| Name |
Label |
Category |
| AIDPAYM
| QC4c SOURCE OF PAYMENT - MEDICAID |
|
| ALLEVNTS
| QB8 COVERED ALL EVENTS FOR 1999 |
|
| ANYCOPAY
| QC7b ANY CO-PAYMENT |
|
| BADDEB
| QC6r BAD DEBT |
|
| BETOS1
| BETOS CODE 1 (CPT4 OR CODED BETOS) |
|
| BETOS10
| BETOS CODE 10 (CPT4 OR CODED BETOS) |
|
| BETOS11
| BETOS CODE 11 (CPT4 OR CODED BETOS) |
|
| BETOS12
| BETOS CODE 12 (CPT4 OR CODED BETOS) |
|
| BETOS13
| BETOS CODE 13 (CPT4 OR CODED BETOS) |
|
| BETOS14
| BETOS CODE 14 (CPT4 OR CODED BETOS) |
|
| BETOS15
| BETOS CODE 15 (CPT4 OR CODED BETOS) |
|
| BETOS16
| BETOS CODE 16 (CPT4 OR CODED BETOS) |
|
| BETOS17
| BETOS CODE 17 (CPT4 OR CODED BETOS) |
|
| BETOS18
| BETOS CODE 18 (CPT4 OR CODED BETOS) |
|
| BETOS19
| BETOS CODE 19 (CPT4 OR CODED BETOS) |
|
| BETOS2
| BETOS CODE 2 (CPT4 OR CODED BETOS) |
|
| BETOS20
| BETOS CODE 20 (CPT4 OR CODED BETOS) |
|
| BETOS21
| BETOS CODE 21 (CPT4 OR CODED BETOS) |
|
| BETOS22
| BETOS CODE 22 (CPT4 OR CODED BETOS) |
|
| BETOS23
| BETOS CODE 23 (CPT4 OR CODED BETOS) |
|
| BETOS3
| BETOS CODE 3 (CPT4 OR CODED BETOS) |
|
| BETOS4
| BETOS CODE 4 (CPT4 OR CODED BETOS) |
|
| BETOS5
| BETOS CODE 5 (CPT4 OR CODED BETOS) |
|
| BETOS6
| BETOS CODE 6 (CPT4 OR CODED BETOS) |
|
| BETOS7
| BETOS CODE 7 (CPT4 OR CODED BETOS) |
|
| BETOS8
| BETOS CODE 8 (CPT4 OR CODED BETOS) |
|
| BETOS9
| BETOS CODE 9 (CPT4 OR CODED BETOS) |
|
| CAREPAYM
| QC4b SOURCE OF PAYMENT - MEDICARE |
|
| CCCNDPR
| PRINCIPAL COLLAPSED CCHPR (NK) CODE |
|
| CCHPRC1
| COLLAPSED CCHPR (NK) CODE #1 |
|
| CCHPRC10
| COLLAPSED CCHPR (NK) CODE #10 |
|
| CCHPRC11
| COLLAPSED CCHPR (NK) CODE #11 |
|
| CCHPRC12
| COLLAPSED CCHPR (NK) CODE #12 |
|
| CCHPRC13
| COLLAPSED CCHPR (NK) CODE #13 |
|
| CCHPRC14
| COLLAPSED CCHPR (NK) CODE #14 |
|
| CCHPRC15
| COLLAPSED CCHPR (NK) CODE #15 |
|
| CCHPRC16
| COLLAPSED CCHPR (NK) CODE #16 |
|
| CCHPRC17
| COLLAPSED CCHPR (NK) CODE #17 |
|
| CCHPRC18
| COLLAPSED CCHPR (NK) CODE #18 |
|
| CCHPRC19
| COLLAPSED CCHPR (NK) CODE #19 |
|
| CCHPRC2
| COLLAPSED CCHPR (NK) CODE #2 |
|
| CCHPRC20
| COLLAPSED CCHPR (NK) CODE #20 |
|
| CCHPRC21
| COLLAPSED CCHPR (NK) CODE #21 |
|
| CCHPRC3
| COLLAPSED CCHPR (NK) CODE #3 |
|
| CCHPRC4
| COLLAPSED CCHPR (NK) CODE #4 |
|
| CCHPRC5
| COLLAPSED CCHPR (NK) CODE #5 |
|
| CCHPRC6
| COLLAPSED CCHPR (NK) CODE #6 |
|
| CCHPRC7
| COLLAPSED CCHPR (NK) CODE #7 |
|
| CCHPRC8
| COLLAPSED CCHPR (NK) CODE #8 |
|
| CCHPRC9
| COLLAPSED CCHPR (NK) CODE #9 |
|
| CCNDPR
| PRINCIPAL CCHPR CONDITION CODE |
|
| CHAMPAYM
| QC4f SOURCE OF PAYMENT - CHAMPVA/CHAMPUS |
|
| CHP1C1
| CCHPR CONDITION CODE #1 |
|
| CHP1C10
| CCHPR CONDITION CODE #10 |
|
| CHP1C11
| CCHPR CONDITION CODE #11 |
|
| CHP1C12
| CCHPR CONDITION CODE #12 |
|
| CHP1C13
| CCHPR CONDITION CODE #13 |
|
| CHP1C14
| CCHPR CONDITION CODE #14 |
|
| CHP1C15
| CCHPR CONDITION CODE #15 |
|
| CHP1C16
| CCHPR CONDITION CODE #16 |
|
| CHP1C17
| CCHPR CONDITION CODE #17 |
|
| CHP1C18
| CCHPR CONDITION CODE #18 |
|
| CHP1C19
| CCHPR CONDITION CODE #19 |
|
| CHP1C2
| CCHPR CONDITION CODE #2 |
|
| CHP1C20
| CCHPR CONDITION CODE #20 |
|
| CHP1C21
| CCHPR CONDITION CODE #21 |
|
| CHP1C3
| CCHPR CONDITION CODE #3 |
|
| CHP1C4
| CCHPR CONDITION CODE #4 |
|
| CHP1C5
| CCHPR CONDITION CODE #5 |
|
| CHP1C6
| CCHPR CONDITION CODE #6 |
|
| CHP1C7
| CCHPR CONDITION CODE #7 |
|
| CHP1C8
| CCHPR CONDITION CODE #8 |
|
| CHP1C9
| CCHPR CONDITION CODE #9 |
|
| CKBX1
| QB4a CHECK BOX1 FOR PRINCIPAL DIAG #1 |
|
| CKBX10
| QB4a CHECK BOX10 FOR PRINCIPAL DIAG #10 |
|
| CKBX11
| QB4a CHECK BOX11 FOR PRINCIPAL DIAG #11 |
|
| CKBX12
| QB4a CHECK BOX12 FOR PRINCIPAL DIAG #12 |
|
| CKBX13
| QB4a CHECK BOX13 FOR PRINCIPAL DIAG #13 |
|
| CKBX14
| QB4a CHECK BOX14 FOR PRINCIPAL DIAG #14 |
|
| CKBX15
| QB4a CHECK BOX15 FOR PRINCIPAL DIAG #15 |
|
| CKBX16
| QB4a CHECK BOX16 FOR PRINCIPAL DIAG #16 |
|
| CKBX17
| QB4a CHECK BOX17 FOR PRINCIPAL DIAG #17 |
|
| CKBX18
| QB4a CHECK BOX18 FOR PRINCIPAL DIAG #18 |
|
| CKBX19
| QB4a CHECK BOX19 FOR PRINCIPAL DIAG #19 |
|
| CKBX2
| QB4a CHECK BOX2 FOR PRINCIPAL DIAG #2 |
|
| CKBX20
| QB4a CHECK BOX20 FOR PRINCIPAL DIAG #20 |
|
| CKBX21
| QB4a CHECK BOX21 FOR PRINCIPAL DIAG #21 |
|
| CKBX3
| QB4a CHECK BOX3 FOR PRINCIPAL DIAG #3 |
|
| CKBX4
| QB4a CHECK BOX4 FOR PRINCIPAL DIAG #4 |
|
| CKBX5
| QB4a CHECK BOX5 FOR PRINCIPAL DIAG #5 |
|
| CKBX6
| QB4a CHECK BOX6 FOR PRINCIPAL DIAG #6 |
|
| CKBX7
| QB4a CHECK BOX7 FOR PRINCIPAL DIAG #7 |
|
| CKBX8
| QB4a CHECK BOX8 FOR PRINCIPAL DIAG #8 |
|
| CKBX9
| QB4a CHECK BOX9 FOR PRINCIPAL DIAG #9 |
|
| COPAYAMT
| QC7c CO-PAYMENT AMOUNT |
|
| COVAID
| QC7ab INSURANCE PLAN - MEDICAID |
|
| COVCARE
| QC7aa INSURANCE PLAN - MEDICARE |
|
| COVCHAM
| QC7ae INSURANCE PLAN - CHAMPVA/CHAMPUS |
|
| COVOTHR
| QC7ag INSURANCE PLAN - OTHER |
|
| COVOTOS
| QC7ag INSURANCE PLAN - OTHER (SPECIFY) |
|
| COVPINS
| QC7ac INSURANCE PLAN - PRIVATE INS |
|
| COVVA
| QC7ad INSURANCE PLAN - VA |
|
| COVWORK
| QC7af INSURANCE PLAN - WORKERS COMP |
|
| CPAYAID
| QC7dc CO-PAYMENT - MEDICAID |
|
| CPAYCARE
| QC7db CO-PAYMENT - MEDICARE |
|
| CPAYOTHR
| QC7de CO-PAYMENT - OTHER |
|
| CPAYOTOS
| QC7de CO-PAYMENT - OTHER (SPECIFY) |
|
| CPAYPAT
| QC7da CO-PAYMENT - PATIENT |
|
| CPAYPINS
| QC7dd CO-PAYMENT - PRIVATE INS |
|
| DISCAID
| QC6b ADJUST/DISCOUNT - MEDICAID |
|
| DISCARE
| QC6a ADJUST/DISCOUNT - MEDICARE |
|
| DISCNT
| QC6c ADJUST/DISCOUNT -CONTRACT AGREEMENT |
|
| DISCRTS
| QC6d ADJUST/DISCOUNT - COURTESY DISCOUNT |
|
| DISINSU
| QC6e ADJUST/DISCOUNT -INSURANCE WRITEOFF |
|
| DISOTH
| QC6h ADJUST/DISCOUNT - OTHER |
|
| DISOTOS
| QC6h ADJUST/DISCOUNT - OTHER (SPECIFY) |
|
| DISWORK
| QC6f ADJUST/DISCOUNT - WORKERS COMP |
|
| DUPERSID
| PUBLIC USE PERSON ID (DUID + PID) |
Identifiers |
| ELIGVET
| QC6g ADJUST/DISCOUNT - ELIGIBLE VETERAN |
|
| EPAYAID
| QC6k EXPECTS ADD PAYMENT - MEDICAID |
|
| EPAYCAR
| QC6j EXPECTS ADD PAYMENT - MEDICARE |
|
| EPAYCHAM
| QC6n EXPECTS ADD PAYMENT-CHAMPVA/CHAMPUS |
|
| EPAYOTH
| QC6p EXPECTS ADD PAYMENT - OTHER |
|
| EPAYOTOS
| QC6p EXPECTS ADD PAYMENT-OTHER (SPECIFY) |
|
| EPAYPAT
| QC6i EXPECTS ADD PAYMENT - PATIENT |
|
| EPAYPINS
| QC6l EXPECTS ADD PAYMENT - PRIVATE INS |
|
| EPAYVA
| QC6m EXPECTS ADD PAYMENT - VA |
|
| EPAYWORK
| QC6o EXPECTS ADD PAYMENT - WORKERS COMP |
|
| EVNTBEGD
| QB1/B6c EVENT DATE - DAY |
|
| EVNTBEGM
| QB1/B6c EVENT DATE - MONTH |
|
| EVNTBEGY
| QB1/B6c EVENT DATE - YEAR |
|
| EVNTTYPE
| EVENT TYPE |
|
| FEEORCAP
| QC3 FEE FOR SERVICE OR CAPITATED BASIS |
|
| FORMID
| UNIQUE FORM IDENTIFIER |
|
| FORMNUM
| COVER SHEET - FORM NUMBER OF THE TOTAL |
|
| FORMTOT
| COVER SHEET - TOTAL NUMBER OF FORMS |
|
| GFEEBEGD
| QB2b GLOBAL FEE DATE - DAY |
|
| GFEEBEGM
| QB2b GLOBAL FEE DATE - MONTH |
|
| GFEEBEGY
| QB2b GLOBAL FEE DATE - YEAR |
|
| GFEEFUTS
| QB2d FUTURE SERVICES BY THIS GLOBAL FEE |
|
| GFTYPE
| QB2c TYPE OF EVENT IN THIS GLOBAL FEE |
|
| GLOFEE
| QB2a GLOBAL FEE VISIT |
|
| GOTORVIS
| BOX2 FILTER ON GLOBAL FEE/NUMBR OF EVNTS |
|
| HHRKUID
| COVER SHEET - PATIENT ID |
|
| ICDCND1
| QB4a ORIG ICD9 CONDITION CODE #1 |
|
| ICDCND10
| QB4a ORIG ICD9 CONDITION CODE #10 |
|
| ICDCND11
| QB4a ORIG ICD9 CONDITION CODE #11 |
|
| ICDCND12
| QB4a ORIG ICD9 CONDITION CODE #12 |
|
| ICDCND13
| QB4a ORIG ICD9 CONDITION CODE #13 |
|
| ICDCND14
| QB4a ORIG ICD9 CONDITION CODE #14 |
|
| ICDCND15
| QB4a ORIG ICD9 CONDITION CODE #15 |
|
| ICDCND16
| QB4a ORIG ICD9 CONDITION CODE #16 |
|
| ICDCND17
| QB4a ORIG ICD9 CONDITION CODE #17 |
|
| ICDCND18
| QB4a ORIG ICD9 CONDITION CODE #18 |
|
| ICDCND19
| QB4a ORIG ICD9 CONDITION CODE #19 |
|
| ICDCND2
| QB4a ORIG ICD9 CONDITION CODE #2 |
|
| ICDCND20
| QB4a ORIG ICD9 CONDITION CODE #20 |
|
| ICDCND21
| QB4a ORIG ICD9 CONDITION CODE #21 |
|
| ICDCND3
| QB4a ORIG ICD9 CONDITION CODE #3 |
|
| ICDCND4
| QB4a ORIG ICD9 CONDITION CODE #4 |
|
| ICDCND5
| QB4a ORIG ICD9 CONDITION CODE #5 |
|
| ICDCND6
| QB4a ORIG ICD9 CONDITION CODE #6 |
|
| ICDCND7
| QB4a ORIG ICD9 CONDITION CODE #7 |
|
| ICDCND8
| QB4a ORIG ICD9 CONDITION CODE #8 |
|
| ICDCND9
| QB4a ORIG ICD9 CONDITION CODE #9 |
|
| ICDPDS1
| QB4a ORIG TEXT DESC FOR DIAGNOSIS #1 |
|
| ICDPDS10
| QB4a ORIG TEXT DESC FOR DIAGNOSIS #10 |
|
| ICDPDS11
| QB4a ORIG TEXT DESC FOR DIAGNOSIS #11 |
|
| ICDPDS12
| QB4a ORIG TEXT DESC FOR DIAGNOSIS #12 |
|
| ICDPDS13
| QB4a ORIG TEXT DESC FOR DIAGNOSIS #13 |
|
| ICDPDS14
| QB4a ORIG TEXT DESC FOR DIAGNOSIS #14 |
|
| ICDPDS15
| QB4a ORIG TEXT DESC FOR DIAGNOSIS #15 |
|
| ICDPDS16
| QB4a ORIG TEXT DESC FOR DIAGNOSIS #16 |
|
| ICDPDS17
| QB4a ORIG TEXT DESC FOR DIAGNOSIS #17 |
|
| ICDPDS18
| QB4a ORIG TEXT DESC FOR DIAGNOSIS #18 |
|
| ICDPDS19
| QB4a ORIG TEXT DESC FOR DIAGNOSIS #19 |
|
| ICDPDS2
| QB4a ORIG TEXT DESC FOR DIAGNOSIS #2 |
|
| ICDPDS20
| QB4a ORIG TEXT DESC FOR DIAGNOSIS #20 |
|
| ICDPDS21
| QB4a ORIG TEXT DESC FOR DIAGNOSIS #21 |
|
| ICDPDS3
| QB4a ORIG TEXT DESC FOR DIAGNOSIS #3 |
|
| ICDPDS4
| QB4a ORIG TEXT DESC FOR DIAGNOSIS #4 |
|
| ICDPDS5
| QB4a ORIG TEXT DESC FOR DIAGNOSIS #5 |
|
| ICDPDS6
| QB4a ORIG TEXT DESC FOR DIAGNOSIS #6 |
|
| ICDPDS7
| QB4a ORIG TEXT DESC FOR DIAGNOSIS #7 |
|
| ICDPDS8
| QB4a ORIG TEXT DESC FOR DIAGNOSIS #8 |
|
| ICDPDS9
| QB4a ORIG TEXT DESC FOR DIAGNOSIS #9 |
|
| ICDPRC1
| ORIG ICD9 PROCEDURE CODE #1 |
|
| ICDPRC10
| ORIG ICD9 PROCEDURE CODE #10 |
|
| ICDPRC11
| ORIG ICD9 PROCEDURE CODE #11 |
|
| ICDPRC12
| ORIG ICD9 PROCEDURE CODE #12 |
|
| ICDPRC13
| ORIG ICD9 PROCEDURE CODE #13 |
|
| ICDPRC14
| ORIG ICD9 PROCEDURE CODE #14 |
|
| ICDPRC15
| ORIG ICD9 PROCEDURE CODE #15 |
|
| ICDPRC16
| ORIG ICD9 PROCEDURE CODE #16 |
|
| ICDPRC17
| ORIG ICD9 PROCEDURE CODE #17 |
|
| ICDPRC18
| ORIG ICD9 PROCEDURE CODE #18 |
|
| ICDPRC19
| ORIG ICD9 PROCEDURE CODE #19 |
|
| ICDPRC2
| ORIG ICD9 PROCEDURE CODE #2 |
|
| ICDPRC20
| ORIG ICD9 PROCEDURE CODE #20 |
|
| ICDPRC21
| ORIG ICD9 PROCEDURE CODE #21 |
|
| ICDPRC3
| ORIG ICD9 PROCEDURE CODE #3 |
|
| ICDPRC4
| ORIG ICD9 PROCEDURE CODE #4 |
|
| ICDPRC5
| ORIG ICD9 PROCEDURE CODE #5 |
|
| ICDPRC6
| ORIG ICD9 PROCEDURE CODE #6 |
|
| ICDPRC7
| ORIG ICD9 PROCEDURE CODE #7 |
|
| ICDPRC8
| ORIG ICD9 PROCEDURE CODE #8 |
|
| ICDPRC9
| ORIG ICD9 PROCEDURE CODE #9 |
|
| ICDPRCPR
| PRINCIPAL ICD9 PROCEDURE CODE |
|
| ICDPRIN
| QB4b PRINCIPAL DIAGNOSIS |
|
| MCPT1
| QB5a ORIG CPT4 PROCEDURE CODE #1 |
|
| MCPT10
| QB5a ORIG CPT4 PROCEDURE CODE #10 |
|
| MCPT11
| QB5a ORIG CPT4 PROCEDURE CODE #11 |
|
| MCPT12
| QB5a ORIG CPT4 PROCEDURE CODE #12 |
|
| MCPT13
| QB5a ORIG CPT4 PROCEDURE CODE #13 |
|
| MCPT14
| QB5a ORIG CPT4 PROCEDURE CODE #14 |
|
| MCPT15
| QB5a ORIG CPT4 PROCEDURE CODE #15 |
|
| MCPT16
| QB5a ORIG CPT4 PROCEDURE CODE #16 |
|
| MCPT17
| QB5a ORIG CPT4 PROCEDURE CODE #17 |
|
| MCPT18
| QB5a ORIG CPT4 PROCEDURE CODE #18 |
|
| MCPT19
| QB5a ORIG CPT4 PROCEDURE CODE #19 |
|
| MCPT2
| QB5a ORIG CPT4 PROCEDURE CODE #2 |
|
| MCPT20
| QB5a ORIG CPT4 PROCEDURE CODE #20 |
|
| MCPT21
| QB5a ORIG CPT4 PROCEDURE CODE #21 |
|
| MCPT22
| QB5a ORIG CPT4 PROCEDURE CODE #22 |
|
| MCPT23
| QB5a ORIG CPT4 PROCEDURE CODE #23 |
|
| MCPT3
| QB5a ORIG CPT4 PROCEDURE CODE #3 |
|
| MCPT4
| QB5a ORIG CPT4 PROCEDURE CODE #4 |
|
| MCPT5
| QB5a ORIG CPT4 PROCEDURE CODE #5 |
|
| MCPT6
| QB5a ORIG CPT4 PROCEDURE CODE #6 |
|
| MCPT7
| QB5a ORIG CPT4 PROCEDURE CODE #7 |
|
| MCPT8
| QB5a ORIG CPT4 PROCEDURE CODE #8 |
|
| MCPT9
| QB5a ORIG CPT4 PROCEDURE CODE #9 |
|
| MCPTCH1
| QB5b CHARGE FOR SERVICE #1 |
|
| MCPTCH10
| QB5b CHARGE FOR SERVICE #10 |
|
| MCPTCH11
| QB5b CHARGE FOR SERVICE #11 |
|
| MCPTCH12
| QB5b CHARGE FOR SERVICE #12 |
|
| MCPTCH13
| QB5b CHARGE FOR SERVICE #13 |
|
| MCPTCH14
| QB5b CHARGE FOR SERVICE #14 |
|
| MCPTCH15
| QB5b CHARGE FOR SERVICE #15 |
|
| MCPTCH16
| QB5b CHARGE FOR SERVICE #16 |
|
| MCPTCH17
| QB5b CHARGE FOR SERVICE #17 |
|
| MCPTCH18
| QB5b CHARGE FOR SERVICE #18 |
|
| MCPTCH19
| QB5b CHARGE FOR SERVICE #19 |
|
| MCPTCH2
| QB5b CHARGE FOR SERVICE #2 |
|
| MCPTCH20
| QB5b CHARGE FOR SERVICE #20 |
|
| MCPTCH21
| QB5b CHARGE FOR SERVICE #21 |
|
| MCPTCH22
| QB5b CHARGE FOR SERVICE #22 |
|
| MCPTCH23
| QB5b CHARGE FOR SERVICE #23 |
|
| MCPTCH3
| QB5b CHARGE FOR SERVICE #3 |
|
| MCPTCH4
| QB5b CHARGE FOR SERVICE #4 |
|
| MCPTCH5
| QB5b CHARGE FOR SERVICE #5 |
|
| MCPTCH6
| QB5b CHARGE FOR SERVICE #6 |
|
| MCPTCH7
| QB5b CHARGE FOR SERVICE #7 |
|
| MCPTCH8
| QB5b CHARGE FOR SERVICE #8 |
|
| MCPTCH9
| QB5b CHARGE FOR SERVICE #9 |
|
| MCPTDS1
| QB5a DESCRIPTION OF SERVICE #1 |
|
| MCPTDS10
| QB5a DESCRIPTION OF SERVICE #10 |
|
| MCPTDS11
| QB5a DESCRIPTION OF SERVICE #11 |
|
| MCPTDS12
| QB5a DESCRIPTION OF SERVICE #12 |
|
| MCPTDS13
| QB5a DESCRIPTION OF SERVICE #13 |
|
| MCPTDS14
| QB5a DESCRIPTION OF SERVICE #14 |
|
| MCPTDS15
| QB5a DESCRIPTION OF SERVICE #15 |
|
| MCPTDS16
| QB5a DESCRIPTION OF SERVICE #16 |
|
| MCPTDS17
| QB5a DESCRIPTION OF SERVICE #17 |
|
| MCPTDS18
| QB5a DESCRIPTION OF SERVICE #18 |
|
| MCPTDS19
| QB5a DESCRIPTION OF SERVICE #19 |
|
| MCPTDS2
| QB5a DESCRIPTION OF SERVICE #2 |
|
| MCPTDS20
| QB5a DESCRIPTION OF SERVICE #20 |
|
| MCPTDS21
| QB5a DESCRIPTION OF SERVICE #21 |
|
| MCPTDS22
| QB5a DESCRIPTION OF SERVICE #22 |
|
| MCPTDS23
| QB5a DESCRIPTION OF SERVICE #23 |
|
| MCPTDS3
| QB5a DESCRIPTION OF SERVICE #3 |
|
| MCPTDS4
| QB5a DESCRIPTION OF SERVICE #4 |
|
| MCPTDS5
| QB5a DESCRIPTION OF SERVICE #5 |
|
| MCPTDS6
| QB5a DESCRIPTION OF SERVICE #6 |
|
| MCPTDS7
| QB5a DESCRIPTION OF SERVICE #7 |
|
| MCPTDS8
| QB5a DESCRIPTION OF SERVICE #8 |
|
| MCPTDS9
| QB5a DESCRIPTION OF SERVICE #9 |
|
| MORECAID
| QC6t PAYMENT>CHARGES - MEDICAID |
|
| MORECARE
| QC6s PAYMENT>CHARGES - MEDICARE |
|
| MOREPINS
| QC6u PAYMENT>CHARGES - PRIVATE INS |
|
| MPSID
| UNIQUE MPS IDENTIFIER |
|
| MPSTYPE
| SINGLE, GLOBAL, OR REPEAT VISIT EVENT |
|
| NOICDPRN
| NO PRINCIPAL DIAGNOSIS CHECKED |
|
| OTHAID
| QC7fc SOURCE OF PAYMENT - MEDICAID |
|
| OTHCARE
| QC7fb SOURCE OF PAYMENT - MEDICARE |
|
| OTHCHAM
| QC7ff SOURCE OF PAYMENT -CHAMPVA/CHAMPUS |
|
| OTHIDVIS
| QB6a OTHER IDENTICAL VISITS |
|
| OTHOTHR
| QC7fh SOURCE OF PAYMENT - OTHER |
|
| OTHOTOS
| QC7fh SOURCE OF PAYMENT -OTHER (SPECIFY) |
|
| OTHPAT
| QC7fa SOURCE OF PAYMENT - PATIENT |
|
| OTHPAY
| QC7e ANY OTHER PAYMENTS |
|
| OTHPINS
| QC7fd SOURCE OF PAYMENT - PRIVATE INS |
|
| OTHRPAYM
| QC4h SOURCE OF PAYMENT - OTHER |
|
| OTHVA
| QC7fe SOURCE OF PAYMENT - VA |
|
| OTHWORK
| QC7fg SOURCE OF PAYMENT - WORKERS COMP |
|
| OTPAYMOS
| QC4h SOURCE OF PAYMENT - OTHER (SPECIFY) |
|
| PAIRID
| PERSON PROVIDER RU LEVEL IDENTIFIER |
|
| PATPAYM
| QC4a SOURCE OF PAYMENT - PATIENT |
|
| PAYMOTH
| QC6v PAYMENT>CHARGES - OTHER |
|
| PAYMOTOS
| QC6v PAYMENT>CHARGES - OTHER (SPECIFY) |
|
| PDDIRID
| COVER SHEET - PROVIDER DIRECTORY ID |
|
| PERSID
| CONFIDENTIAL INTERNAL USE ONLY PERSON ID |
Identifiers |
| PINSPAYM
| QC4d SOURCE OF PAYMENT - PRIVATE INS |
|
| PROVNAME
| COVER SHEET - PROVIDER NAME |
|
| RCSPC
| QB3 OTHER SVCE SOMEWHERE ELSE (SPECIFY) |
|
| RCSRV
| QB3 TYPE OF MEDICAL SERVICE RECEIVED |
|
| SLIDSCA
| QC6q CHARITY CARE OR SLIDING SCALE |
|
| TOTLCHRG
| QC2 TOTAL CHARGES |
|
| TOTLPAYM
| QC5 TOTAL PAYMENTS |
|
| VAPAYM
| QC4e SOURCE OF PAYMENT - VA |
|
| VISNUM
| QB6b NUMBER OF OTHER IDENTICAL VISITS |
|
| WHSPC
| QB2c EVENT TYPE IN GLOBAL FEE (SPECIFY) |
|
| WORKPAYM
| QC4g SOURCE OF PAYMENT - WORKERS COMP |
|
540 Gaither Road Rockville, MD 20850