Claim Demonstration Information Text

Variable Name: DEMOTXT{x}  where { x } ranges from 1 to 5 

Label: Claim Demonstration Information Text

Effective with Version H, the text field that contains related demo information. For example, a claim involving a CHOICES demo id '05' would contain the MCO plan contract number in the first five positions of this text field. NOTE: During the Version H conversion this field was populated with data throughout history. DB2 ALIAS: CLM_DEMO_INFO_TXT SAS ALIAS: DEMOTXT STANDARD ALIAS: CLM_DEMO_INFO_TXT TITLE ALIAS: DEMO_INFO DERIVATION: DERIVATION RULES: Demo ID = 01 (RUGS) -- the text field will contain a 2, 3 or 4 to denote the RUGS phase. If RUGS phase is blank or not one of the above the text field will reflect 'INVALID'. NOTE: In Version 'G', RUGS phase was stored in redefined Claim Edit Group, 3rd occurrence, 4th position. Demo ID = 02 (Home Health demo) -- the text field will contain PROV#. When demo number not equal to 02 then text will reflect 'INVALID'. Demo ID = 03 (Telemedicine demo) -- text field will contain the HCPCS code. If the required HCPCS is not shown then the text field will reflect 'INVALID'. Demo ID = 04 (UMWA) -- text field will contain W0 denoting that condition code W0 was present. If condition code W0 not present then the text field will reflect 'INVALID'. Demo ID = 05 (CHOICES) -- the text field will contain the CHOICES plan number, if both of the following conditions are met: (1) CHOICES plan number present and PPS or Inpatient claim shows that 1st 3 positions of provider number as '210' and the admission date is within HMO effective/termination date; or non-PPS claim and the from date is within HMO effective/termination date and (2) CHOICES plan number matches the HMO plan number. If either condition is not met the text field will reflect 'INVALID CHOICES PLAN NUMBER'. When CHOICES plan number not present, text will reflect 'INVALID'. NOTE: In Version 'G', a valid CHOICES plan ID is stored as alpha character in redefined Claim Edit Group, 4th occurrence, 2nd position. If invalid, CHOICES indicator 'ZZ' displayed. Demo ID = 15 (ESRD Managed Care) -- text field will contain the ESRD/MCO plan number. If ESRD/ MCO plan number not present the field will reflect 'INVALID'. Demo ID = 38 (Physician Encounter Claims) -- text field will contain the MCO plan number. When MCO plan number not present the field will reflect 'INVALID'. SOURCE: CWF

Variable Name: DGNSND{x} where { x } ranges from 1 to 10

Label: NCH Diagnosis Trailer Indicator Code

Effective with Version H, the code indicating the presence of a diagnosis trailer. NOTE: During the Version H conversion this field was populated throughout history (back to service year 1991). DB2 ALIAS: DGNS_TRLR_IND_CD SAS ALIAS: DGNSIND STANDARD ALIAS: NCH_DGNS_TRLR_IND_CD CODES: Y = Diagnosis code trailer present SOURCE: NCH 

Variable Name: DGNSCD{x} where { x } ranges from 1 to 10

Label: Claim Diagnosis Code

The ICD-9-CM based code identifying the beneficiary's principal or other diagnosis (including E code). NOTE: Prior to Version H, the principal diagnosis code was not stored with the 'OTHER' diagnosis codes. During the Version H conversion the CLM_PRNCPAL_DGNS_CD was added as the first occurrence. DB2 ALIAS: CLM_DGNS_CD SAS ALIAS: DGNS_CD STANDARD ALIAS: CLM_DGNS_CD TITLE ALIAS: DIAGNOSIS EDIT-RULES: ICD-9-CM COMMENT: Prior to Version H this field was named: CLM_OTHR_DGNS_CD. 

Variable Name: CNDND{x} where { x } ranges from 1 to 30

Label: NCH Condition Trailer Indicator Code

Effective with Version H, the code indicating the presence of a condition code trailer. NOTE: During the Version H conversion this field was populated throughout history (back to service year 1991). DB2 ALIAS: COND_TRLR_IND_CD SAS ALIAS: CONDIND STANDARD ALIAS: NCH_COND_TRLR_IND_CD CODES: C = Condition code trailer present SOURCE: NCH