Revenue Center IDE, NDC, UPC Number

Variable Name :IDENDC{x} where { x } ranges from 1 to 58    

Label : Revenue Center IDE, NDC, UPC Number where { x } ranges from 1 to 58
 Effective with Version H, the exemption number assigned by the Food and Drug Administration (FDA) to an investigational device after a manufacturer has been approved by FDA to conduct a clinical trial on that device. HCFA established a new policy of covering certain IDE's which was implemented in claims processing on 10/1/96 (which is NCH weekly process 10/4/96) for service dates beginning 10/1/95. IDE's are always associated with revenue center code '0624'. NOTE1: Prior to Version H a 'dummy' revenue center code '0624' trailer was created to store IDE's. The IDE number was housed in two fields: HCPCS code and HCPCS initial modifier; the second modifier contained the value 'ID'. There can be up to 7 distinct IDE numbers associated with an '0624' dummy trailer. During the Version H conversion IDE's were moved from the dummy '0624' trailer to this dedicated field. NOTE2: Effective with Version 'I', this field was renamed to eventually accommodate the National Drug (NDC) and the Universal Product Code (UPC). This field could contain either of these 3 fields (there would never be an instance where more than one would come in on a claim). The size of this field was expanded to X(24) to accommodate either of the new fields (under Version 'H' it was X(7). DATA ANAMOLY/LIMITATION: During an CWFMQA review an edit revealed the IDE was missing. The problem occurs in claim with an NCH weekly process dates of 6/9/00 through 9/8/00. During processing of the new format the program receives the IDE but then blanked out the data. 

DB2 ALIAS: IDE_NDC_UPC_NUM SAS ALIAS: IDENDC 

STANDARD ALIAS: REV_CNTR_IDE_NDC_UPC_NUM 

TITLE ALIAS: IDE_NDC_UPC 

SOURCE: CWF

Variable Name : RVUNT{x} where { x } ranges from 1 to 58    

Label :Revenue Center Unit Count
A quantitative measure (unit) of the number of times the service or procedure being reported was performed to the revenue center/HCPCS code definition as described an institutional claim. Depending on type of service, units are measured by of covered days in a particular accommodation, pints of blood, emergency room visits, clinic visits, dialysis treatments (sessions or days), outpatient therapy visits, and outpatient clinical diagnostic laboratory tests. 
NOTE1: When revenue center code = '0022' (SNF PPS) the unit count will reflect the number of covered days for each HIPPS code and, if applicable, the number of visits for each rehab therapy code. 
7 DIGITS SIGNED 
DB2 ALIAS: REV_CNTR_UNIT_CNT 
SAS ALIAS: REV_UNIT STANDARD ALIAS: REV_CNTR_UNIT_CNT 
TITLE ALIAS: UNITS 
SOURCE: CWF 

Revenue Center Payment Method Indicator Code

Variable Name : MDFCD1{x} where { x } ranges from 1 to 58

Label : Revenue Center HCPCS Initial Modifier Code

A first modifier to the procedure code to enable a more specific procedure identification for the claim. DB2 ALIAS: REV_HCPCS_MDFR_CD SAS ALIAS: MDFR_CD1 

STANDARD ALIAS: REV_CNTR_HCPCS_INITL_MDFR_CD 

TITLE ALIAS: INITIAL_MODIFIER 

EDIT-RULES: Carrier Information File 

 COMMENT: Prior to Version H this field was named: HCPCS_INITL_MDFR_CD. With Version H, a prefix was added to denote the location of this field on each claim type (institutional: REV_CNTR and non-institutional: LINE). 

 SOURCE: CWF

 

Variable Name : MDFCD2{x} where { x } ranges from 1 to 58   

Label : Revenue Center HCPCS Second Modifier Code

A second modifier to the procedure code to make it more specific than the first modifier code to identify the procedures performed on the beneficiary for the claim. 

DB2 ALIAS: REV_HCPCS_2ND_CD 

SAS ALIAS: MDFR_CD2 

STANDARD ALIAS: REV_CNTR_HCPCS_2ND_MDFR_CD

TITLE ALIAS: SECOND_MODIFIER EDIT-RULES: CARRIER INFORMATION FILE COMMENT: Prior to Version H this field was named: HCPCS_2ND_MDFR_CD. With Version H, a prefix was added to denote the location of this field on each claim type (institutional: REV_CNTR and non-institutional: LINE). SOURCE: CWF

Variable Name : MDFCD3{x} where { x } ranges from 1 to 58   

Label : Revenue Center HCPCS Third Modifier Code

 Effective with Version I, a third modifier to the procedure code to make it more specific than the second modifier code to identify the procedures performed on the beneficiary for the claim. 

DB2 ALIAS: REV_HCPCS_3RD_CD 

SAS ALIAS: MDFR_CD3 

STANDARD ALIAS: REV_CNTR_HCPCS_3RD_MDFR_CD 

TITLE ALIAS: THIRD_MODIFIER EDIT-RULES: CARRIER INFORMATION FILE 

COMMENT: NOTE: Beginning with NCH weekly process date 8/18/00, this field will be populated with data. Claims processed prior to 8/18/00 will contain spaces in this field.

 SOURCE: CWF

Variable Name : MDFCD4{x} where { x } ranges from 1 to 58

Label : Revenue Center HCPCS Fourth Modifier Code 
 Effective with Version I, a fourth modifier to the procedure code to make it more specific than the third modifier code to identify the procedures performed on the beneficiary for the claim. 

DB2 ALIAS: REV_HCPCS_4TH_CD 

SAS ALIAS: MDFR_CD4 

STANDARD ALIAS: REV_CNTR_HCPCS_4TH_MDFR_CD 

TITLE ALIAS: FOURTH_MODIFIER EDIT-RULES: CARRIER INFORMATION FILE 

COMMENT: NOTE: Beginning with NCH weekly process date 8/18/00, this field will be populated with data. Claims processed prior to 8/18/00 will contain spaces in this field. 

SOURCE: CWF

Variable Name : MDFCD5{x}where { x } ranges from 1 to 58   

Label : Revenue Center HCPCS Fifth Modifier Code
 Effective with Version I, a fifth modifier to the procedure code to make it more specific than the fourth modifier code to identify the procedures performed on the beneficiary for the claim. 

DB2 ALIAS: REV_HCPCS_5TH_CD 

SAS ALIAS: MDFR_CD5 

STANDARD ALIAS: REV_CNTR_HCPCS_5TH_MDFR_CD

TITLE ALIAS: FIFTH_MODIFIER EDIT-RULES: CARRIER INFORMATION FILE 

COMMENT: NOTE: Beginning with NCH weekly process date 8/18/00, this field will be populated with data. Claims processed prior to 8/18/00 will contain spaces in this field. 

SOURCE: CWF

Variable Name : PMTTHD{x} where { x } ranges from 1 to 58   

Label : Revenue Center HCPCS Fifth Modifier Code

Effective with Version I, a fifth modifier to the procedure code to make it more specific than the fourth modifier code to identify the procedures performed on the beneficiary for the claim. 
DB2 ALIAS: REV_HCPCS_5TH_CD 
SAS ALIAS: MDFR_CD5 
STANDARD ALIAS: REV_CNTR_HCPCS_5TH_MDFR_CD 
TITLE ALIAS: FIFTH_MODIFIER EDIT-RULES: CARRIER INFORMATION FILE 
COMMENT: NOTE: Beginning with NCH weekly process date 8/18/00, this field will be populated with data. Claims processed prior to 8/18/00 will contain spaces in this field. 
SOURCE: CWF 

Variable Name : PMTTHD{x} where { x } ranges from 1 to 58    

Label : Revenue Center Payment Method Indicator Code
 Effective with Version 'I', the code used to identify how the service is priced for payment. This field is made up of two pieces of data, 1st position being the service indicator and the 2nd position being the payment indicator. NOTE: Beginning with NCH weekly process date 8/18/00, this field will be populated with data. Claims processed prior to 8/18/00 will contain spaces in this field. 

DB2 ALIAS: REV_PMT_MTHD_CD SAS ALIAS: PMTMTHD 

STANDARD ALIAS: REV_CNTR_PMT_MTHD_IND_CD 

SYSTEM ALIAS: LTPMTHD 

TITLE ALIAS: PMT_MTHD CODES: REFER TO: REV_CNTR_PMT_MTHD_IND_TB IN THE CODES APPENDIX

 SOURCE: CWF

NCH Span Trailer Indicator Code

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

Label :  Effective with Version H, the code indicating the presence of a span code trailer. 

NOTE: During the Version H conversion this field was populated throughout history (back to service year 1991). 

DB2 ALIAS: SPAN_TRLR_IND_CD 

SAS ALIAS: SPANIND STANDARD ALIAS: NCH_SPAN_TRLR_IND_CD CODES: S = Span code trailer present 

SOURCE: NCH

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

 

Label : Claim Occurrence Span Code 

 The 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).

DB2 ALIAS: CLM_OCRNC_SPAN_CD 

SAS ALIAS: SPAN_CD STANDARD ALIAS: CLM_OCRNC_SPAN_CD SYSTEM ALIAS: LTSPAN 

TITLE ALIAS: SPAN_CD CODES: REFER TO: CLM_OCRNC_SPAN_TB IN THE CODES APPENDIX 

SOURCE: CWF

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

 

Label :Claim Occurrence Span From Date

 The from date of a period associated with an occurrence of a specific event relating to an institutional claim that may affect payer processing. 8 DIGITS UNSIGNED 

DB2 ALIAS: OCRNC_SPAN_FROM_DT SAS ALIAS: SPANFROM STANDARD ALIAS: CLM_OCRNC_SPAN_FROM_DT

 TITLE ALIAS: SPAN_FROM_DT EDIT-RULES: YYYYMMDD 

SOURCE: CWF 

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

 

Label :Claim Occurrence Span Through Date

 The thru date of a period associated with an occurrence of a specific event relating to an institutional claim that may affect payer processing. 8 DIGITS UNSIGNED 

DB2 ALIAS: OCRNC_SPAN_THRU_DT 

SAS ALIAS: SPANTHRU 

STANDARD ALIAS: CLM_OCRNC_SPAN_THRU_DT 

TITLE ALIAS: SPAN_THRU_DT EDIT-RULES: YYYYMMDD

 SOURCE: CWF 

Variable Name : VALIND{x} where { x } ranges from 1 to 36

 

Label :NCH Value Trailer Indicator Code

Effective with Version H, the code indicating the presence of a value code trailer. NOTE: During the Version H conversion this field was populated throughout history (back to service year 1991).

 DB2 ALIAS: VAL_TRLR_IND_CD 

SAS ALIAS: VALIND 

STANDARD ALIAS: NCH_VAL_TRLR_IND_CD CODES: V = Value code trailer present 

SOURCE: NCH 

Variable Name : VAL_CD{x} where { x } ranges from 1 to 36

  

Label :Claim Value Code

 The code indicating the value of a monetary condition which was used by the intermediary to process an institutional claim. DB2 ALIAS: CLM_VAL_CD SAS ALIAS: VAL_CD 

STANDARD ALIAS: CLM_VAL_CD 

SYSTEM ALIAS: LTVALUE 

TITLE ALIAS: VALUE_CD 

CODES: REFER TO: CLM_VAL_TB IN THE CODES 

APPENDIX 

SOURCE: CWF 

Variable Name :  VALAMT{x} where { x } ranges from 1 to 36

  

Label :Claim Value Amount

 The amount related to the condition identified in the CLM_VAL_CD which was used by the intermediary to process the institutional claim. 9.2 DIGITS SIGNED 

DB2 ALIAS: CLM_VAL_AMT 

SAS ALIAS: VAL_AMT 

STANDARD ALIAS: CLM_VAL_AMT 

TITLE ALIAS: VALUE_AMOUNT EDIT-RULES: $$$$$$$$$CC 

SOURCE: CWF