWF SECTOR NAME:
                   The literal associated with each of the nine CWF
                   Hosts. HIMR Inquiry screens will display the name
                   of the sector on the second line of each screen if
                   Beneficiary data is being displayed from a remote
                   host. If the Beneficiary data resides at the local
                   host, the same area of the screen will display
                   "Local Host".
                   VALID VALUES:
                   Great Western
                   Keystone
                   Mid-Atlantic
                   Northeast
                   Pacific
                   South
                   Southeast
                   Southwest
                   Local Host
CWF UPDATE         CLINICAL LABORATORY IMPROVEMENT AMENDMENT CWF DATE:
                   The date of the most recent CWF weekly batch
                   processing update to the CLIA Record. The date is
                   displayed in Gregorian format (MM/DD/YY).
DATE HCFA          DATE OF HCFA RESPONSE:
RESPONDED          The date in month, day, and year format (MM/DD/YY)
                   that HCFA BDMS responded to the transfer request to
                   locate the Beneficiary data.
DATE OF TRANSFER   DATE OF TRANSFER:
                   The date of the most recent transfer request sent by
                   the host to HCFA BDMS to locate the Beneficiary
                   record. The date is displayed in Gregorian format
                   (MM/DD/YY).
DATE RANGE FROM    ARCHIVE CLAIM DATE RANGE FROM DATE:
                   The claim from date of service as requested on the
                   HIMR screen, in month, day and year format
                   (MM/DD/YY). If a from date is not entered, the CWF
                   system will default to the earliest from date of
                   service on the archived claim records.
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DATE RANGE THRU    ARCHIVED CLAIM DATE RANGE THRU DATE:
                   The claim through date of service as requested on
                   the HIMR screen, in month, day, and year format
                   (MM/DD/YY). If a through date is not entered, the
                   CWF system will default to the latest through date
                   of service on the archived claim records.
DAYS CST           INPATIENT COST REPORT DAYS:
                   The number of days that Medicare reimbursed as
                   credited to the Provider Statistical & Reimbursement
                   Report.
DAYS NON UTL       INPATIENT NON-UTILIZATION DAYS:
                   The number of days of care not chargeable to
                   Medicare utilization.
DAYS USED          OUTPATIENT HOSPICE DAYS USED:
                   The number of covered Hospice days used by a
                   Beneficiary in a Hospice benefit period.
DAYS UTL           INPATIENT UTILIZATION DAYS:
                   The number of days that are chargeable to Medicare
                   utilization. Utilization days comprise the total
                   number of full days, coinsurance days and lifetime
                   reserve days.
DECISION IND       DMEPOS DECISION INDICATOR:
                   A code that indicates this claim represents an
                   original decision or a reversal of an earlier
                   decision on the original claim.
                   VALID VALUES:
                   O - Original medical review determination
                   R - Medical review determination after reversal of
                       original decision
DED                DEDUCTIBLE MET INDICATOR:
                   A code that indicates whether or not deductible has
                   been applied to the history claim.
                   VALID VALUES:
                   Y - Deductible has been applied
                   N - Deductible has not been applied
DED AMT            CASH DEDUCTIBLE AMOUNT:
                   The total amount of allowable claim charges that
                   were applied toward the deductible for this claim.
DED MED            PART B TOTAL CHARGE SUBJECT TO DEDUCTIBLE:
                   The allowable charges for this claim that are
                   subject to the Part B cash deductible
DED OTHPY          PART B TOTAL OCCUPATIONAL THERAPY CHARGES SUBJECT TO
                   DEDUCT:
                   The total allowable occupational therapy charges
                   that are subject to deductible and, for charges
                   prior to 10/86, not paid by another insurer.
DED PSYC           PART B TOTAL PSYCHIATRIC CHARGES SUBJECT TO
                   DEDUCTIBLE:
                   The total allowable psychiatric charges that are
                   subject to deductible and, for charges prior to
                   10/86, not paid by another insurer.
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DED PTHPY          PART B TOTAL PHYSICAL THERAPY CHARGES SUBJECT TO
                   DEDUCTIBLE:
                   The total allowable physical therapy charges that
                   are subject to deductible, and for charges prior to
                   10/86, not paid by another insurer.
DEL IND            MEDICARE AS SECONDARY PAYER DELETE INDICATOR:
                   A code that indicates the veracity of the MSP data.
                    A code "D" indicates the record was incorrectly
                   input and the information is not valid.
                   VALID VALUES:
                   SPACE - No action
                   D - Record to be deleted
DELIVERY DT        CERTIFICATE OF MEDICAL NECESSITY DELIVERY1DATE:
                   The date that the DMEPOS item was delivered to the
                   Beneficiary, displayed in Gregorian format (MMDDYY).
DEMO NUMBER        An identification code for one of many demonstration
                   projects for which Medicare benefits for specific
                   services are offered at lower prices.
                   RUGS-VALUE '01'. INP
                   HHA-VALUE '02'. Not active in CWF
                   TELEMED-VALUE '03'. PTB
                   UMWA-VALUE '04'. INP
                   CHOICES-VALUE '05'. INP, OUT, PTB
                   CABG-VALUE '06'. INP, PTB
                   COE-VALUE '07'. Not active in CWF
                   MPPP-VALUE '08'. Not active in CWF
                   ESRD-VALUE '15'. INP, OUT, PTB
                   LUNG-VALUE '30'. INP, PTB
                   VA-VALUE '31'. INP, PTB
DESCRIPTION        MEDICARE AS SECONDARY PAYER CODE DESCRIPTION:
                   A 17 character literal description of the Medicare
                   Secondary Payer code field. Refer to the definition
                   for MEDICARE AS SECONDARY PAYER CODE.
DI-01              DATA INDICATOR (01) - NAME CHANGE:
                   A code that indicates whether or not a name change
                   has been processed.
                   VALID VALUES:
                   0 - Does not apply
                   1 - Discrepant Beneficiary name in universal RIC
                   2 - Clerical name change processed
                   3 - Both conditions present
DI-02              DATA INDICATOR (02) - CLERICAL SEX CODE:
                   A code that indicates whether or not a clerical sex
                   code change has been processed.
                   VALID VALUES:
                   0 - Does not apply
                   1 - Clerical sex code change processed
                   2 - Reserved for future use
                   3 - Both conditions present
DI-03              DATA INDICATOR (03) - HOST ID:
                   A code that has been assigned by HCFA BPO to each
                   CWF sector.
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                   VALID VALUES:
                   A-National Maintenance Contractor
                   B-MA-Mid-Atlantic
                   C-SW-Southwest
                   D-NE-Northeast
                   F-GW-Great Western
                   G-KS-Keystone
                   H-SE-Southeast
                   I-SO-South
                   J-PA-Pacific
DI-04              DATA INDICATOR (04) - RAILROAD RETIREMENT BENEFITS:
                   A code that indicates whether or not a Beneficiary
                   was previously covered under Railroad Retirement
                   Board benefits.
                   VALID VALUES:
                   0 - Does not apply
                   1 - Bene previously covered under RRB
                   2 - Reserved for future use
                   3 - Both conditions present
DI-05              DATA INDICATOR (05) - DATE OF DEATH SOURCE:
                   A code that indicates the source of Beneficiary
                   deceased information.
                   VALID VALUES:
                   0 - Does not apply
                   1 - Master Beneficiary Record
                   2 - Medical claim
                   3 - Master Beneficiary Record/Medical claim or
                   clerical
DI-06              DATA INDICATOR (06) - REPRESENTATIVE PAYEE CODE:
                   A code that indicates whether or not the Beneficiary
                   has a representative payee.
                   VALID VALUES:
                   0 - Does not apply
                   1 - Selected for GEP contact (not maintained by CWF)
                   2 - Beneficiary has representative payee
                   3 - Both conditions exist
DI-07              DATA INDICATOR (07) - DATE OF DEATH INFORMATION:
                   A code that indicates whether or not the date of
                   death information was received from the Master
                   Beneficiary Record (MBR).
                   VALID VALUES:
                   0 - Does not apply
                   1 - Proven date of death received from the MBR
                   2 - Part B coverage term (not maintained by CWF)
                   3 - Both conditions present
DI-08              DATA INDICATOR (08) - DATE OF DEATH CONFIRMATION:
                   A code that indicates the validity of the date of
                   death information.
                   VALID VALUES:
                   0 - Does not apply
                   1 - Clerically investigated temp
                   2 - Valid day of death
                   3 - Both conditions present
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DI-09              DATA INDICATOR (09) - WORKER'S COMPENSATION
                   ENTITLEMENT:
                   A code that indicates whether or not the Beneficiary
                   has a separate application for Medicare and/or
                   Worker's Compensation entitlement
                   VALID VALUES:
                   0 - Does not apply
                   1 - Separate application for Medicare
                   2 - Current Worker's Compensation entitlement
                   3 - Both conditions present
DI-10              DATA INDICATOR (10) - MASTER DATA RETRIEVAL:
                   A code that indicates whether or not a master record
                   has been retrieved from the inactive HCFA BDMS
                   master file.
                   VALID VALUES:
                   0 - Does not apply
                   1 - P.L. #96-265 critical case
                   2 - Master record retrieved from inactive master
                       file
DI-11              DATA INDICATOR (11) - ACCOUNT ENTITLEMENT
                   INFORMATION:
                   A code that indicates two account numbers for one
                   Beneficiary and/or that the Beneficiary was part of
                   the Weissert Nursing Home Study.
                   VALID VALUES:
                   0 - Does not apply
                   1 - The bene is entitled on two account numbers;
                       Medicare entitlement exists at the other
                       account number
                   2 - Weissert Nursing Home Study
                   3 - Both conditions present
DI-12              DATA INDICATOR (12) - HEALTH INSURANCE CARD
                   INFORMATION:
                   A code that indicates whether or not a health
                   insurance card was issued.
                   VALID VALUES:
                   0 - Does not apply
                   1 - Health insurance card issued
                   2 - Reserved for future use
                   3 - Both conditions present
DI-13              DATA INDICATOR (13): - UNITED MINE WORKER
                   INFORMATION:
                   A code that indicates the presence of a United Mine
                   Worker special carrier
                   VALID VALUES:
                   0 - Does not apply
                   1 - United Mine Workers (UMW) special carrier
                   2 - Reserved for future use
                   3 - Both conditions exist
DI-14              DATA INDICATOR (14) - DATE OF BIRTH INFORMATION:
                   A code that indicates whether or not proof of a
                   Beneficiary's date of birth is required.
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                   VALID VALUES:
                   0 - Does not apply
                   1 - Proof of Beneficiary's date of birth required
                   2 - Reserved for future use
                   3 - Both conditions present
DI-15              DATA INDICATOR (15) - CASE FILE INFORMATION:
                   A code that indicates Part B case file information.
                   VALID VALUES:
                   0 - Does not apply
                   1 - Advanced filing case (Part B enrollment date is
                       contained in Beneficiary master record)
                   2 - Attainment case (Part B option must be
                       solicited)
                   3 - Both conditions present
DI-16              DATA INDICATOR (16) - STATE "BUY-IN"
                   INFORMATION/SAMPLE IND:
                   A code that indicates whether or not a Beneficiary
                   was ever covered under a state "buy-in" agreement.
                   VALID VALUES:
                   0 - Does not apply
                   1 - Bene previously covered under state "buy-in"
                   2 - Reserved for future use
                   3 - Both conditions present
DI-17              DATA INDICATOR (17) - PSYCHIATRIC PRE-ENTITLEMENT
                   INFO:
                   A code that indicates whether or not a psychiatric
                   pre-entitlement reduction has been applied.
                   VALID VALUES:
                   0 - Does not apply
                   1 - Psychiatric pre-entitlement reduction applied
                   2 - Reserved for future use
                   3 - Both conditions exist
DI-18              DATA INDICATOR (18) - CENTURY INDICATOR:
                   A code that indicates the Beneficiary was born in
                   the prior century. This field is not used within
                   the CWF software after 1/1/1999.
                   VALID VALUES:
                   0 - Does Not Apply
                   1 - Date of Birth prior century
                   2 - SSN oriented master record accreted (Not
                       maintained
                   3 - Both conditions present by CWF)
DI-19              DATA INDICATOR (19) - A/B COVERAGE INFORMATION:
                   A code that indicates whether or not a Beneficiary
                   has two or more prior periods of Part A or Part B
                   coverage.
                   VALID VALUES:
                   0 - Does not apply
                   1 - Bene has two more prior periods of Part A
                       coverage
                   2 - Bene has two or more prior periods of Part B
                       coverage
                   3 - Both conditions present
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DI-20              DATA INDICATOR (20) - FEDERAL EMPLOYEE
                   CLASSIFICATION INFO:
                   A code that indicates the federal employee
                   classification of a Beneficiary.
                   VALID VALUES:
                   0 - Does not apply
                   1 - Currently or previously identified as MQTE
                        Federal Employee on this or another claim
                        number
                   2 - Currently identified as Deemed Insured Federal
                        Employee
                   3 - Beneficiary previously identified as Deemed
                        Insured Federal Employee on this or another
                        claim number
DI-21              DATA INDICATOR (21) - HYPERTENSION STUDY
                   INFORMATION:
                   A code that indicates the Beneficiary took part in a
                   hypertension study and/or that the Beneficiary is an
                   on-line query facility Beneficiary.
                   VALID VALUES:
                   0 - Does not apply
                   1 - Hypertension study
                   2 - On-line query facility Beneficiary
                   3 - Both conditions apply
DI-22              DATA INDICATOR (22) - SOCIAL SECURITY NUMBER
                   VALIDATION INFO:
                   A code that indicates the Beneficiary's Social
                   Security Number has been validated.
                   VALID VALUES:
                   0 - Does not apply
                   1 - Language preference
                   2 - SSN Validated
                   3 - Both conditions apply
DI-23              DATA INDICATOR (23) - MEDICAID MAINTAINED
                   INFORMATION:
                   A code that indicates whether or not Medicaid
                   information is maintained for a particular
                   Beneficiary.
                   VALID VALUES:
                   0 - Does not apply
                   1 - Medicaid data present
                   2 - For future use
                   3 - Both conditions exist
DI-24              DATA INDICATOR (24) - HEALTH INSURANCE INFORMATION:
                   A code used to maintain information regarding HI/SMI
                   entitlement
                   VALID VALUES:
                   0 - Does not apply
                   1 - HI/SMI entitlement dates based on non-
                        consecutive months of DIB entitlement
                   2 - HI/SMI entitlement extended based on DIB trial
                        work plan
                   3 - Both conditions apply
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DI-25              DATA INDICATOR (25) - FOREIGN INCOME INFORMATION:
                   A code that indicates the total foreign income for
                   the Beneficiary.
                   VALID VALUES:
                   0 - Does not apply
                   1 - Beneficiary's earnings record has been totaled
                        with a foreign country
DI-26              DATA INDICATOR (26) - ESRD ENTITLEMENT INFORMATION:
                   A code used to maintain information regarding ESRD
                   benefits.
                   VALID VALUES:
                   0 - Does not apply
                   1 - Beneficiary is entitled to ESRD benefits as the
                        child or spouse of a worker
                   2 - Not used
                   3 - Both conditions present
DI-27              DATA INDICATOR (27) - ADDITIONAL RECORDS
                   INFORMATION:
                   A code that indicates additional record information
                   on the Beneficiary.
                   VALID VALUES:
                   0 - Doe s not apply
                   1 - Ancillary record present
                   2 - Master record frozen
                   3 - Both conditions present
DI-28              DATA INDICATOR (28) - CLAIM/ADMISSION DATA:
                   A code that indicates the presence of a claim or
                        admission control record for the Beneficiary.
                   VALID VALUES:
                   0 - Does not apply
                   1 - Reserved for future use
                   2 - Claim/Admission control record is present for
                        this account
DI-29              DATA INDICATOR (29) - QUERY CONTROL INFORMATION:
                   A code that indicates the presence of a query
                        control record for the Beneficiary.
                   VALID VALUES:
                   0 - Does not apply
                   1 - Query control record present for this account
                   2 - 1973 conversion reject
                   3 - Both conditions present
DI-30              DATA INDICATOR (30) - CABG/COE:
                   A code that indicates the presence Part A CABG or
                   COE bills
                   VALID VALUES:
                   0 - Does not apply
                   1 - Part A CABG or COE bills are present.
DI-31              DATA INDICATOR (31) - DISABILITY COVERAGE
                        INFORMATION:
                   A code that indicates whether or not a Beneficiary
                   was previously or is currently entitled to
                   disability benefits
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                   VALID VALUES:
                   0 - Does not apply
                   1 - Beneficiary previously entitled to disability
                       benefits
                   2 - Beneficiary currently entitled to disability
                       benefits
                   3 - Both conditions present
DI-32              DATA INDICATOR (32) - PART A TRAILER INFORMATION:
                   A code that indicates a Part A spell trailer has
                   been dropped for the Beneficiary, and/or there has
                   been activity concerning the utilization record.
                   VALID VALUES:
                   0 - Does not apply
                   1 - Part A spell trailer has been dropped
                   2 - Clerical adjustment has been made to utilization
                       record; however, intermediary correspondence is
                       required
                   3 - Both conditions present
DI-33              DATA INDICATOR (33) - END STAGE RENAL DISEASE
                       INFORMATION:
                   A code that indicates the reason for ESRD benefits.
                   VALID VALUES:
                   0 - Does not apply
                   1 - Beneficiary has participated in self-care
                       dialysis training program
                   2 - ESRD entitlement due to transplant
                   3 - Both conditions present
DI-34              DATA INDICATOR (34) - ENTITLEMENT INFORMATION:
                   A code that indicates the original reason for
                       entitlement.
                   VALID VALUES:
                   0 - OASI
                   1 - Disability
                   2 - Renal
                   3 - Both Disability & Renal
DI-35              DATA INDICATOR (35) - CURRENT ENTITLEMENT
                       INFORMATION:
                   A code that indicates the current reason for
                       entitlement.
                   VALID VALUES:
                   0 - OASI
                   1 - Disability
                   2 - Renal
                   3 - Both Disability & Renal
DI-36              DATA INDICATOR (36) - BENEFICIARY MASTER AUXILIARY
                       INFO:
                   A code that indicates the type of auxiliary
                   information present on the Beneficiary Master file.
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                   VALID VALUES:
                   0 - Does not apply
                   1 - Beneficiary Master contains prior Part A/Part B
                       entitlement data, GHO data, and universal RIC
                       reject data
                   2 - Read error has been recovered and reentered to
                       system
                   3 - Both conditions present
DI-37              DATA INDICATOR (37) - COVERAGE INFORMATION:
                   A code that indicates further information concerning
                   the Beneficiary's coverage.
                   VALID VALUES:
                   0 - Does not apply
                   1 - Not used
                   2 - Beneficiary will not be deprived of Medicare
                       coverage received
DI-38              DATA INDICATOR (38) - ESRD SOURCE INFORMATION:
                   A code that indicates the source of ESRD
                       information.
                   VALID VALUES:
                   0 - No Renal
                   A - MBR
                   B - HI
                   C - NIH
                   D - MBR/HI
                   E - MBR/NIH
                   F - HI/NIH
                   G - MBR/HI/NIH
                   H - OAS Clerical
                   I - MBR/OAS Clerical
                   J - HI/OAS Clerical
                   K - NIH/OAS Clerical
                   L - MBR/HI/OAS Clerical
                   M - MBR/NIH/OAS Clerical
                   N - HI/NIH/OAS Clerical
                   P - MBR/HI/NIH/OAS Clerical
DIAG               PATIENT DIAGNOSIS:
                   Four possible ICD-9-CM diagnosis codes which
                       identify the condition for which the durable
                       medical equipment, prosthetics, orthotics or
                       supply items has been prescribed. Refer to the
                       definition for DIAGNOSIS CODES.
DIAG CD            DIAGNOSIS CODES:
                   The International Classification of Diseases, 9th
                       Revision, Clinical Modification diagnosis codes
                       which indicate the primary or principal
                       condition of the Beneficiary for the indicated
                       period. ICD-9-CM diagnosis and procedure codes
                       use definitions contained in the Department of
                       Health and Human Services publication number
                       (PHS) 80-1260 or HCFA BPO approved errata and
                       supplements to this publication.
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DIAG CD 1          MEDICARE AS SECONDARY PAYER DIAGNOSIS CODE 1:
                   A code that identifies the primary disease or
                       condition that required medical treatment.
                       Refer to the definition for DIAGNOSIS CODES.

DIAG CD 2          MEDICARE AS SECONDARY PAYER DIAGNOSIS CODE 2:
                   A code that indicates any additional disease or
                       condition that required medical treatment.
                       Refer to the definition for DIAGNOSIS CODES.
DIAG CD PRI        PRIMARY DIAGNOSIS CODE:
                   The primary ICD-9-CM diagnosis code indicated by the
                       provider of service on this claim. Refer to
                       the definition for DIAGNOSIS CODES.
DIAG CD SEC1       PART B SECONDARY DIAGNOSIS CODE 1:
                   The first secondary ICD-9-CM diagnosis code
                       indicated by the provider of service on this
                       claim. Refer to the definition for DIAGNOSIS
                       CODES.
DIAG CD SEC2       PART B SECONDARY DIAGNOSIS CODE 2:
                   The second secondary ICD-9-CM diagnosis code
                       indicated by the provider of service on this
                       claim. Refer to the definition for DIAGNOSIS
                       CODES.
DIALYSIS TYPE      END STAGE RENAL DISEASE DIALYSIS TYPE:
                   A code that indicates the type of dialysis that the
                       Beneficiary receives for permanent kidney
                       failure.
                   VALID VALUES:
                   1 - Hemodialysis
                   2 - Continuous Ambulatory Peritoneal Dialysis (CAPD)
                   3 - Continuous Cycling Peritoneal Dialysis (CCPD)
                   4 - Peritoneal dialysis
DISCHARGE DATE     BENEFICIARY PSYCHIATRIC HOSPITAL DISCHARGE1DATE
                   The last date of service that a Beneficiary was a
                       patient in a psychiatric hospital, where the
                       Beneficiary's Medicare entitlement began and
                       ended during the hospitalization period. The
                       date is displayed in Gregorian format
                       (MM/DD/YY).
DISCHARGE IND      BENEFICIARY PSYCHIATRIC DISCHARGE DATE INDICATOR:
                   A code that indicates the status of the last
                       psychiatric claim within the pre-entitlement
                       period.
                   VALID VALUES:
                   0 - Initialized
                   1 - Last statement date indicates an interim claim,
                       where the Beneficiary is still hospitalized
DISCHG DTE         INPATIENT DISCHARGE1DATE:
                   The date that the Beneficiary was discharged from a
                       hospital or a SNF. The date is displayed in
                       Gregorian format (MM/DD/YY)
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DISCONTINUE DATE   CERTIFICATE OF MEDICAL NECESSITY DISCONTINUED1DATE:
                   The date on which the Durable Medical Equipment
                       Regional Carrier (DMERC) discontinued a
                       certification. The date is displayed in
                       Gregorian format (MMDDYY).
DISPOSITION        DISPOSITION OF THE TRANSFER NOT-IN-FILE RECORD:
                   A code that indicates the status of the Transfer
                       Not-in-file record.
                   VALID VALUES:
                   0-50-Transfer requested
                   1-51-True not in file
                   2-52-Beneficiary data located at another host
                   3-53-Transfer requested and in HCFA Alpha match
                       status
                   4-54-Pending request for HCFA to transfer Auxiliary
                       data
                    -56-Only skeletal data exists, investigated
                       archived due to death
                   7-57-HCFA archived the Beneficiary data, only
                       skeletal data exists
                   8-58-Beneficiary data blacked by HCFA for cross
                       referencing
                   9-59-Benficiary data frozen by HCFA for clerical
                       correction
DME NECESSARY      DURABLE MEDICAL EQUIPMENT MEDICALLY NECESSARY:
                   The number of months that the durable medical
                       equipment in question will be medically
                       necessary as estimated by the provider of
                       service, if applicable to the line item. The
                       item may be purchased or rented.
DME PURCHASE       DURABLE MEDICAL EQUIPMENT PURCHASE COST:
                   The total amount of the purchase cost or monthly
                       payment amount of durable medical equipment, if
                       applicable to the line item.
DME RNT/COVDT      DURABLE MEDICAL EQUIPMENT COVERAGE1DATE:
                   The start date of the period of coverage per a CMN,
                       prescription, other documentation, or carrier
                       determination. The date is displayed in
                       Gregorian format (MM/DD/YY). This field became
                       effective for claim entry on 5/4/92. Prior to
                       5/4/92, this field contained the total amount
                       of DME rental charges, if they applied to the
                       line item this date.
DMEC               DMEPOS CLAIM TRAILER COUNTER:
                   The number of records containing DMEPOS posted
                       claims data that were added to the CWF history
                       database for the Beneficiary
DMERC              DURABLE MEDICAL EQUIPMENT REGIONAL CARRIER:
                   A code assigned by HCFA BPO that identifies the
                       Durable Medical Equipment Regional carrier that
                       submitted the claim.
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DOA                DATE OF ACCRETION:
                   The date that Beneficiary, auxiliary or claim
                       information was added to the host database.
                       The date is displayed in Gregorian format
                       (MM/DD/YY). Except for claims, this date is
                       established using the system date that the
                       original accretion record from HCFA BDMS
                       processed through batch at the host where the
                       Beneficiary data will reside.
DOB                BENEFICIARY BIRTH1DATE:
                   The Beneficiary's date of birth. The date is
                       displayed in Gregorian format (MMDDYYYY).
DOD                BENEFICIARY DEATH1DATE:
                   The Beneficiary's date of death. The date is
                       displayed in Gregorian format (MM/DD/YY).
DOEBA DAY IND      INPATIENT DATE OF EARLIEST BILLING ACTION INDICATOR:
                   A code that indicates the earliest billing action
                       associated with a benefit period for Part A
                       services occurred on the first day of Medicare
                       entitlement, and/or the patient did not utilize
                       any Inpatient days for the spell of illness.
                   VALID VALUES:
                   0 - Not applicable
                   1 - DOEBA = Part A entitlement date
                   2 - Patient was discharged on the date of
                       entitlement, no Inpatient days were utilized
                   3 - Both 1 and 2
DOSE               CERTIFICATE OF MEDICAL NECESSITY IMMUNOSUPPRESSIVE
                   DRUG DOSE:
                   The dosage amount in milligrams for the
                   immunosuppressive drug that the Beneficiary is
                   certified to receive.
DRG                INPATIENT DIAGNOSTIC RELATED GROUPING:
                   A code that indicates the Diagnostic Related Group
                   (DRG) to which this claim belongs for payment
                   purposes. Diagnostic Related Grouping is a coding
                   system that assigns a number to a specific diagnosis
                   based on age, sex, length of stay, and
                   complications; reimbursement is then based on the
                   DRG and not the total charges for the claim. Refer
                   to the DRG Definitions Manual.
DT CREATED         CERTIFICATE OF MEDICAL NECESSITY CREATION1DATE:
                   The date that the CMN record was created, displayed
                   in Gregorian format (MMDDYY).
DT UPDATED         CERTIFICATE OF MEDICAL NECESSITY UPDATE1DATE:
                   The date of the last update to the Certificate of
                   Medical Necessity record by the DME Regional
                   Carrier. The date is displayed in Gregorian format
                   (MMDDYY).
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EARLIEST BILLING   BENEFICIARY DATE OF EARLIEST BILLING ACTION:
                   A date that indicates the earliest billing action
                   associated with a benefit period or spell of
                   illness. The date is displayed in Gregorian format
                   (MM/DD/YY).
EFF DTE (GHO)      GROUP HEALTH ORGANIZATION EFFECTIVE1DATE:
                   The date that the GHO period became effective for
                   the Beneficiary. The date is displayed in Julian
                   format (YYDDD).
EFF DTE (MSP)      MEDICARE AS SECONDARY PAYER EFFECTIVE1DATE:
                   The date that the Beneficiary's benefits became
                   effective under the insurer that has primary
                   responsibility for payment of medical claims. The
                   date is displayed in Gregorian format (MM/DD/YYYY).
EMERG              END STAGE RENAL DISEASE EMERGENCY INDICATOR:
                   A code that indicates emergency supplies were
                   required for the designated month.
EMPLOYEE ID        MEDICARE AS SECONDARY PAYER EMPLOYEE IDENTIFICATION
NUMBER             NUMBER:
                   The identification number assigned by the employer
                   to the employee.
EMPLOYEE INFO      MEDICARE AS SECONDARY PAYER EMPLOYEE INFORMATION
                   CODE:
                   A code that indicates whether the employment
                   information given in the related areas applies to an
                   insured, the patient or the patient's spouse.
                   VALID VALUES:
                   P - Patient
                   S - Spouse
                   M - Mother
                   F - Father
EMPLR INFO         MEDICARE AS SECONDARY PAYER EMPLOYER ADDRESS:
ADDRESS            The street address of the Beneficiary's employer.
EMPLR INFO CITY    MEDICARE AS SECONDARY PAYER EMPLOYER CITY ADDRESS:
                   The city address of the Beneficiary's employer.
EMPLR INFO NAME    MEDICARE AS SECONDARY PAYER EMPLOYER NAME:
                   The name of the employer that provides primary
                   health care coverage for the Beneficiary.
EMPLR INFO STATE   MEDICARE AS SECONDARY PAYER EMPLOYER STATE ADDRESS:
                   The United States Postal Service state address
                   abbreviation of the Beneficiary's employer. Refer
                   to the STATE CODE table of codes.
EMPLR INFO ZIP     MEDICARE AS SECONDARY PAYER EMPLOYER ZIP CODE:
CODE               The zip code address of the Beneficiary's employer.
END DT             CMN CERTIFICATION END1DATE:
                   This date may indicate one of three possible dates:
                   the date that the certification was discontinued,
                   the last date of medical necessity for DMEPOS, or
                   the date of recertification for the use of DMEPOS.
                   The date is displayed in Gregorian format (MMDDYY).
ENTRY CD           PART B ENTRY CODE:
                   A code that indicates the type of claim that was
                   submitted.
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                   VALID VALUES:
                   1 - Original debit
                   3 - Full credit
                   5 - Replacement debit
                   9 - Accrete claim history only
ESRD FROM DTE      END STAGE RENAL DISEASE FROM1DATE:
                   The first service date from the prior claim detail
                   for emergency supplies, displayed in Gregorian
                   format (MM/DD/YY).
ESRD IND           END STAGE RENAL DISEASE AUXILIARY INDICATOR:
                   A code that indicates the existence of auxiliary End
                   Stage Renal Disease (ESRD) Payment Method Selection
                   data and/or Payment Limitation data records. This
                   code is used to indicate whether or not a
                   Beneficiary has elected to receive ESRD benefits.
                   VALID VALUES:
                   0 - No ESRD exist
                   1 - ESRD Method Selection data exists
                   2 - ESRD Payment Limitation data exists
                   3 - Both conditions present
ESRD REIMB METH    OUTPATIENT END STAGE RENAL DISEASE METHOD OF
                   REIMBURSEMENT:
                   A code that indicates whether the ESRD covered
                   services on this claim are to be reimbursed under
                   Method 1 or Method 2, or do not apply. Refer to the
                   definition for END STAGE RENAL DISEASE METHOD CODE.
                   VALID VALUES:
                   0 - Not ESRD
                   1 - Method 1
                   2 - Method 2
ESRD THRU DTE      END STAGE RENAL DISEASE THRU1DATE:
                   The last service date from the prior claim detail
                   for emergency supplies, displayed in Gregorian
                   format (MM/DD/YY).
EXAMINER           EXAMINER NUMBER:
                   A code that identifies the claims processing
                   operator who entered the claim.
EXCEPTION IND      END STAGE RENAL DISEASE EXCEPTION INDICATOR:
                   A code that indicates the relation of the option
                   year to the year of selection.
                   VALID VALUES:
                   SPACE - No change in option year or select date
                   Y - Initial or exception (option year same as year
                   of selection)
                   N - Change (option year 1 year greater than year of
                   selection)
EXP SUB DED        EXPENSES SUBJECT TO DEDUCTIBLE:
                   The portion of total charges that is subject to
                   deductible for this claim.
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EXPIRATION         ARCHIVED POINTER EXPIRATION1DATE:
                   The expiration date that determines the period of
                   time that the claim will be retained on the
                   temporary Archived History file (HARC200), once it
                   is extracted from the Archived History file. A
                   claim will be retained for a maximum of 60 days.
                   The date is displayed in Gregorian format
                   (MM/DD/YY).
FAIL IND           CERTIFICATE OF MEDICAL NECESSITY FAILED TRANSPLANT
                   INDICATOR:
                   A code that indicates whether or not the
                   transplanted organ that the Beneficiary received was
                   rejected.
                   VALID VALUES:
                   Y - Transplant failed
                   N - Transplant did not fail
FI                 BENEFICIARY FIRST INITIAL:
                   The first character of a Beneficiary's given first
                   name.
FR                 CMN ARTERIAL BLOOD GAS FLOW RATE CODE:
                   A code that indicates the oxygen flow rate in the
                   arteries.
                   VALID VALUES:
                   SPACE - Normal
                   QE - Less than 1 liter/min
                   QG - Greater than 4 liters/min
                   QF - Greater than 4 with a portable allowance
FREQ/DAY           CMN ENTERAL NUTRITION FREQUENCY PER DAY:
                   The number of enteral feedings that the Beneficiary
                   receives per day.
FREQ/WK            CMN PARENTERAL/ENTERAL NUTRITION FREQUENCY PER WEEK:
                   The number of times per week that the Beneficiary
                   receives nutrient feedings. For parenteral, this is
                   the number of feedings per week. For enteral, this
                   is the number of daily feedings times seven.
FROM (SRCH) DTE    FROM SEARCH1DATE:
                   This date is used to indicate the earliest dated
                   claim that is desired to display claim history data.
                    This date can be in MMDDYY or MM/DD/YY format.
FROM DTE           FROM1DATE:
                   The date that indicates the first day of the
                   institutional provider's billing statement or
                   physician/supplier's service date for services
                   rendered to the Beneficiary. The date is displayed
                   in Gregorian format (MM/DD/YY).

                   For Inpatient, SNF, Home Health and Hospice claims,
                   the statement from date is not necessarily the same
                   date as the admission date.
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FULL DAYS          BENEFICIARY REMAINING INPATIENT FULL DAYS:
                   The number of Inpatient coverage days remaining from
                   the allotted 60 full coverage days of service for a
                   benefit period. In each benefit period, after
                   meeting an Inpatient deductible, the Beneficiary is
                   entitled to up to 60 days of full coverage (and 30
                   days of coinsurance coverage). Full days must be
                   exhausted before coinsurance days can be used. The
                   number of days is decremented through the acceptance
                   of Part A claims, by subtraction of covered days.
FULL SNF DAYS      BENEFICIARY REMAINING SKILLED NURSING FACILITY FULL
                   DAYS:
                   The number of full coverage days of Skilled Nursing
                   Facility (SNF) services remaining for a benefit
                   period. After a hospital stay of 3 days or more, a
                   Beneficiary is entitled to up to 20 full days of
                   care in a certified SNF (and up to 80 coinsurance
                   days) for each benefit period. Full days must be
                   exhausted before coinsurance days are used. The
                   number of full coverage days is decremented through
                   the acceptance of Part A claims. A Skilled Nursing
                   Facility is a specially qualified facility that has
                   the staff and equipment to provide skilled nursing
                   care or rehabilitation services as well as other
                   related health services.
GHO                GROUP HEALTH ORGANIZATION OVERRIDE INDICATOR:
                   A code that indicates either the Beneficiary does
                   not have GHO coverage, or GHO coverage is involved
                   and is not applicable to this claim.
                   VALID VALUES:
                   0 - No investigation
                   1 - GHO investigation shows not applicable to this
                       claim
GHO IND            GROUP HEALTH ORGANIZATION AUXILIARY INDICATOR:
                   A code that indicates the existence of Beneficiary
                   Group Health Organization (GHO) information
                   physically stored on records in the auxiliary GHO
                   file. The Medicare program makes provisions for
                   beneficiaries participating in GHO's.

                   Medicare pays health care providers such as Group
                   Health Organizations and Competitive Medical Plans a
                   monthly fee to provide Medicare covered hospital and
                   medical insurance coverage to each enrollee.
                   VALID VALUES:
                   0 - No GHO records exist
                   1 - GHO records exist
                   2 - No GHO record currently exists, record did exist
                       but was deleted.
GHO PERIODS        GROUP HEALTH ORGANIZATION PERIODS:
                   A count that indicates the total number of GHO
                   periods for the Beneficiary. Values may range from
                   1 to 9.
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HCFA ACT CODE      ACTION CODE:
                   A code used to relay descriptive information on the
                   EOMB form, concerning payment or denial of payment.
                    An action code may have one message related to the
                   provider and one to the Beneficiary. Action codes
                   are carrier specific.
HCFA ANESTHESIA    ANESTHESIA RELATIVE VALUE UNITS:
                   The number of base units of anesthesia used to
                   compute payment.
HCFA ASSIGNMENT    HCFA ASSIGNMENT INDICATOR:
                   A code that indicates whether or not the provider of
                   service is participating in or accepting assignment
                   for this line item.
                   VALID VALUES:
                   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
HCFA DED           DEDUCTIBLE INDICATOR:
                   A code, assigned by HCFA BPO, that indicates whether
                       or not a procedure is subject to deductible.
                   VALID VALUES:
                   0 - Subject to deductible
                   1 - Not subject to deductible
HCFA DOC IND       DOCUMENT INDICATOR:
                   A code that indicates whether or not there is
                       additional documentation on file for this line
                       item service.
                   VALID VALUES:
                   0 - No additional documentation
                   1 - Additional documentation submitted
                   2 - CMN for non-DME and electronic media claims,
                       prescription, or other documentation submitted
                       which justifies medical necessity
                   3 - Prior authorization obtained and approved
                   4 - Prior authorization requested but not approved
                   5 - CMN, prescription, or other documentation
                       submitted but did not justify medical necessity
                   6 - CMN, prescription, other documentation submitted
                       and approved after prior authorization was
                       rejected
                   7 - Recertification CMN, prescription, or other
                       documentation
HCFA PAY PROCESS   PAYMENT PROCESS INDICATOR:
                   A code that indicates the payment processing method.
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                    VALID VALUES:
                    A - Allowed
                    B - Benefits exhausted
                    C - Non-covered care
                    M - Multiple submitted (i.e. duplicate line item)
                    N - Medical necessity
                    O - Other
                    R - Reprocessed adjustment based on subsequent
                        reprocessing of claim
                    S - Secondary payer
HCFA PAY SCREEN     PAYMENT RATE METHOD INDICATOR:
                    A code that indicates the type of payment rate
                    method that was used to determine the allowable
                    charge for the line item procedure code.
                    VALID VALUES:
                    1 - Actual charge
                    2 - Customary charge
                    3 - Prevailing charge (adjusted, unadjusted, gap
                        fill, lowest charge level, etc.)
                    4 - Other (including ASC facility fees, radiology
                        and Outpatient limits and non-payment because
                        of denial)
                    5 - Lab/Fee schedule
                    6 - Physician fee schedule - full fee schedule
                        amount
                    7 - Physician fee schedule - transition amount
                    8 - Clinical psychologist - fee schedule
                    9 - Durable Medical Equipment (DME and
                        Prosthetic/Orthotics fee schedule
HCFA REIMB          REIMBURSEMENT INDICATOR:
                    A code, assigned by HCFA BPO, that indicates the
                        percentage used for reimbursement.
                    VALID VALUES:
                    0 - 80% of allowable charges
                    1 - 100% of allowable charges
                    3 - 100% of limitation of liability only
HCFA TYPE SERVICE   HCFA SERVICE TYPE:
                    A code, assigned by HCFA BPO, that indicates the
                        type of service.
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                   VALID VALUES:
                   1 - Medical Care
                   2 - Surgery
                   3 - Consultation
                   4 - Diagnostic x-ray
                   5 - Diagnostic laboratory
                   6 - Radiation therapy
                   7 - Anesthesia
                   8 - Assistance at surgery
                   9 - Other medical service
                   0 - Whole blood or packed red cells
                   A - Used durable medical equipment
                   B - High risk mammography
                   C - Low risk mammography
                   D – Ambulance
                   F - Ambulatory surgical center (facility usage)
                   G - Immunosuppressive drugs within 12 months
                   H - Hospice services
                   I - Installment purchase of durable medical
                        equipment
                   L - Renal supplier in the home
                   M - Monthly capitation payment (dialysis)
                   N - Kidney donor
                   P - Lump sum purchase of durable medical equipment
                   R - Rental of durable medical equipment
                   T - Psychological therapy
                   U - Occupational therapy
                   V - Pneumococcal vaccine
                   W - Physical therapy
                   Y - Second opinion on elective surgery
                   Z - Third opinion on elective surgery
HCPCS              HCFA COMMON PROCEDURE CODING SYSTEM CODE:
                   A code used to indicate the type of medical
                   procedure performed by the provider of service.
                   HCPCS are based on the American Medical
                   Association's Current Procedural Terminology list;
                   as well as alphanumeric codes for physician and non-
                   physician services not included in the CPT list, and
                   codes for services needed by individual contractors
                   or state agencies to process Medicare claims. Refer
                   to the Intermediary Manual S3600 Addendum F.

                   HCPCS codes that are displayed on the HIMR CMNA and
                   CMND screens for parenteral/enteral nutrition and
                   Epoetin prescriptions will consist of mnemonic codes
                   that describe a group of interchangeable HCPCS.
                   Refer to the MNEMONIC HCPCS CODE table of codes.
HCPCS CODE         A code that indicates which HCPCS code on the line
                   item (PART B) or revenue code (OUTPATIENT) is
                   responsible for the creation of this cancer response
                   segment record.
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HCPCS YR           HCFA COMMON PROCEDURE CODING SYSTEM YEAR:
                   The terminal digit of the HCPCS version used to
                   determine the procedure codes on this claim. Values
                   may range from 0 - 9.
HCPCS/NDC          National Drug Claims code
HH                 HOME HEALTH CLAIM INDICATOR:
                   A code that specifies a Home Health claim
                   VALID VALUES:
                   SPACE - Not applicable
                   Y - Home Health claim
HH VISIT           OUTPATIENT HOME HEALTH VISITS:
                   The number of Outpatient Home Health visits that are
                   submitted on this claim.
HIC                HEALTH INSURANCE CLAIM NUMBER:
                   This number uniquely identifies each Medicare
                   Beneficiary. This number is composed of a Social
                   Security number and a specified prefix or suffix
                   depending on the Beneficiary's program. The Social
                   Security Administration program uses a suffix and
                   the Railroad Retirement Board program uses a prefix.
                    Refer to Intermediary Manual 3203.

                   The HIC may be entered in its internal format as
                   well, the internal format is the prefixed or
                   suffixed Social Security number or Railroad
                   Retirement number converted to an internal format
                   used in the software at HCFA BDMS and CWF.
HICR               LAST CORRECTION1DATE:
                   The date on which the CWF Beneficiary files were
                   updated on -line through HCFA Central Offices, using
                   the HICR facility. This date is in month, day year
                   format (MM/DD/YY). This field is for future use.
HOSC               HOSPICE TRAILER COUNTER:
                   The number of records containing posted Hospice
                   claims data that were added to CWF history databases
                   for the Beneficiary.
HOSP IND           HOSPICE AUXILIARY INDICATOR:
                   A code that identifies the existence of Auxiliary
                   Hospice Master records. This code is used to
                   indicate whether or not a Beneficiary has ever
                   elected to receive. Hospice care.
                   VALID VALUES:
                   0-No Hospice records exist
                   1-Hospice records exist
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HOSP PER           HOSPICE PERIOD:
                   The chronological number (1 through 4) of the
                   Hospice period elected by the Beneficiary.
                   Terminally ill Beneficiaries may elect Hospice
                   coverage in lieu of the benefits normally provided
                   under Medicare Part A. Up to four Hospice elections
                   are possible (2 periods of 90 days each, one 30-day
                   period, and a 4th period, which is an extension
                   period of indefinite duration).

                   A Hospice is a public or private organization that
                   is primarily engaged in providing pain relief,
                   symptom management and supportive services to
                   terminally ill patients.
HOSP STR DTE       HOSPICE START1DATE:
                   The start date of a Beneficiary's elected period of
                   Hospice coverage. The date is displayed in
                   Gregorian format (MM/DD/YY).
HOSPICE            HOSPICE INDICATOR:
                   A code that indicates either the Beneficiary has not
                   elected Hospice benefits, or Hospice benefits are
                   involved and are not applicable to this claim.
                   VALID Values:
                   0 - No investigation
                   1 - Hospice investigation shows not applicable to
                        this claim
HOST ID            BENEFICIARY HOST IDENTIFICATION CODE:
                   The identification code used to designate each CWF
                   Host.
                   VALID VALUES:
                   B - Mid-Atlantic Host
                   C - Southwest Host
                   D - Northeast Host
                   F - Great Western Host
                   G - Keystone Host
                   H - Southeast Host
                   I - South Host
                   J - Pacific Host
HOST SITE          HOST INDICATOR:
                   A single alphabetic character indicating the
                   location of the Beneficiary data.
                   VALID VALUES:
                   B - Mid-Atlantic
                   C - Southwest
                   D - Northeast
                   F - Great Western
                   G - Keystone
                   H - Southeast
                   I - South
                   J - Pacific
ICN                FISCAL INTERMEDIARY/CARRIER CLAIM CONTROL NUMBER:
                   A unique control number assigned to a claim by an
                   intermediary or a carrier.
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IDE NUM             Number given to devices that are still in the
                    preliminary stage of approval by FDA.
IMP                 CMN ENTERAL NUTRITION IMPAIRMENT INDICATOR:
                    A code that indicates the impairment that has
                    created the need to provide a higher category
                    nutrition formula for the patient.
                    VALID VALUES:
                    1 - Intolerance to nutritionally equivalent product
                    2 - Severe allergic reaction
                    3 - Change to a blenderized nutrient to alleviate
                    adverse symptoms
IMPLANT FAC         CMN IMMUNOSUPPRESSIVE FACILITY NAME:
                    The name of the hospital, transplant center, or ESRD
                    backup facility where the transplant surgery was
                    performed.

                    The HIMR display screens use the prompt "IMPLANT
                    FAC" to denote the facility name, city and state
                    address.
IND 3               PART B INDICATOR 3:
                    A code indicating that the claim is a Part B claim
                    transaction.
                    VALID VALUES:
                    0-Part B
IND 4               PART B INDICATOR 4:
                    A defined space that is reserved for future use on
                    the Part B History file.
IND 5               PART B INDICATOR 5:
                    A Defined space that is reserved for future use on
                    the Part B History file.
INIT CERT DT        CERTIFICATE OF MEDICAL NECESSITY INITIAL
                    CERTIFICATION1DATE:
                    The date of initial certification for the
                    Beneficiary's use of DMEPOS. The date is displayed
                    in Gregorian format (MMDDYY).
INP DED             INPATIENT CASH DEDUCTIBLE AMOUNT:
                    The total amount of allowable claim charges that
                    were applied toward the deductible for this claim.
INP DED REMAINING   BENEFICIARY REMAINING INPATIENT CASH DEDUCTIBLE
                    AMOUNT:
                    The amount of the Beneficiary's Inpatient hospital
                    deductible remaining to be met for the benefit
                    period. After meeting an Inpatient deductible, a
                    Beneficiary is entitled to renewable Inpatient
                    hospital coverage of up to 90 days for each benefit
                    period. The calendar year in which the benefit
                    period began determines the amount of deductible to
                    be collected from the Beneficiary.
INPA                INPATIENT TRAILER COUNTER:
                    The number of records that contain Inpatient posted
                    claim data that were added to CWF history databases
                    for the Beneficiary.
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INPA INDEX         INPATIENT CLAIM HISTORY TRAILER COUNTER:
                   The number of records that contain Inpatient posted
                   claim data that were added to CWF Paid Claim History
                   databases for the Beneficiary.
INQUIRY TYPE       INQUIRY TYPE:
                   An identifier used in the HIMR inquiry system for
                   each screen type.
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                   VALID VALUES:
                   ARCI - Display & Update Archived Claim Pointers –
                          Inpatient
                   ARCO - Display & Update Archived Claim Pointers –
                          Outpatient
                   ARCH - Display & Update Archived Claim Pointers –
                          Hospice
                   ARCB - Display & Update Archived Claim Pointers –
                          Part B
                   BENA - Beneficiary Master Part A
                   BENB - Beneficiary Master Part B
                   CLIA - Clinical Laboratory Improvement Amendment
                   CLIC - Clinical Laboratory Improvement Amendment
                          Certifications
                   CLIH - Clinical Laboratory Improvement Amendment PT
                          HCPCS
                   CLIS - Clinical Laboratory Improvement Amendment
                          Specialty Codes
                   CLIU - Clinical Laboratory Improvement Amendment
                          UPINs
                   CMNA - Certificate of Medical Necessity Summary
                   CMND - Certificate of Medical Necessity Detail
                   CNCR - Cancer Screening Data
                   DMEC - DMEPOS Summary Records
                   DMEH - DMEPOS Claim History
                   DMEL - DMEPOS Claim List
                   ESRD - End Stage Renal Disease
                   GHOD - Group Health Organization
                   GPRO - GHO Pro Rated Data
                   HIMR - HIMR Main Menu
                   HOSC - Hospice Summary Records
                   HOSH - Hospice Claim History
                   HOSL - Hospice Claim List
                   HOSP - Hospice Master Record Display
                   INPA - INP/SNF Summary Records
                   INPH - INP/SNF Claim History
                   INPL - INP/SNF Claim List
                   MSPA - MSP Summary Display
                   MSPD - MSP Detail Display
                   OUTH - OUTP/HHA Claim History
                   OUTL - OUTP/HHA Claim List
                   OUTP - OUTP/HHA Summary Records
                   PCHD - Paid Claim History Detail
                   PCHL - Paid Claim History List
                   PTBC - Part B Summary Records
                   PTBH - Part B Claim History
                   PTBL - Part B Claim List
                   SURG - Surgery Record Display
                   TNIF - TNIF Record Display
                   XREF - Beneficiary Cross-Reference
INSR INFO          MEDICARE AS SECONDARY PAYER INSURERS ADDRESS:
ADDRESS1           The address of the Beneficiary's primary insuring
                   organization.
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INSR INFO          MEDICARE AS SECONDARY PAYER PRIMARY INSURERS ADDRESS
ADDRESS2           - 2:
                   The second address line of the Beneficiary's primary
                   insurer
INSR INFO CITY     MEDICARE AS SECONDARY PAYER INSURERS CITY:
                   The city address of the Beneficiary's primary
                   insuring organization
INSR INFO          GROUP NAME MEDICARE AS SECONDARY PAYER INSURERS
                   GROUP NAME:
                   The name of the group or plan through which the
                   Beneficiary's primary insurance is provided.
INSR INFO GROUP    MEDICARE AS SECONDARY PAYER INSURERS GROUP NUMBER:
NUM                The identification number, control number, or code
                   assigned by the primary insurer to identify the
                   group under which the Beneficiary is covered.
INSR INFO NAME     MEDICARE AS SECONDARY PAYER INSURERS NAME:
                   The name of the primary insuring organization
                   responsible for payment of the medical claim.
INSR INFO STATE    MEDICARE AS SECONDARY PAYER INSURERS STATE:
                   The United States Postal Service state address
                   abbreviation of the Beneficiary's primary insuring
                   organization. Refer to the State Code table of
                   codes.
INSR INFO TYPE     MEDICARE AS SECONDARY PAYER INSURER TYPE:
                   A code that indicates the source of the
                   Beneficiary's primary insurance
                   VALID VALUES:
                   A - Insurance or indemnity
                   B - HMO
                   C - Preferred provider organization
                   D - Third party administrator arrangement under an
                        administrative service only contract without
                        stop loss from any entity
                   E - Third party administrator arrangement with stop
                        loss insurance issued from any entity
                   F - Self-insured/self-administered
                   G - Collectively-bargained health and welfare
                   H - Multiple employer health plan with at least one
                        employer who has more than 100 full and/or
                        part-time employees
                   I - Multiple employer health plan with at least one
                        employer who has more than 20 full and/or part-
                        time employees
                   J - Hospitalization only plan which covers only
                        Inpatient services
                   K - Medicare services only plan which covers only
                        non-inpatient services
                   M - Medicare supplemental plan: Medigap, Medicare
                        Wraparound Plan or Medicare Carve Out Plan
INSR INFO ZIP      MEDICARE AS SECONDARY PAYER INSURERS ZIP CODE:
CODE               The zip code address of the Beneficiary's primary
                   insuring organization
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INTER              INTERMEDIARY NUMBER:
                   A code assigned by HCFA BPO which identifies the
                   specific intermediary that submitted the claim.
ITEMS              PART B NUMBER OF ITEMS:
                   The number of PART B items processed for the line
                   item on the claim.
KRON               INPATIENT KRON INDICATOR:
                   A code that indicates the hospital bill for this
                   claim starts a new spell of illness (benefit
                   period), regardless of the contents of the
                   Beneficiary's utilization data.
                   VALID VALUE:
                   0 - Does not apply
                   1 - New spell of illness regardless of the HCFA BDMS
                        utilization record
                   K - Claim established a new spell of illness
                   L - There are no other spells of illness on file,
                        KRON indicator was not required
                   M - Claim is not within 60 days of any spell of
                        illness, KRON indicator was not required
L/OL               LAST ON-LINE ACTIVITY1DATE:
                   The system date on which the Beneficiary last had
                   claim activity. This date is displayed in Gregorian
                   format (MM/DD/YY).
LATEST BILLING     BENEFICIARY DATE OF LATEST BILLING ACTION:
                   A date that indicates the latest billing action
                   associated with a benefit period. This date
                   represents the latest claim thru date on processed
                   claims within a spell of illness. The date is
                   displayed in Gregorian format (MM/DD/YY).
LFE                INPATIENT TOTAL LIFETIME RESERVE DAYS USED:
                   The number of lifetime reserve days used by the
                   Beneficiary on this claim. Reserve days are extra
                   days of care that may be used once all days of care
                   in a benefit period are exhausted. Each Beneficiary
                   has a lifetime reserve of 60 additional days of
                   Inpatient hospital services after using 90 days
                   during a spell of illness.
LFE 2              INPATIENT SECOND YEAR LIFETIME RESERVE DAYS:
                   The lifetime reserve days that fall in the second
                   year, when a claim spans two or more calendar years.
                    Refer to the definition for INPATIENT TOTAL
                   LIFETIME RESERVE DAYS USED.
LIFE PROC          CLAIM HISTORY VALIDATION INPATIENT CLAIM INDICATOR2:
                   A code that indicates the surgery listed on this
                   claim was a once in a lifetime surgical procedure
                   (e.g. appendix removal).
                   VALID VALUES:
                   SPACE - Does not apply
                   E - Once in a lifetime surgical procedure
LINE_OF_           PART B LINE NUMBER SELECTION:
                   The line item number selected from the total number
                   of up to 13 procedures within one claim.
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LITERAL FOR ID      LITERAL FOR HOST IDENTIFICATION:
                    The corresponding sector name for the abbreviated
                    identification. Refer to the definition for
                    BENEFICIARY HOST IDENTIFICATION CODE.
LITERAL/DISPOSITI   LITERAL FOR DISPOSITION:
ON                  The corresponding literal for the indicated
                    disposition code. Refer to the definition for
                    DISPOSITION OF THE TRANSFER NOT-IN-FILE RECORD
LPSY                BENEFICIARY LIFETIME PSYCHIATRIC DAYS REMAINING:
                    The remaining lifetime Inpatient psychiatric
                    hospital days available for the Beneficiary's use.
                    There is a maximum of 190 lifetime psychiatric days
                    available to a Beneficiary.
LRSV                BENEFICIARY LIFETIME RESERVE DAYS REMAINING:
                    The number of a Beneficiary's remaining lifetime
                    reserve days. There is a maximum of 60 days. These
                    reserve days may not be used until full and
                    coinsurance days have been exhausted for a benefit
                    period. Each of the reserve days is subject to a
                    coinsurance rate.
LST SEEN            CERTIFICATE OF MEDICAL NECESSITY LAST SEEN1DATE:
                    The date that the patient was last seen for the
                    diagnosis indicated on the CMN. The date is
                    displayed in Gregorian format (MMDDYY).
MAINT DATE          CERTIFICATE OF MEDICAL NECESSITY SCHEDULED
                    MAINTENANCE1DATE:
                    The date after which scheduled maintenance and
                    repairs for the DMEPOS item will be covered by
                    Medicare. The date is displayed in Gregorian format
                    (MMDDYY).
MAMM PROF           BENEFICIARY MAMMOGRAPHY PROFESSIONAL COMPONENT1DATE:
                    A date that indicates professional claims were
                    presented for x-rays used for mammography screening.
                     This date is set based on the type of bill, revenue
                    codes and HCPCS codes present on a claim. The date
                    is displayed in month and year format (MMYY).
MAMM RISK           BENEFICIARY MAMMOGRAPHY RISK INDICATOR:
                    A code that indicates whether or not a Beneficiary
                    is in a high risk category for mammography
                    screening. This code is set based on the type of
                    service and diagnosis codes present on a claim.
                    VALID VALUES:
                    0 – Low Risk
                    1 - High risk
MAMM TECH           BENEFICIARY MAMMOGRAPHY TECHNICAL COMPONENT1DATE:
                    A date that indicates technician claims were
                    presented for x-rays used for mammography screening.
                     This date is set based on the type of bill, revenue
                    codes and HCPCS codes present on a claim. The date
                    is displayed in month and year format (MMYY).
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MED EXP            OUTPATIENT CLAIM MEDICAL EXPENSES:
                   The total amount of charges, excluding all charges
                   for psychiatric services and professional component,
                   for this Outpatient claim.
MED REC NUM        MEDICAL RECORD NUMBER:
                   A patient's unique alphanumeric code assigned by the
                   provider to facilitate the retrieval of individual
                   case records and the posting of the payment.
MEDICAID INFO      MEDICAID INFORMATION:
                   Medicaid information codes provided by the satellite
                   to Medicaid.
                   VALID VALUES:
                   164 - Number of attachments submitted
                   166 - Abortion/sterilization code
                   167 - Child Health Assurance Program Referral Code
                   168 - Civilian Health and Medical Program of the
                        Uniformed Services Code
MEDICAID NUM       MEDICAID PROVIDER NUMBER:
                   The number assigned to the provider of services by
                   Medicaid
                   MEDICARE STATUS CODE:
                   A code calculated by CWF during utilization
                   processing that indicates the Beneficiary's
                   eligibility for Medicare coverage.
                   VALID VALUES:
                   10 - Aged
                   11 - Aged with ESRD
                   20 - Disabled
                   21 - Disabled with ESRD
                   31 - ESRD only
MESSAGE            HIMR INQUIRY SYSTEM MESSAGE LINE:
                   A statement, displayed on line 23, to indicate an
                   error, system or user instruction messages.
METH               CMN PARENTERAL/ENTERAL NUTRITION METHOD:
                   A code that indicates the method of delivery of
                   nutrient therapy to the patient.
                   VALID VALUES:
                   1 - Syringe
                   2 - Gravity
                   3 - Pump
METHOD             END STAGE RENAL DISEASE METHOD CODE:
                   A code that describes the method of payment for home
                   dialysis patients.
                   VALID VALUES:
                   1 - The dialysis facility with which the Beneficiary
                        is associated assumes the responsibility for
                        providing all home dialysis equipment and
                        supplies
                   2 - The Beneficiary deals directly with a supplier
                        for home dialysis equipment and supplies
MICRO              MICROFILM INDICATOR:
                   The carrier's microfilm number for front-end filming
                   or back-end filming.
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MN                 CERTIFICATE OF MEDICAL NECESSITY MEDICAL NECESSITY
                   LENGTH:
                   The number of months that have been certified by a
                   physician as medically necessary for the use of
                   DMEPOS. A value of 99 indicates the item has been
                   determined to be necessary for the patient's
                   lifetime.
MNT DTE            MAINTENANCE1DATE:
                   The most recent date of maintenance by CWF,
                   displayed in Gregorian format (MM/DD/YY).
MOD                PROCEDURE CODE MODIFIER:
                   A modifier used when the HCPCS procedure code
                   requires further clarification (e.g., the service
                   was performed by an assistant surgeon).
MORE               END STAGE RENAL DISEASE MORE HISTORY INDICATOR:
                   A code that indicates whether or not the previous
                   claim for emergency supplies is the first ESRD
                   claim.
                   VALID VALUES
                   SPACE - There are no other emergency claims
                   Y - There are other emergency claims
                   MOST RECENT DATES OF Cancer screening dates of
                   service, can be either "Technical" or "Professional"
                   dates.
MSP                MEDICARE AS SECONDARY PAYER CODE:
                   A code that identifies the type of coverage (a
                   Federal or non-Medicare program) that has primary
                   responsibility over Medicare for the payment of the
                   Beneficiary's medical claims.
                   VALID VALUES:
                   A - Working Aged
                   B - ESRD
                   D - Auto/Liability
                   E - Worker's Compensation
                   F - Federal
                   G - Working Disabled
                   H - Black Lung
                   I - Veteran's Affairs
                   L - Liability
MSP AMT            MEDICARE AS SECONDARY PAYER AMOUNT:
                   The amount paid by the primary payer for services
                   billed on this claim.
MSP APPLIED        MEDICARE AS SECONDARY PAYER APPLIED AMOUNTS:
                   The amount paid by the primary payer for this line
                   item service.
MSP FLAG           MEDICARE AS SECONDARY PAYER FLAG:
                   A code that identifies the type of primary payer for
                   services billed on this claim.
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                   VALID VALUES:
                   A - Working aged Beneficiary/spouse with employer
                        group health plan
                   B - ESRD Beneficiary in 12 month period with
                        employer group health plan
                   C - Any conditional Medicare payment situation
                   D - Automobile no fault or any liability insurance
                   E - Worker's Compensation including Black Lung
                   F - Veteran's Affairs, Public Health Service, or
                        other Federal agency
                   G - Working Disabled
                   H - Black Lung
                   I - Veteran's Affairs
                   L - Liability
                   M - Override Code Employee Group Health Plan service
                        involved
                   N - Override Code non-Employee Group Health Plan
                        service involved
                   X - Override Code MSP Cost Avoided
                   Y - Other secondary payer investigation shows
                        Medicare primary
                   Z - Medicare is primary payer
MSP IND            MEDICARE AS SECONDARY PAYER AUXILIARY INDICATOR:
                   A code that indicates the existence of Medicare as
                   Secondary Payer (MSP) auxiliary records. This code
                   depicts MSP involvement or no involvement.
                   VALID VALUES:
                   0 - No MSP records exist
                   1 - MSP records exist
                   2 - History archive first claim development assumed
                        processed
                   3 - First claim development processed
                   4 - First claim development has been bypassed.
MTU                TOTAL MILEAGE AND TIME UNITS:
                   The total units associated with services needing
                   unit reporting such as miles, anesthesia time units,
                   number of services, volume of oxygen or blood units.
MTU IND            TOTAL MILEAGE AND TIME UNITS INDICATOR:
                   A code that indicates whether miles, units, or
                   zeroes are stored or displayed in TOTAL MILEAGE AND
                   TIME UNITS.
                   VALID VALUES:
                   0 - Values reported as zero
                   1 - Transported miles
                   2 - Anesthesia time unit
                   3 - Number of services
                   4 - Oxygen volume units
                   5 - Blood units
NAME               BENEFICIARY FULL NAME:
                   The full name of the Beneficiary stored in last
                   name, first name, initial order; periods are used as
                   separators between each portion of the name.
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NC SPELL DAYS      INPATIENT NON-COVERED SPELL DAYS:
                   Days within a spell of illness that are determined
                   to be not covered by other claim elements such as
                   non-covered spans and dates, or exhaustion of
                   benefits
NCOV CHG           FINANCIAL OR REVENUE NON-COVERED CHARGES:
                   Inpatient charges pertaining to medical services not
                   covered by Medicare. This field is intended for
                   future use on Outpatient and Hospice related files.
NDC                CERTIFICATE OF MEDICAL NECESSITY IMMUNOSUPPRESSIVE
                   DRUG NAME:
                   The National Drug Code for the prescribed medication
                   the Beneficiary is certified to receive.
NO PAY             NON-PAYMENT CODE:
                   A code that indicates the reason why a Medicare
                   payment was not issued.
                   VALID VALUES:
                   B - Benefits exhausted
                   C - Non-covered care (includes all "bene at fault"
                        waiver cases)
                   E - GHO out-of-plan services not emergency or
                        urgently needed
                   N - Medical necessity and all other reasons for non-
                        payment
                   P - Payment requested
                   R - Benefits refused, or evidence not submitted
                   T – IEQ Contractor MSP Cost Avoid
                   U – HMO Rate Cell Adjustment MSP cost avoid
                   V – Litigation Settlement MSP Cost Avoid
                   X - MSP cost avoided
                   Y - IRS/SSA data match project. MSP cost avoided
NOC DESC           DMEPOS NOT OTHERWISE CLASSIFIED HCPCS CODE
                   DESCRIPTION:
                   The identification of the DMEPOS item for which the
                   NOT Otherwise Classified HCPCS code is used.
NUM-LINES          NUMBER OF LINES:
                   The number of line items on this claim.
                   VALID VALUES:
                   Inpatient claim - 1 thru 28
                   Outpatient claim - 1 thru 28
                   Carrier claim     - 1 thru 13
NXT SCH RC         CMN SCHEDULED RECERTIFICATION1DATE:
                   The date on which additional information must be
                   obtained in order to continue the period of medical
                   necessity. The date is displayed in Gregorian
                   format (MMDDYY).
OCCURS CODE        OCCURRENCE CODE:
                   A code defining a significant event relating to this
                   claim that may affect processing. Refer to the
                   Intermediary Manual S3871.
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OCCURS DATE        OCCURRENCE1DATE:
                   The date associated with the occurrence code, refer
                   to the definition for OCCURRENCE CODE. The date is
                   displayed in Gregorian format (MM/DD/YY).
OP                 OUTPATIENT CLAIM INDICATOR:
                   A code that specifies an Outpatient claim.
                   VALID VALUES:
                   SPACE - Not applicable
                   Y - Outpatient claim
OPR PHYS           INPATIENT OPERATING PHYSICIAN NUMBER:
                   The state license number of the physician who
                   performed the principal procedure. This number is
                   used by the provider to identify the operating
                   physician who performed the surgical procedure.
OPT                GROUP HEALTH ORGANIZATION OPTION CODE:
                   A code that describes the Beneficiary's relationship
                   with the GHO, and who is responsible for processing
                   the Beneficiary's claim. Refer to the Intermediary
                   Manual S3555.1
                   VALID VALUES:
                   Beneficiary is not restricted to a GHO:
                        1 - Intermediary to process all Part A and B
                   claims
                        2 - GHO to process claims for directly provided
                           services and for services from providers
                           with effective arrangements; the
                           intermediary will process all other claims
                   Beneficiary is restricted to a GHO:
                        A - Intermediary to process all Part A and B
                           provider claims
                        B - GHO to process claims only for directly
                           provided services
                        C - GHO to process all claims
OPTION YR          END STAGE RENAL DISEASE OPTION YEAR:
                   The year, displayed in YY format or ## for the
                   default, the End Stage Renal Disease Beneficiary's
                   selection of the method for purchasing home dialysis
                   equipment/supplies is effective. ESRD beneficiaries
                   who dialyze at home elect whether to purchase
                   supplies through the dialysis facility or to deal
                   directly with the supplier. The Beneficiary can
                   change the method selection at any time during the
                   option year, but the change will not be effective
                   until the first day of the next calendar year method
                   selection at any time during the option year, but
                   the change will not be effective until the first day
                   of the next calendar year.
ORD NAME           CERTIFICATE OF MEDICAL NECESSITY PHYSICIAN NAME:
                   The first 13 characters of the prescribing
                   physician's surname. The HIMR display screens use
                   the prompt "ORD NAME" to denote the physicians
                   surname and first initial of the physician's first
                   name.
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ORD UPIN           CERTIFICATE OF MEDICAL NECESSITY PHYSICIAN UPIN:
                   The UPIN of the physician who prescribed the DMEPOS
                   item. Refer to the definition for UNIQUE PHYSICIAN
                   IDENTIFICATION NUMBER.
ORIG CONTRACTOR    ORIGINATING CONTRACTOR:
                   The identification number of the satellite who
                   established the auxiliary information record.
ORIG ICN           ORIGINAL INTERMEDIARY CONTROL NUMBER:
                   The original intermediary control number used as a
                   reference for debit adjustment claims. Refer to the
                   definition for FISCAL INTERMEDIARY/CARRIER CLAIM
                   CONTROL NUMBER
ORIGINAL TNIF      ORIGINAL TRANSFER NOT-IN-FILE1DATE:
DATE               The date that the host received a response to a
                   transfer request from HCFA BDMS to locate the
                   Beneficiary data. The date is displayed in
                   Gregorian format (MM/DD/YY).
OTH PHYS           OTHER PHYSICIAN IDENTIFIER CODE:
                   The name and/or number of the licensed physician
                   other than the attending physician as defined by the
                   payer organization.
OTHER AMT          END STAGE RENAL DISEASE OTHER PAYMENT AMOUNT:
                   The monthly payment amount for the designated month
                   for all dialysis services excluding CCPD.
OTHER AMTS         OTHER AMOUNTS APPLIED:
APPLIED            Up to five amounts that were used to adjust the
                   amount payable when processing the line item. Refer
                   to the definition for OTHER AMOUNTS INDICATOR.
OTHER AMTS IND     OTHER AMOUNTS INDICATOR:
                   Up to five, one character codes that indicate the
                   reason for the presence of a corresponding OTHER
                   AMOUNTS APPLIED.
                   VALID VALUES:
                   A - Gramm-Rudman reduction (Refer to Section 3600.6
                        of the Intermediary manual for applicable dates
                        and percentages)
                   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
                   N - None
OUTP               OUTPATIENT TRAILER COUNTER:
                   The number of records that contain posted Outpatient
                   and/or Home Health claim data that were added to CWF
                   History databases for the Beneficiary.
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OUTP/HOSC INDEX    OUTPATIENT CLAIM HISTORY TRAILER COUNTER:
                   The number of records that contain posted Outpatient
                   and/or Home Health claim data that were added to CWF
                   Paid Claim History databases for the Beneficiary.
OVERRIDE CODE      END STAGE RENAL DISEASE OVERRIDE CODE:
                   A code that indicates the type of CWF maintenance
                   transaction.
                   VALID VALUES:
                   SPACE - No correction to a particular
                   iteration/field or fields
                   1 - A correction to a particular field or fields on
                        the most current iteration
                   2 - A correction to a particular field or fields on
                        the first previous iteration
                   3 - A correction to a particular field or fields on
                        the second previous iteration
                   4 - A deletion of a specific ESRD Method Selection
                        iteration based on the selection date field
OVR CD             FINANCIAL OR REVENUE OVERRIDE CODE:
                   A code that indicates special handling for a
                   specific revenue center code. Refer to the
                   definition for REVENUE CENTER CODE.
                   VALID VALUE:
                   0 - Both deductible and coinsurance apply
                   1 - Deductible does not apply
                   2 - Coinsurance does not apply
                   3 - Neither deductible nor coinsurance apply
                   4 - No need for charges (used multiple HCPCS for
                        single revenue center code)
                   5 - Psych override
                   M – Override code EGHP
                   N – Override code non-EGHP
OXA                CERTIFICATE OF MEDICAL NECESSITY OXIMETRY TEST
                   ADMINISTRATOR:
                   A code assigned to the entity that performed the
                   oximetry test.
OXC                CERTIFICATE OF MEDICAL NECESSITY OXIMETRY TEST
                   CONDITION:
                   A code that indicates the conditions under which the
                   oximetry test was performed
                   VALID VALUES:
                   1 - At Rest
                   2 - During Exercise
                   3 - During sleep
OXDT               CERTIFICATE OF MEDICAL NECESSITY OXIMETRY1DATE:
                   The date that the most recent oximetry test,(a test
                   measuring the oxygen saturation level of the blood
                   by an oximeter), was performed on the Beneficiary.
                   The date is displayed in Gregorian format. (MMDDYY).
PAGE_OF_           PAGE NUMBER OF TOTAL PAGES:
                   Displays the number of the displayed page and the
                   total number of pages of data for the inquiry as
                   Page N of N.
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PAID IND.          GROUP HEALTH ORGANIZATION PAID INDICATOR:
                   A code that indicates whether or not the payment for
                   this claim was paid by a GHO.
                   VALID VALUES:
                   1-Payment made by GHO
PAP RISK           BENEFICIARY PART B PAP TEST RISK INDICATOR:
                   A code that indicates whether or not a PA smear
                   (Papanicolaou test) used to test for cervical
                   cancer, should be taken every 5 years (normal) or
                   more frequently (high risk).
                   VALID VALUES:
                   N-Normal risk
                   H-High risk
PART A REM DED     BENEFICIARY REMAINING PART A BLOOD DEDUCTIBLE PINTS:
                   The number of remaining blood deductible pints that
                   can be used for Part A benefits. Beginning in 1989,
                   a Beneficiary is responsible for payment of a
                   deductible equal to the expenses incurred, or the
                   replacement of the first three pints of whole blood
                   (or units of packed red cells) furnished during the
                   calendar year. This deductible can be reduced to
                   the extent that the blood deductible under Part B is
                   satisfied.
PART A REM YR      BENEFICIARY REMAINING PART A BLOOD DEDUCTIBLE YEAR:
                   The year associated with the calculation for
                   remaining Part A blood deductible pints. The year
                   is displayed as YY or '##' as the default.
PART B DED         BENEFICIARY PART B DEDUCTIBLE MET:
                   Part B years prior to 1989 will reflect Part B total
                   medical charges incurred by the Beneficiary for the
                   year indicated. Effective 1989 and after, this
                   field will reflect total deductible applied amounts.
PART B HHVIS       BENEFICIARY PART B HOME HEALTH VISITS:
                   The number of Part B Home Health visits incurred for
                   the year indicated.
PART B OTHPY       BENEFICIARY PART B OCCUPATIONAL THERAPY LIMITATION
AMOUNT             AMOUNT:
                   The Part B occupational therapy limitation amount
                   met by the beneficiary for a specific benefit year.
PART B PTHPY       BENEFICIARY PART B PHYSICAL THERAPY EXPENSE:
AMOUNT             The Part B physical therapy limitation amount met by
                   the Beneficiary for a specific benefit year.
PART B YR          BENEFICIARY PART B YEAR:
                   The calendar year to which the Part B utilization
                   data applies.
PASS PER DIEM      INPATIENT PASS THRU PER DIEM RATE:
                   The pass through per diem rate consists of the
                   established reimbursable costs for the current year
                   divided by the estimated Medicare days for the
                   current year (all Prospective Payment System
                   claims). Refer to the Provider Reimbursement Manual
                   S2405.2.
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PAT CNTL           PATIENT CONTROL NUMBER:
                   The patient's unique number assigned by the provider
                   to facilitate the retrieval of individual case
                   records and the posting of payments.
PAT PAID BLD DED   PATIENT PAID TO BLOOD DEDUCTIBLE:
                   The amount of payment the patient made toward the
                   total blood deductible charge for this claim.
PAT PD EXCL BLD    DEDUCTIBLE PATIENT PAID EXCLUDING BLOOD:
                   The amount of payment the patient made toward the
                   total charges for this claim, excluding any charges
                   for blood transfusions.
PAT REL            PATIENT RELATIONSHIP CODE:
                   A code that indicates the relation to the patient to
                   the insured.
                   VALID VALUES:
                   1 - Self
                   2 - Spouse
                   3 - Child
                   4 - Other
PAT STAT           PATIENT STATUS CODE:
                   A code that indicates the patient's status as fo the
                   statement covers thru date.
                   VALID VALUES:
                   01 - Discharged to home or self care (routine
                        discharge)
                   02 - Discharged/transferred to another short-term
                        general hospital
                   03 - Discharged/transferred to a SNF
                   04 - Discharged/transferred to an intermediate care
                        facility
                   05 - Discharged/transferred to another type of
                        institution
                   06 - Discharged/transferred to home under the care
                        of an organized Home Health service
                        organization
                   07 - Left against medical advice
                   08 - Outpatient
                   20 - Expired (or did not recover - Christian Science
                        patient)
                   30 - Still patient
                   40 - Expired at home - Hospice beneficiary
                   41 - Expired in a hospital, SNF, or intermediate
                        care facility - Hospice Beneficiary
                   42 - Expired - place unknown - Hospice Beneficiary
PATIENT REL        MEDICARE AS SECONDARY PAYER PATIENT RELATIONSHIP:
                   A code that indicates the relationship of the
                   patient to the insured
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                   VALID VALUES:
                   00 - Default
                   01 - Patient is insured
                   02 - Spouse
                   03 - Natural child/insured has financial
                        responsibility
                   04 - Natural child/insured does not have financial
                        responsibility
                   05 - Stepchild
                   06 - Foster child
                   07 - Ward of the court
                   08 - Employee
                   09 - Unknown
                   10 - Handicapped dependent
                   11 - Organ donor
                   12 - Cadaver donor
                   13 - Grandchild
                   14 - Niece/nephew
                   15 - Injured plaintiff
                   16 - Sponsored dependent
                   17 - Minor dependent of a minor dependent
                   18 - Parent
                   19 - Grandparent
PAY DENIAL DTE     PAYMENT OR DENIAL1DATE:
                   The anticipated date that the claim will be paid or
                   denied. The date is displayed in Gregorian format.
                   (MM/DD/YY).
PAY DENIAL IND     PAYMENT/DENIAL INDICATOR:
                   A code that indicates to whom the payment was made
                   or if the claim was denied.
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                   VALID 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 (i.e. employer, union)
                   8 - Federally funded entities
                   9 – PA services
                   A - Beneficiary under limitation of liability
                   B - Physician/supplier under limitation of liability
                   D - PCOE or CABG demonstration
                   E – Cost avoid for IRS/SSA/HCFA data match
                   F – Cost avoid for HMO rate cell
                   G – Cost avoid for Litigation Settlement
                   H – Cost avoid for Employer Voluntary Reporting
                   J – Cost avoid for Insurer Voluntary Reporting
                   K – Cost avoid for Initial Enrollment Questionnaire
                   N – Non-covered
                   Q – AT&T Contractor MSP cost avoided
                   S – Secondary Payer
                   T – IEQ Contractor MSP cost avoided
                   U – HMO Rate Cell adjustment MSP cost avoid
                   V – Litigation Settlement MSP cost avoid
                   X - MSP cost avoided
                   Y - IRS/SSA data match project MSP cost avoided
PBI                CMN PARENTERAL NUTRITION PB INDICATOR:
                   A code that indicates the ESRD patient's condition
                   has been certified by the attending physician as a
                   permanent functional impairment; therefore,
                   parenteral nutrition will be permitted at an ESRD
                   facility for the patient.
                   VALID VALUES
                   Y - Payment for nutrition in an ESRD facility is
                   permitted
                   N - Payment for nutrition in an ESRD facility is not
                   permitted
PCT ALLOWED        PERCENTAGE ALLOWED:
                   A code that indicates the percentage of prevailing
                   charges allowed for services provided by a physician
                   assistant.
                   VALID VALUES:
                   0 - Not applicable
                   1 - 65% for assistance in surgery services
                   2 - 75% for assistance in a hospital (other than
                        surgery services)
                   3 - 85% for assistance in services other than
                        surgery
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PHP DTE            MEDICARE AS SECONDARY PAYER PREPAID HEALTH
                   PLAN1DATE:
                   The date that the Beneficiary was notified that
                   Medicare is the secondary payer for services
                   performed outside the prepaid health plan, when the
                   services could have been performed by a prepaid
                   health plan provider. The date is displayed in
                   Gregorian format. (MM/DD/YYYY).
PHYS SUP NO        PHYSICIAN/SUPPLIER NUMBER INDICATOR:
                   A code that indicates the type of identification
                   number used in the PROVIDER TAX IDENTIFICATION
                   NUMBER.
                   VALID VALUES:
                   0 - Default
                   1 - The provider tax number represents the same
                        physician or supplier regardless of multiple
                        locations
                   2 - The provider tax number represents one of
                        multiple numbers used for the same physician or
                        supplier
PHYS ZIP CODE      PHYSICIAN/SUPPLIER ZIP CODE:
                   The zip code address of the provider of services.
PI-OCE             PAYMENT INDICATOR
                   A field that is 2 bytes numeric for Outpatient,
                   Inpatient, Home Health and Hospice claims.
PL SV              CLAIM HISTORY PLACE OF SERVICE:
                   A code that indicates the place of service on the
                   Carrier Paid Claim History Claim.
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                   VALID VALUES:
                   11 - Office
                   12 - Home
                   21 - Inpatient Hospital
                   22 - Outpatient Hospital
                   23 - Emergency Room - Hospital
                   24 - Ambulatory Surgical Center
                   25 - Birthing Center
                   26 - Military Treatment Facility
                   31 - SNF
                   32 - Nursing Facility
                   33 - Custodial Care Facility
                   34 - Hospice
                   41 - Ambulance - Land
                   42 - Ambulance - Air or Water
                   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
                   61 - CIRF
                   62 - CORF
                   65 - ESRD Treatment Center
                   71 - State or Local Public Health Clinic
                   72 - Rural Health Clinic
                   81 - Independent Laboratory
                   99 - Other Unlisted Facility
PLACE              PLACE OF SERVICE:
                   A code that indicates the place of service.
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                   VALID VALUES:
                   11 - Office
                   12 - Home
                   21 - Inpatient Hospital
                   22 - Outpatient Hospital
                   23 - Emergency Room - Hospital
                   24 - Ambulatory Surgical Center
                   25 - Birthing Center
                   26 - Military Treatment Facility
                   31 - SNF
                   32 - Nursing Facility
                   33 - Custodial Care Facility
                   34 - Hospice
                   41 - Ambulance - Land
                   42 - Ambulance - Air or Water
                   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
                   61 - CIRF
                   62 - CORF
                   65 - ESRD Treatment Center
                   71 - State or Local Public Health Clinic
                   72 - Rural Health Clinic
                   81 - Independent Laboratory
                   99 - Other Unlisted Facility
PLAN               GROUP HEALTH ORGANIZATION PLAN NUMBER:
                   The GHO plan number for the Beneficiary.
                   VALID VALUES:
                   Position1
                   Value 0 or 9 (For plan numbers beginning with "0" an
                        "H" is displayed; otherwise, a "9" is
                        displayed. Most plan numbers begin with "H";
                        however, HCFA BPO has assigned "9" to some plan
                        numbers).
                   Position 2 - 3
                        State Code
                   Position 4 - 5
                   GHO number assigned by the state.
PMT DIST PAT       PAYMENT DISTRIBUTION TO PATIENT:
                   The portion of the total refund amount that was paid
                   to the Beneficiary for this claim.
PMT DIST PROV      PAYMENT DISTRIBUTION TO PROVIDER:
                   The portion of the total payment amount that was
                   paid to the provider of services for this claim.
POCI NUMBER        CLIA PHYSICIAN OWNERSHIP CONTROL IDENTIFIER:
                   The clinical laboratory identification number, or
                   the carrier number combined with the clinical
                   laboratory number. Refer to the definitions for
                   CLINICAL LABORATORY IDENTIFICATION NUMBER and
                   INTERMEDIARY NUMBER
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POLICY NUM         MEDICARE AS SECONDARY PAYER INSURER POLICY NUMBER:
                   The primary insuring organization's policy number
                   for the Medicare Beneficiary.
POSSIBLE CORRECT   POSSIBLE CORRECT HIC NUMBER:
HIC                A Beneficiary HIC number identified by a HCFA BDMS
                   Alpha Search as a possible correction.
PPS CAP/L DRG      PPS DIAGNOSTIC RELATED GROUPING WEIGHT FRACTION:
WEIGHT             A relative measure of the hospital resource
                   consumption for each DRG. DRGs requiring greater use
                   of resources would be assigned higher weights; those
                   requiring fewer resources, lower weights. The DRG
                   Weight Fraction is determined by computing the DRG
                   Weight times the Discharge Fraction.
PPS CAP/L DSCHG    PPS CAPITAL DISCHARGE FRACTION:
FRC                The percentage of a patient's stay in the billing
                   facility. For transfer cases the billed days are
                   divided by the average length of stay, not to exceed
                   1 percent. For all other cases, the discharge
                   fraction is 1.
PPS CAPITAL AMT    PPS CAPITAL HOLD HARMLESS AMOUNT:
HARM               The hold harmless amount payable for old capital as
                   computed by the HCFA BDMS software program pricer.
                   In 1992, hospitals with a hospital specific rate for
                   capital that is above the Federal PPS rate for the
                   cost reporting period that ended in financial year
                   1990, can receive the highest of:
                        - the hold harmless-old capital rate, which is
                           100 percent of the reasonable costs of old
                           capital for sole community hospitals,

                        OR

                        - 85 percent of the reasonable costs associated
                           with old capital for all other hospitals,
                           plus a payment for new capital,

                        OR

                        - the hold harmless capital rate, which is 100
                           percent of the Federal rate.
PPS CAPITAL AMTS   PPS CAPITAL DISPROPORTIONATE HOSPITAL SHARE AMOUNT:
DSH                The Prospective Payment System (PPS) is a payment
                   method that establishes rates for payment before
                   services are rendered and costs are incurred. A
                   hospital may receive additional payments for certain
                   conditions. The disproportionate hospital share is
                   an additional amount based on the DRG payment rate
                   to achieve increased payments to hospitals serving a
                   disproportionate share of low income patients.
PPS CAPITAL AMTS   PPS CAPITAL EXCEPTIONS AMOUNT:
EXC                The additional payment amount made either to urban
                   hospitals with a minimum of 100 beds that have a 30
                   percent disproportionate share of low-income
                   patients or a rural sole community hospital.
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PPS CAPITAL AMTS   PPS CAPITAL FEDERAL SPECIFIC PORTION AMOUNT:
FSP                The federal portion of the PPS payment for capital
                   National and regional amounts are used to calculate
                   the federal portion of the DRG payment rates. The
                   amounts are based on the average historical costs of
                   treating patients in different regions of the
                   nation.

                   Capital related costs include depreciation,
                   interest, leases, rent, property taxes and return on
                   equity capital.
PPS CAPITAL AMTS   PPS CAPITAL HOSPITAL SPECIFIC PORTION AMOUNT:
HSP                The hospital's allowable adjusted base year
                   Inpatient capital costs per discharge.
PPS CAPITAL AMTS   PPS CAPITAL INDIRECT MEDICAL EDUCATION AMOUNT:
IME                The additional payment amount made for the indirect
                   costs of medical education to prospective payment
                   hospitals that have interns and residents in an
                   approved graduate medical education program.
PPS CAPITAL AMTS   PPS CAPITAL OUTLIER AMOUNTS:
OLR                The amount of additional payment, for extra days or
                   charges, intended to cover the cost of services
                   rendered beyond the DRG payment rate of most other
                   patients in a diagnostic related group.
PPS CAPITAL AMTS   PPS CAPITAL TOTAL AMOUNT:
TOT                The total amount payable for capital for this claim.
                    The PPS capital amount total is the sum of the
                   following PPS amounts:
                   Hospital specific portion, Federal specific portion,
                   Outlier disproportionate hospital share, and the
                   Hold harmless amount.
PPV                Pneumococcal Pneumonia Vaccination (PPV):
                   Date the Beneficiary received the PPV
PR SP              CLAIM HISTORY PROVIDER SPECIALTY CODE:
                   A code, assigned by HCFA BPO, to define the
                   specialty of the physician or the supplier of
                   medical service as found on the Carrier Paid Claim
                   History Claim. Refer to the Carrier Manual 13700
                   Exhibit 7.
PRE ENT PSYCH      INPATIENT PRE-ENTITLEMENT PSYCHIATRIC DAYS:
                   The number of days the Beneficiary used in a
                   psychiatric facility during the 150 days immediately
                   prior to Medicare entitlement
PRIOR A ENT        BENEFICIARY PRIOR PART A ENTITLEMENT DATE:
                   A date that indicates the start of prior entitlement
                   to Medicare Part A benefits. This date is used when
                   a Beneficiary terminates involvement in the Medicare
                   program and subsequently re-enrolls. The date is
                   displayed in Gregorian format (MM/DD/YY).
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PRIOR A TRM        BENEFICIARY PRIOR PART A TERMINATION DATE:
                   A date that indicates the termination of prior
                   entitlement to Medicare Part A benefits. This date
                   is used when a Beneficiary terminates involvement in
                   the Medicare program and subsequently re-enrolls.
                   The date is displayed in Gregorian format
                   (MM/DD/YY).
PRIOR B ENT        BENEFICIARY PRIOR PART B ENTITLEMENT DATE:
                   A date that indicates the start of prior entitlement
                   to Medicare Part B benefits. This date is used when
                   a Beneficiary terminates involvement in the Medicare
                   program and subsequently re-enrolls. The date is
                   displayed in Gregorian format (MM/DD/YY).
PRIOR B TRM        BENEFICIARY PRIOR PART B TERMINATION DATE:
                   A date that indicates the termination of prior
                   entitlement to Medicare Part B Benefits. This date
                   is used when a Beneficiary terminates involvement in
                   the Medicare program and subsequently re-enrolls.
                   The date is displayed in Gregorian format
                   (MM/DD/YY).
PRIOR EMERG        PRIOR EMERGENCY SATELLITE CONTROL NUMBER:
                   A unique control number assigned to a claim by a
                   carrier. In this case the control number identifies
                   the prior emergency claim.
PRIOR FROM         INPATIENT PRIOR STAY FROM DATE:
                   The admission date of the patient's prior stay in a
                   health care facility. The date is displayed in
                   Gregorian format (MM/DD/YY).
PRIOR THRU         INPATIENT PRIOR STAY THRU DATE:
                   The discharge date of the patient's prior stay in a
                   health care facility. The date is displayed in
                   Gregorian format (MM/DD/YY).
PRIVACY            PRIVACY FLAG:
                   A code that indicates information on this claim is
                   not allowed outside the carrier site
                   VALID VALUES:
                   SPACE - Data not private
                   N - No data to go forward from carrier site
PRO CONTROL NUM    PEER REVIEW ORGANIZATION CONTROL NUMBER:
                   The unique alphanumeric code assigned to the claim
                   by the Peer Review Organization.
PRO PROCESS DTE    PEER REVIEW ORGANIZATION PROCESS DATE:
                   The date that the Peer Review Organization reviewed
                   this claim. The date is displayed in Gregorian
                   format (MM/DD/YY).
PROC CD            PRINCIPAL PROCEDURE CODE:
                   A code that indicates the principal surgical
                   procedure performed during the period covered by an
                   institutional claim; the procedure that is most
                   closely related to the principal diagnosis. Refer
                   to the ICD-9-CM Manual Volume 3.
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PROC DTE           PROCEDURE DATE:
                   The date that each procedure indicated by the
                   related procedure code was performed. The date is
                   displayed in Gregorian format (MM/DD/YY).
PROC DTE           PROCEDURE DATE:
                   The date that the principle surgery procedure
                   indicated by the procedure code was performed. The
                   date is stored in a YYDDD Julian format.
PROCEDURE          PROCEDURE CODING SYSTEM PROCEDURE DESCRIPTION:
DESCRIPTIO HCFA    The full description of the HCPCS code.
COMMON
PROF IND           CLIA CERTIFICATE PROFICIENCY INDICATOR:
                   A code that indicates whether or not the specialty
                   or sub-specialty code edit and/or proficiency
                   testing HCPCS edit apply for the certification
                   period of a given CLIA number.
                   VALID VALUES:
                   0 - Does not apply
                   1 - Only specialty or sub-specialty edit applies
                   2 - Both specialty or sub-specialty, and proficiency
                        testing HCPCS edit apply
PRORATED AMT       GROUP HEALTH ORGANIZATION PRORATED AMOUNT:
                   For beneficiaries who have GHO coverage, this is an
                   amount, based on the GHO option code, that is
                   applied toward the Part B deductible. GHO amounts
                   are prorated and posted each month for the prior
                   month.
                   VALID VALUES
                   For year 1991:
                        33.29 per month for GHO OPTIONS A, B, and C
                        34.63 per month for GHO OPTIONS 1 and 2
                   For year 1992
                        38.04 per month for all GHO options
PRORATED DTE       GROUP HEALTH ORGANIZATION PRORATED DATE:
                   A date that indicates the month for which the GHO
                   amount was prorated and posted to the Part B
                   deductible for the Beneficiary. GHO amounts are
                   prorated and posted each month for the prior month.
                    The date is displayed in Gregorian format
                   (MM/01/YY).
PRORATED MTHS      GROUP HEALTH ORGANIZATION PRORATED MONTHS:
                   The total number of months for all GHO periods that
                   have prorated GHO amounts. GHO amounts are prorated
                   and posted each month for the prior month. Values
                   may range from 01 to 60.
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PROV               MEDICARE PROVIDER NUMBER:
                   The identification number, assigned by Medicare, to
                   a provider who is certified by Medicare to provide
                   services to the Beneficiary. The first two digits
                   represent the code of the state or foreign country
                   in which the provider is located. The third, or
                   third and fourth digits represent the type of
                   institution (i.e. hospital, SNF, HHA, or psychiatric
                   hospital). The remaining digits are assigned
                   sequentially.
PROV AREA          CARRIER PROVIDER AREA:
                   A code that identifies the carrier pricing locality
                   which is used to determine the usual and customary
                   reasonable fees that are allowed.
                        For Part A claims, this field is intended for
                           future use.
                        For Part B claims, refer to the Carrier Manual
                           13710 Exhibit 6.
                        For DMEPOS claims, refer to the United States
                           Postal Service state codes on the STATE CODE
                           table of codes.
PROV IND           HCFA PROVIDER INDICATOR:
                   A code that indicates whether or not the provider is
                   in a sample, assigned by HCFA BPO.
                   VALID VALUES:
                   0 - Not available
                   1 - Not in provider sample, inclusive ID number
                   2 - Not in provider sample, site only ID number
                   3 - In provider sample, inclusive ID number
                   4 - In provider sample, site only ID number
                   5 - Not available
PROV SPEC          HCFA PROVIDER SPECIALTY CODE:
                   A code, assigned by HCFA BPO, to define the
                   specialty of the physician or the supplier of
                   medical service used to generate payment. Refer to
                   the Carrier Manual 13700 Exhibit 7.
PROV SPEC CODE     PROVIDER SPECIALTY CODE:
                   The specialty code of the physician or the supplier
                   of medical service, used to generate payment and
                   used by the carrier to develop prevailing charge
                   screens. Documentation defining the carrier codes
                   is submitted to HCFA BPO by each carrier for
                   approval.
PROV TAX NUMBER    PROVIDER TAX IDENTIFICATION NUMBER:
                   The provider's Internal Revenue Employer
                   Identification number or Social Security number.
PROV TYPE          HCFA PROVIDER TYPE:
                   A code, assigned by HCFA BPO, that indicates the
                   type of provider.
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                   VALID VALUES:
                   1 - Physicians or suppliers billing as sole-
                        practitioners for whom Social Security numbers
                        are shown in the physician tax identification
                        code field, refer to the definition for
                        PROVIDER TAX IDENTIFICATION NUMBER
                   2 - Physicians or suppliers billing as sole-
                        practitioners for whom the carrier's own
                        physician identification code is shown
                   3 - Suppliers' (other than sole proprietorship)
                        employer identification numbers are used in the
                        coding identification field
                   4 - Suppliers (other than sole proprietorship) for
                        whom the carrier's own code has been shown
                   5 - Institutional providers and independent
                        laboratories for whom employer identification
                        numbers are used in coding the identification
                        field
                   6 - Institutional providers and independent
                        laboratories for whom the carrier's own
                        identification number is shown
                   7 - Clinics, groups, associations, or partnerships
                        for whom employer identification numbers are
                        used in coding the identification field
                   8 - Other entities for which the employer
                        identification number is used in coding the
                        identification field
                   0 - Clinics, groups, associations, partnerships or
                        other entities for which the carrier's own
                        identification number has been assigned
PSYC DAYS          BENEFICIARY REMAINING LIFETIME PSYCHIATRIC DAYS:
                   The number of lifetime psychiatric days available
                   for use by the Beneficiary. This number is
                   initialized to 190, the maximum number of days of
                   care allowed in a participating psychiatric hospital
                   within a Beneficiary's lifetime. The number is
                   decremented through the acceptance of Part A
                   psychiatric claims.
PSYC DAYS USED     BENEFICIARY PRE-ENTITLEMENT PSYCHIATRIC DAYS USED:
                   The number of days of psychiatric care received
                   prior to a Beneficiary being eligible for Medicare
                   benefits if the Beneficiary was in a psychiatric
                   hospital on the day of entitlement. These days are
                   not available for a Beneficiary to use until after
                   the end of the first spell of illness.
PSYCH EXP          PSYCHIATRIC EXPENSES:
                   The total amount of psychiatric expenses for this
                   claim.
PSYCH PRIM IND     PSYCHIATRIC PRIMARY DIAGNOSIS INDICATOR:
                   A code that indicates whether the outpatient claim
                   is for psychiatric services or not. A value of "1"
                   is positive.
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                    VALID VALUE:
                    0 - Off
                    1 - On
PT A                PART A "BUY-IN" CODE:
BUYIN/MEDICAID      A code used to indicate whether or not a "buy-in"
                    agreement exists for Part A coverage for a
                    particular Beneficiary. People 65 and over who have
                    an insufficient work history (of less than ten
                    years) may pay a monthly premium and receive
                    Medicare hospital insurance.
                    VALID VALUES:
                    0 - No Part A "buy-in"
                    1 - Part A "buy-in"
PT HCPCS            CLIA NUMBER OF PROFICIENCY TESTING HCPCS:
                    The number of HCPCS for a given clinical laboratory
                    identified as requiring proficiency testing to
                    measure the accuracy of test performance.
PT HCPCS CODE       CLIA PROFICIENCY TESTING HCPCS:
                    The HCPCS code identified by HCFA BDMS as requiring
                    proficiency testing, to measure the accuracy of test
                    performance.
PT HCPCS EFF DATE   CLIA PROFICIENCY TESTING HCPCS EFFECTIVE DATE:
                    The date that the HCPCS is identified as requiring
                    proficiency testing, displayed in Gregorian format
                    (MM/DD/YYYY).
PT HCPCS TRM DATE   CLIA PROFICIENCY TESTING HCPCS TERMINATION DATE:
                    The date that the HCPCS no longer requires
                    proficiency testing, displayed in Gregorian format
                    (MM/DD/YYYY).
PTBC                CARRIER TRAILER COUNTER:
                    The number of records that contain posted Carrier
                    claims data that were added to CWF History databases
                    for the Beneficiary.
PTBC/DME INDEX      CARRIER CLAIM HISTORY TRAILER COUNTER:
                    The number of records that contain posted Carrier
                    and/or DME claim data that were added to CWF Carrier
                    Paid Claim History databases for the Beneficiary.
PTRS                CERTIFICATE OF MEDICAL NECESSITY RESIDENCE:
                    A code that indicates the patient's type of
                    residence when the DMEPOS item was purchased or
                    rented.
                    VALID VALUES:
                    12 - Home
                    31 - SNF
                    32 - Nursing facility
                    33 - Custodial care facility
                    34 - Hospice
                    54 - Intermediate care facility/mentally retarded
                    55 - Residential substance abuse treatment facility
                    56 - Psychiatric residential treatment center
                    61 - CIRF
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PUMP AUTH          CMN PARENTERAL/ENTERAL NUTRITION PUMP AUTHORIZATION:
                   The diagnosis code that supports the need for the
                   patient's use of an infusion pump for nutrient
                   therapy. Refer to the definition for DIAGNOSIS
                   CODES.
PUR AMT            CERTIFICATE OF MEDICAL NECESSITY PURCHASE AMOUNT:
                   The amount paid for a DMEPOS item.
PUR DEC            CERTIFICATE OF MEDICAL NECESSITY PURCHASE DECISION:
                   A code that indicates a decision was made to
                   purchase a capped rental item or that the rental cap
                   on a DME item has been met.
                   VALID VALUES:
                   P - Item will be purchased
                   R - Rental limit has been met
PUR DT             CERTIFICATE OF MEDICAL NECESSITY PURCHASE DATE:
                   The date on which a capped rental item was purchased
                   or the rental cap was met. The date is displayed in
                   Gregorian format (MMDDYY).
QUERY CD           QUERY CODE:
                   A code that indicates the adjustment status of the
                   claim.
                   VALID VALUES:
                   0 - Credit adjustment
                   1 - Interim claim
                   2 - Final claim
                   3 - Debit adjustment
RATE               FINANCIAL OR REVENUE RATE:
                   The rate for individual medical or health related
                   services
RC/RV DT           CERTIFICATE OF MEDICAL NECESSITY
                   RECERTIFICATION1DATE:
                   The recertification or revision date of a
                   Certificate of Medical Necessity.
REC                RECORD REQUEST NUMBER:
                   A sequential number assigned to each claim or
                   entitlement period (found on MSPA screen) for screen
                   display.
REC/REV            CMN NUMBER OF RECERTIFICATIONS AND REVISIONS:
                   The number of recertifications and revisions
                   associated with the Beneficiary's certification for
                   the use of DMEPOS
RECEIVED DTE       DATE RECEIVED:
                   The date the claim was received by the satellite, or
                   if transmitted via an interactive terminal for an
                   initial claim, the day it passed editing
                   requirements by the satellite. The date is
                   displayed in Gregorian format (MM/DD/YY).
REFER PHYS         REFERRING PHYSICIAN:
                   A number assigned by the carrier that identifies the
                   referring prescribing, or ordering physician.
REFER UPIN         UNIQUE PHYSICIAN IDENTIFICATION NUMBER (UPIN):
                   The number of the referring physician as assigned by
                   the National UPIN Registry
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REIMB AMT          MEDICARE REIMBURSEMENT AMOUNT:
                   The amount Medicare paid to the provider for this
                   claim
REM CD             MEDICARE AS SECONDARY PAYER REMARKS:
                   A series of codes that provide additional
                   Beneficiary information. Refer to the REMARKS CODE
                   table of codes
REMARKS            CARRIER REMARKS:
                   A series of one character codes that may be entered
                   as additional claim information. Up to 13 lines of
                   messages associated with the remark codes will be
                   printed on the EOMB form. Up to 12 codes may be
                   entered, (e.g. Code A - Message "This is the basis
                   for the monthly installment on you medical
                   equipment".
P PAYEE            REPRESENTATIVE PAYEE AUXILIARY INDICATOR:
                   A code that indicates whether or not there is a
                   Medicare representative payee involved for the
                   Beneficiary, and therefore, representative payee
                   auxiliary data exists.
                   VALID VALUES:
                   O - No Representative Payee record exists
                   1 - Representative Payee record exists
                   2 - Beneficiary address record exists
REP TRLR           REPRESENTATIVE PAYEE NAME/ADDRESS:
                   The name and address of the Beneficiary's
                   representative payee who has assumed responsibility
                   for the Beneficiary's obligations.
REPLACE            CERTIFICATE OF MEDICAL NECESSITY REPLACEMENT ITEM:
                   A code that indicates whether or not the DMEPOS item
                   is a replacement for a previously purchased item.
                   VALID VALUES:
                   Y - Replacement for a previous item
                   N - Not a replacement for a previous item
RES STATE          DMEPOS STATE CODE:
                   The United States Postal state code where the
                   Beneficiary was reported to reside. Refer to the
                   STATE CODE table of codes.
REV                REVENUE CENTER CODE:
                   A code that identifies a specific accommodation,
                   ancillary service or billing calculation. Refer to
                   Intermediary Manual S3600 Addendum C-15.
REVOCATION IND     HOSPICE REVOCATION INDICATOR:
                   A code that specifies revocation of the indicated
                   Hospice period by the Beneficiary.
                   VALID VALUES:
                   1 - Revoked
                   0 - Not revoked
RIC                RECORD IDENTIFICATION CODE:
                   A code that identifies the type of claim.
                   VALID VALUES:
                   V - Part A
                   W - Part B
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RISK               Indicates the level of risk associated with
                   performing a specific procedure on the Beneficiary.
                   VALID VALUES:
                   0 – Low risk
                   1 – High risk
                   N - Risk unknown
                   H - Risk high
                   Space - risk not tracked
RNT AMT            CERTIFICATE OF MEDICAL NECESSITY ALLOWED AMOUNT:
                   The total amount paid by Medicare for rental
                   equipment under this certification.
RNT SUP            SUPPLIER CERTIFICATION NUMBER:
                   The certification number assigned to the supplier of
                   record at the time the item was rented to its cap or
                   purchased. This field is used for inexpensive,
                   capped rental and PEN pump items only.
RNT SVC            TOTAL SERVICES:
                   The number of rental services for inexpensive,
                   capped items and PEN pumps, billed under the
                   Beneficiary's certification for the use of DMEPOS.
                   For skeleton CMN's, the count includes dates of
                   service commencing with 5/4/1992.
RTE                CMN PARENTERAL/ENTERAL NUTRITION ROUTE:
                   A code that identifies the method of Patenteral
                   (intravenous) or Enteral (feeding tube), Nutrition
                   (PEN) administration.
                   VALID VALUES:
                   1 - Central line
                   2 - Peripheral line
                   3 - IDPN
                   4 - Nasogastric tube
                   5 - Gastrostomy tube
                   6 - Jejunostomy tube
                   7 - Other
RUGS               RUGS PROVIDER INDICATOR:
                   A VALUE OF TWO ('2'), THREE ('3') OR FOUR ('4'
                   INDICATES A RUGS PROVIDER.
SATL               CERTIFICATE OF MEDICAL NECESSITY SATURATION LEVEL:
                   The percentage of oxygen measured in the blood
                   stream, the oximetry saturation level.
SCHED PMT DTE      SCHEDULED PAYMENT1DATE:
                   The date that the payment is scheduled to be mailed,
                   deposited in the provider's account, or transferred
                   electronically. The date is displayed in Gregorian
                   format (MM/DD/YY).
SCREEN RES IND     DURABLE MEDICAL EQUIPMENT SCREEN RESULT INDICATOR:
                   A code that identifies the outcome of the medical
                   review units' review of the DME item.
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                   VALID VALUES:
                   A - Denied for lack of medical necessity; highest
                       level of review was automated Level I
                   B - Reduced (partially denied) for lack of medical
                       necessity; highest level of review was
                       automated Level I
                   C - Denied as statutorily non-covered; highest level
                       of review was automated Level I
                   D - Denied for coding/unbundling reasons; highest
                       level of review was automated Level I
                   E - Paid after automated Level I review
                   F - Denied for lack of medical necessity; highest
                       level of review was manual Level I
                   G - Reduced (partially denied) for lack of medical
                       necessity; highest level of review was manual
                       Level I
                   H - Denied as statutorily non-covered; highest level
                       of review was manual Level I
                   I - Denied for coding/unbundling reasons; highest
                       level of review was manual Level I
                   J - Paid after manual Level I review
                   K - Denied for lack of medical necessity; highest
                       level of review was manual Level II
                   L - Reduced (partially denied) for lack of medical
                       necessity; highest level of review was manual
                       Level II
                   M - Denied as statutorily non-covered; highest level
                       of review was manual Level II
                   N - Denied for coding/unbundling reasons; highest
                       level of review was manual Level II
                   O - Paid after manual Level II review
                   P - Denied for lack of medical necessity; highest
                       level of review was manual Level III
                   Q - Reduced (partially denied) for lack of medical
                       necessity; highest level of review was manual
                       Level III
                   R - Denied as statutorily non-covered; highest level
                       of review was manual Level III
                   S - Denied for coding/unbundling reasons; highest
                       level of review was manual Level III
                   T - Paid after manual Level III review
SCREEN SUS IND     DURABLE MEDICAL EQUIPMENT SCREEN SUSPENSION
                       INDICATOR:
                   A code that indicates the medical review screening
                       technique that caused the claim to suspend.
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                   VALID VALUES:
                   MUxx - Mandated unbundling screens
                   Uxxx - Local unbundling screens
                   Cxxx - Statutorily non-covered screens
                   M1xx - Mandated Cat I screens
                   1xxx - Local Cat I screens
                   M2xx - Mandated Cat II screens
                   2xxx - Local Cat II screens
                   M3xx - Mandated Cat III screens
                   3xxx - Local Cat III screens
SCREEN SVGS        DURABLE MEDICAL EQUIPMENT SCREEN SAVINGS AMOUNT:
                   The savings amounts attributable to the use of
                   coverage screening techniques.
SEL                ARCHIVED CLAIM RECORDS SELECTION INDICATION:
                   An entry field used to select archived records. An
                   "S" placed in the first entry TO SELECT ALL RECORDS
                   will retrieve all archived records per claim type
                   selected for the Beneficiary.
                   VALID VALUES:
                   SPACE - No action
                   S - Select
SELECTION DTE      END STAGE RENAL DISEASE SELECTION1DATE:
                   The date that the Beneficiary chose either selection
                   Method 1 or Method 2. The date is displayed in
                   Gregorian format (MM/DD/YY). Refer to the
                   definition for END STAGE RENAL DISEASE METHOD CODE.
SEQ CTR            BENEFICIARY ON-LINE SEQUENCE COUNTER:
                   A numeric field that indicates the sequential number
                   of the Beneficiary's approved claims for the on-line
                   sequence date.
SEX                BENEFICIARY SEX CODE:
                   A code that indicates the sex of the Beneficiary.
                   VALID VALUES:
                   0-U-Unknown
                   1-M-Male
                   2-F-Female
SI                 CERTIFICATE OF MEDICAL NECESSITY SEVERITY OF
                   ILLNESS:
                   A code that indicates new oximetry or ABG testing is
                   not necessary due to the severity of the patient's
                   illness.
                   NOTE: CMN only field
                   VALID VALUES:
                   Y - The severity of illness overrides the need for
                        additional tests
                   N - Additional tests are required
SI-OCE             STATUS INDICATOR
                   A field that is 2 bytes alpha value for Outpatient,
                   Inpatient, Home Health and Hospice claims.
SIGNATURE          SIGNATURE INDICATOR:
                   A code that indicates whether or not the claimant's
                   signature is on file.
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                   VALID VALUES:
                   Y - Signature on file
                   N - Signature not on file
SKLTN              CERTIFICATE OF MEDICAL NECESSITY SKELETON CMN
                   INDICATOR:
                   A code that indicates the CMN record was created by
                   CWF from a Carrier claim record.
                   VALID VALUES:
                   Y - CMN record created from Carrier claim
                   N - CMN record not created from Carrier claim
                   U - CMN record was updated with data accumulated
                        from Paid claims History (the process was
                        initialized by an original claim)
                   A - CMN record was updated with data accumulated
                        from Paid Claims History (the process was
                        initiated by an adjustment)
SOURCE             DATA INDICATOR (05) - DATE OF DEATH SOURCE:
                   Refer to definition for DATE OF DEATH SOURCE for
                   data definition
SOURCE CD          MEDICARE AS SECONDARY PAYER SOURCE CODE:
                   A code that indicates the source of MSP information
                   that pertains to the Beneficiary's health benefits.
                   VALID VALUES:
                   Space - Unknown
                   A - Claim processing
                   B - IRS/SSA/HCFA data match
                   C - First claim development
                   D - Mass mailing
                   E - Black Lung
                   F - Veterans
                   G - Other data matches
                   H - Worker's Compensation
                   I - Notified by Beneficiary
                   J - Notified by provider
                   K - Notified by insurer
                   L - Notified by employer
                   M - Notified by attorney
                   N - Notified by group health plan/primary payer
                   O – Initial enrollment questionnaire
                   P – HMO rate cell adjustment
                   Q – Voluntary insurer reporting
                   R – Office of personnel management data match
                   S – Miscellaneous reporting
                   T – IRS/SSA/HCFA data match III
                   U – IRS/SSA/HCFA data match IV
                   SPACES – Unknown
SPAN CODE          OCCURRENCE SPAN CODE:
                   A code that identifies a significant event relating
                   to an institutional claim that may affect payer
                   processing. These codes are claim related
                   occurrences that are related to a time period (span
                   of dates). Refer to the Intermediary Manual S3871.
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SPAN FROM          OCCURRENCE SPAN FROM1DATE:
                   The from date related to the occurrence span code,
                   refer to the definition for OCCURRENCE SPAN CODE.
                   The date is displayed in Gregorian format
                   (MM/DD/YY).
SPAN THRU          OCCURRENCE SPAN THRU1DATE:
                   The thru date related to the occurrence span code,
                   refer to the definition for OCCURRENCE SPAN CODE.
                   The date is displayed in Gregorian format
                   (MM/DD/YY).
SPEC FORMULA       CMN PARENTERAL/ENTERAL NUTRITION FORMULA:
                   A code that indicates the type of special nutrient
                   formula the Beneficiary requires for the certified
                   condition.
                   VALID VALUES:
                   R - Renal
                   H - Hepatic
                   S - Stress
                   O - Other
SPEC/LTY PRICING   SPECIALTY PRICING INDICATOR:
IND                A code used to calculate the payment based on the
                   provider's specialty. The specialty pricing
                   indicator is carrier specific.
SPECIALTY CODE     CLINICAL LABORATORY IMPROVEMENT AMENDMENT SPECIALTY
                   CODE:
                   The Independent Laboratory Code used to classify
                   laboratory procedures according to specialty
                   certification categories defined by HCFA BDMS.
                   Specialty certification categories are determined by
                   the complexity of the testing procedure and the
                   level of skill required to perform the test
                   proficiently.
SPECIALTY DATE     CLIA SPECIALTY EFFECTIVE1DATE:
EFF                A date that indicates the start of the specialty
                   code for a given clinical laboratory.
SPECS              CLIA NUMBER OF SPECIALTY CODES:
                   The number of specialty code periods for a given
                   clinical laboratory.
SPELL DI 1         BENEFICIARY SPELL DATA INDICATOR 1:
                   A code that conveys information concerning manual
                   adjustment of the spell data and/or Christian
                   Science SNF information.
                   VALID VALUES:
                   0 - Does not apply
                   1 - Spell manually adjusted
                   2 - Christian Science SNF usage
                   3 - Both
SPELL DI 2         BENEFICIARY SPELL DATA INDICATOR 2:
                   A code that indicates whether or not the
                   Beneficiary's last billing date is an interim claim,
                   and/or a four-year-old claim.
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                   VALID VALUES:
                   0 - Does not apply
                   1 - Date of last billing is interim
                   2 - Four-year old claim processed
                   3 - Both
SPLIT              SPLIT CLAIM INDICATOR:
                   A code that indicates the claim has been split or is
                   a replicate of a previous claim.
                   VALID VALUES:
                   Y - Split
                   N - Not split
                   R - Replicate
                   B - Both split and replicate
SRCE               SOURCE OF BILL:
                   A code that indicates the source of the claim
                   billing information.
                   VALID VALUES:
                   0 - Converted history
                   1 - HCFA BDMS batch posted
                   2 - Batch submitted (OSA)
                   3 - On-line
                   4 - HCFA BDMS bill history
ST                 CERTIFICATE OF MEDICAL NECESSITY STATUS:
                   A code that indicates the status of the CMN record.
                   VALID VALUES:
                   D - Deleted
                   T - Discontinued
                   X - Discontinued, then deleted
ST CODE            STATE ADDRESS CODE:
                   The Social Security Administration's standard
                   numeric code for a Beneficiary's state of residence.
                    It is used, in conjunction with a county code, as
                   selection criteria for the determination of payment
                   rates for GHO reimbursement. Concerning individuals
                   directly billable for Part A/Part B premiums, this
                   element is used to determine if the Beneficiary will
                   receive an Explanation of Medicare Benefits (EOMB)
                   in English or Spanish. It is also used for special
                   studies. Refer to the STATE CODE table of codes.
SUB CHG            SUBMITTED CHARGES:
                   The total amount charged for this line item service.
SUB HCPCS          SUBMITTED HCPCS:
                   The HCPCS code that was originally documented on the
                   CMN or the DMEPOS claim.   Refer to the definition
                   for HCFA COMMON PROCEDURE CODING SYSTEM CODE.
SUBMITTER          SUBMITTER IDENTIFICATION NUMBER:
                   The identification number of the provider submitting
                   the claim.
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SUBSCRIBER NAME    MEDICARE AS SECONDARY PAYER SUBSCRIBER LAST NAME:
                   The last name of the subscriber whose health plan
                   has primary responsibility for payment for the
                   Beneficiary's medical expenses. The subscriber may
                   be the Beneficiary or the Beneficiary's spouse or
                   parent.
SUP NO             DOCTOR/SUPPLIER:
                   The number that the carrier uses to identify each
                   individual physician, group clinic, or medical
                   supplier
SUPP TAX NUMBER    DMEPOS SUPPLIER TAX IDENTIFICATION NUMBER:
                   The supplier's Internal Revenue Employer
                   Identification number or Social Security number.
SUPPLIER           SUPPLIER OF DMEPOS ITEMS:
                   A number assigned by the carrier prior to July, 1993
                   and by HCFA BPO effective July, 1993, to the
                   supplier of DMEPOS items.
SUPPLIER TYPE      DMEPOS SUPPLIER TYPE:
                   The type of supplier code assigned by HCFA BPO.
                   Refer to HCFA PROVIDER TYPE for a list of valid
                   values.
SURG               A LITERAL THAT DESCRIBES THE PROCEDURE CODE FOUND ON
                   THE SURGERY TRAILER.
SURG               THIS FIELD HOLDS THE UNITS OF SERVICE THAT WERE
                   SUBMITTED WITH THE PROCEDURE CODE ON THIS SURGERY
                   TRAILER.
SURG CODE          SURGERY CODE:
                   A code that indicates the type of medical procedure
                   performed by the provider of service. The surgery
                   code may be one of the three possible codes: HCPCS
                   based on the American Medical Association's Current
                   Procedural Terminology list, refer to the definition
                   for HCFA COMMON PROCEDURE CODING SYSTEM CODE; the
                   principal surgical procedure performed during the
                   period covered by an institutional claim, refer to
                   the definition for PRINCIPAL PROCEDURE CODE; or in
                   the case of DMEPOS claims (HIMR/CMND screen), the
                   HCPCS of the transplant surgery that resulted in the
                   need for immunosuppressive drugs, refer to the
                   MNEMONIC HCPCS CODE table of codes.
SURG DT            CMN IMMUNOSUPPRESSIVE SURGERY DATE:
                   The date that the transplant surgery was performed
                   on the Beneficiary, displayed in Gregorian format
                   (MMDDYY).
SURG IND           SURGERY AUXILIARY INDICATOR:
                   A code that indicates the existence of auxiliary
                   Surgery records derived from claims submitted for
                   designated one-time surgical procedures performed
                   after 2/23/91 for the Beneficiary.
                   VALID VALUES:
                   0 - No Surgical records exist
                   1 - Surgical records exist
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SURNAME            BENEFICIARY SURNAME:
                   The first six characters of the Beneficiary's
                   surname
SV DTE             FINANCIAL OR REVENUE DATE OF SERVICE:
                   The date that the associated ancillary service, as
                   identified by the revenue center code, was
                   delivered. The date is displayed in month, day and
                   year format (MM/DD/YY). Ancillary services are
                   diagnostic or therapeutic services rendered to
                   hospital patients, such as lab tests, x-rays,
                   medications and respiratory therapy.
THERAPY            CMN PARENTERAL/ENTERAL NUTRITION THERAPY TYPE:
                   A code that indicates the type of nutritional
                   therapy that the patient receives.
                   VALID VALUES:
                   E - Enteral
                   P - Parenteral
THRU (SRCH) DTE    THRU (SEARCH) DATE:
                   This date is used on the HIMR Main Menu to indicate
                   the latest dated claim that is desired for a display
                   of claim history data. This date may be displayed in
                   MMDDYY or MM/DD/YY format.
THRU DTE           THRU DATE:
                   The last day of the claim billing statement for the
                   provided services rendered to the Beneficiary. The
                   date is displayed in Gregorian format(MM/DD/YY), and
                   is used as matching criteria when checking for
                   duplicate and adjustment claims, for benefit period
                   extension, and for calculations to see if a claim
                   links to another spell. For Inpatient, SNF, Home
                   Health and Hospice claims, the statement thru date
                   is not necessarily the same as the discharge date.
TOS                TYPE OF SERVICE:
                   The type of service codes used in the carrier
                   system. Documentation defining the codes is
                   submitted to HCFA BPO by each carrier for approval.
                    Carrier type service codes are carrier specific.
                   The type of service codes displayed on the HIMR DME
                   screens are assigned by HCFA. Refer to the
                   definition for HCFA SERVICE TYPE for a list of valid
                   values.
TOT CHRG           TOTAL CHARGES:
                   The amount of total charges on this claim.
TOT LFE            FIRST YEAR INPATIENT TOTAL LIFETIME RESERVE DAYS
                   USED:
                   The number of lifetime reserve days used by the
                   Beneficiary on this claim. Each Beneficiary has a
                   lifetime reserve of 60 additional days of Inpatient
                   hospital services after using 90 days during a spell
                   of illness.
TOT MED            TOTAL MEDICAL CHARGES:
                   The total medical charges for this claim.
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TOT OTHPY          TOTAL OCCUPATIONAL THERAPY CHARGES:
                   The total occupational therapy charges for this
                   claim.
TOT PSYC           TOTAL PSYCHIATRIC CHARGES:
                   The total psychiatric charges for this claim.
TOT PTHPY          TOTAL PHYSICAL THERAPY CHARGES:
                   The total physical therapy charges for this claim.
TOTAL PAT REIMB    TOTAL PATIENT REIMBURSEMENT:
                   The total amount paid to the Beneficiary for the
                   procedure.
TOTAL PROV REIMB   TOTAL PROVIDER REIMBURSEMENT:
                   The total amount paid to the provider of service for
                   the procedure.
TOTAL RECORDS      TOTAL RECORDS NUMBER:
                   The total number of claims or entitlement periods
                   (from MSPA screen) found for the Beneficiary.
TOTAL SUPP REIMB   DMEPOS TOTAL SUPPLIER REIMBURSEMENT:
                   The total amount paid to the supplier for the DMEPOS
                   item.
TRANS              TRANSACTION CODE:
                   A code that indicates the type of health care
                   facility that was responsible for submitting this
                   claim for payment.
                   VALID VALUES:
                   0 - Christian Science SNF/Part B
                   1 - Psychiatric hospital facility
                   2 - Tuberculosis hospital facility
                   3 - General care hospital facility
                   4 - Regular SNF
                   5 - Home Health agency
                   6 - Outpatient facility
                   7 - CORF
                   8 - Hospice
TRANS CD           INPATIENT TRANSACTION CODE:
                   A code that indicates the type of health care
                   facility that was responsible for submitting this
                   claim for payment.
                   VALID VALUES:
                   0 - Christian Science skilled nursing facility
                   1 - Psychiatric hospital facility
                   2 - Tuberculosis hospital facility
                   3 - General care hospital facility
                   4 - Regular skilled nursing facility
                   5 - Home health agency
                   6 - Outpatient facility
                   C - Comprehensive outpatient rehabilitation facility
                        (CORF)
TRANSPL DISCHRG    TRANSPLANT DATA DISCHARGE1DATE:
DATE BENEFICIARY   The date that the Beneficiary was discharged from a
                   hospital stay during which the indicated transplant
                   occurred. The date is displayed in Gregorian format
                   (MM/DD/YY).
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TRANSPLANT COV     BENEFICIARY TRANSPLANT DATA COVERAGE INDICATOR:
IND                A code that indicates whether or not the Beneficiary
                   has received a Medicare covered transplant.
                   VALID VALUES:
                   SPACE - Not covered
                   C - Transplant covered
TRANSPLANT TYPE    BENEFICIARY TRANSPLANT TYPE INDICATOR:
IND                A code that indicates the type of transplant surgery
                   performed on the Beneficiary.
                   VALID VALUES:
                   1 - Allograft bone marrow - transplant from another
                        person
                   2 - Autograft bone marrow - transplant from
                        Beneficiary
                   H - Heart transplant
                   K - Kidney transplant
                   L - Liver transplant
TREAT AUTH         TREATMENT AUTHORIZATION NUMBER:
                   A numeric or alphabetic indicator that designates
                   the treatment covered by this claim has been
                   authorized by the payer organization.
TRM DTE (GHO)      GROUP HEALTH ORGANIZATION TERMINATION DATE:
                   The date that the GHO period was terminated for the
                   Beneficiary. The date is displayed in Julian format
                   (YYDDD).
TRM DTE (MSP)      MEDICARE AS SECONDARY PAYER TERMINATION DATE:
                   The date that the Beneficiary's benefits were
                   terminated under the satellite that has primary
                   responsibility for payment of medical claims. The
                   date is displayed in Gregorian format (MM/DD/YYYY).
TYPE               CERTIFICATE OF MEDICAL NECESSITY OCCURRENCE TYPE:
                   A code that indicates the certification, other than
                   an initial certification, is either a
                   recertification or a revision.
                   VALID VALUES:
                   2               RV          Revision
                   3               RC          Recertification
UNITS              FINANCIAL OR REVENUE UNITS OF SERVICE:
                   A quantitative measure of services provided to a
                   Beneficiary associated with accommodation and
                   ancillary revenue centers described on an
                   institutional claim. Depending on the type of
                   service, units are measured by the number of covered
                   days in a particular accommodation, pints of blood,
                   emergency room visits, clinic visits, dialysis
                   treatments (sessions or days), Outpatient therapy
                   visits, or Outpatient clinical diagnostic laboratory
                   tests. Refer to the Intermediary Manual S3870.
UNITS/IND          DMEPOS UNITS:
                   The total number of units associated with services
                   needing unit reporting, including number of
                   services, oxygen volume, and drug dose.
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UNITS/IND          DMEPOS INDICATOR:
                   A code that indicates the type of units reported.
                   Refer to the definition for DMEPOS UNITS.
                   VALID VALUES
                   0 - Values reported as zero
                   3 - Number of services
                   4 - Oxygen volume units
                   6 - Drug dosage
UPDATED DTE        GROUP HEALTH ORGANIZATION UPDATED DATE:
                   The date that the GHO amount was prorated and posted
                   to the Part B deductible for the Beneficiary. The
                   date is displayed in Gregorian format (MM/DD/YY).
UPDT CONTRACTOR    UPDATING CONTRACTOR:
                   The identification number of the satellite who last
                   updated the auxiliary information.
UPIN               LINE ITEM UNIQUE PHYSICIAN IDENTIFICATION NUMBER:
                   The number, as assigned by the National UPIN
                   Registry, of the physician who provided the services
                   on this claim as referred from another physician.
UPIN DATE EFF      CLIA UNIQUE PHYSICIAN IDENTIFICATION NUMBER
                   EFFECTIVE DATE:
                   The date that the UPIN assigned to the clinical
                   laboratory became effective, displayed in Gregorian
                   format (MM/DD/YY). Refer to the definition for
                   UNIQUE PHYSICIAN IDENTIFICATION NUMBER.
UPIN DATE TRM      CLIA UNIQUE PHYSICIAN IDENTIFICATION NUMBER
                   TERMINATION DATE:
                   The date that the UPIN assigned to the clinical
                   laboratory was terminated, displayed in Gregorian
                   format (MM/DD/YY). Refer to the definition for
                   UNIQUE PHYSICIAN IDENTIFICATION NUMBER.
UPIN-REFER         CLAIM HISTORY REFERRING PHYSICIAN UPIN:
                   The UPIN of the referring physician as selected on
                   the HIMR Paid Claim History List screen. Refer to
                   the definition for UNIQUE PHYSICIAN IDENTIFICATION
                   NUMBER.
UPIN-SERV          CLAIM HISTORY PHYSICIAN OF SERVICE UPIN:
                   The UPIN of the physician of service as selected on
                   the HIMR Paid Claim History List screen. Refer to
                   the definition for UNIQUE PHYSICIAN IDENTIFICATION
                   NUMBER.
UPINS              CLIA NUMBER OF UPINS:
                   The number of UPINs for a given clinical laboratory.
USEFUL LIFE        CERTIFICATE OF MEDICAL NECESSITY EQUIPMENT USEFUL
                   LIFE DATE:
                   The projected last date of useful life for the
                   DMEPOS item, displayed in Gregorian format (MMDDYY).
VAL IND            MEDICARE AS SECONDARY PAYER VALIDITY INDICATOR:
                   A code that indicates the Beneficiary has valid
                   primary coverage under another insurer.
                   VALID VALUES:
                   Y - Beneficiary has coverage
                   N - Beneficiary does not have other coverage
                                                                    79
                                                              HIMRPROM
                                                              4/5/2009
HIMR Screen Prompts
_______________________________________________________________________


VALUE AMT          VALUE AMOUNT:
                   The dollar amount related to the associated value
                   code. Refer to the definition for VALUE CODE.
VALUE CODE         VALUE CODE:
                   A code that identifies monetary information that is
                   necessary for processing this claim as qualified by
                   the payer organization. Refer to the Intermediary
                   Manual S3871.
VER BLD DED        VERIFIED PATIENT LIABILITY BLOOD DEDUCTIBLE:
                   The portion of the total charges for this claim that
                   was applied toward the patient's blood deductible
                   amount for which the patient is liable for payment
                   to the provider of services.
VER CO INS         VERIFIED PATIENT COINSURANCE:
                   The portion of the total allowable charges for this
                   claim not paid by Medicare or assigned to deductible
                   for which the patient is liable for payment to the
                   provider of services.
WAIVER             DMEPOS WAIVER OF PROVIDER LIABILITY:
                   A code that indicates the Beneficiary was notified
                   that the DMEPOS item might not be considered
                   medically necessary and agreed in writing to pay for
                   the item.
                   VALID VALUES:
                   Y - Beneficiary notified and agrees to pay for the
                       item
                   N - Does not apply
WARRANTY IND       CERTIFICATE OF MEDICAL NECESSITY WARRANTY INDICATOR:
                   A code that indicates whether or not the DMEPOS
                   purchased item is covered by a warranty for repairs.
                   VALID VALUES:
                   Y - Item has warranty of repair coverage
                   N - Item does not have warranty coverage
WARRANTY LEN       CERTIFICATE OF MEDICAL NECESSITY WARRANTY LENGTH:
                   The number of months for which the DMEPOS item has
                   warranty of repairs coverage. A value of "99"
                   indicates that the warranty covers the Beneficiary's
                   lifetime.
WARRANTY TYPE      CERTIFICATE OF MEDICAL NECESSITY WARRANTY TYPE:
                   A code that indicates the type of repairs that are
                   covered by the warranty for the DMEPOS item.
                   VALID VALUES:
                   1 - Full replacement
                   2 - Pro- rated replacement
                   3 - Parts and labor
                   4 - Parts only
WORK RELATED       WORK RELATIONSHIP INDICATOR:
                   A code that indicates whether or not this claim
                   resulted from an incident related to the
                   Beneficiary's work.
                   VALID VALUES:
                   Y - Yes
                   N - No
                                                                    80
                                                              HIMRPROM
                                                              4/5/2009
HIMR Screen Prompts
_______________________________________________________________________


XREF               BENEFICIARY CROSS-REFERENCED HEALTH INSURANCE CLAIM
                   NUMBER:
                   An additional Beneficiary HIC number associated with
                   the original Medicare Beneficiary. The Beneficiary
                   was previously entitled under this number, but has
                   been cross-referred from this number to the active
                   HIC number. It is necessary to store all previously
                   assigned numbers for each Beneficiary.
XREF IND           CROSS-REFERENCE AUXILIARY INDICATOR:
                   A code that indicates the existence of auxiliary
                   Cross-reference records, and therefore, whether or
                   not a Beneficiary has processed information through
                   CWF under more than one HIC number.
                   VALID VALUES:
                   0 - No Cross-reference records exist
                   1 - Cross-reference records exist
YEAR               END STAGE RENAL DISEASE LIMITATION YEAR:
                   The current year for the associated ESRD limitation
                   values. It is displayed in year format (YY) or '##'
                   as the default.
ZIP CODE           ZIP CODE EXTENSION:
                   The zip code extension portion of the Beneficiary's
                   address.
ZIP CODE           ZIP CODE:
                   The zip code portion of the Beneficiary's address.

				
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