Master Data Element Dictionary, version 20240608: NCMMIS 2501 - 3000

EDIT ADJUSTMENT REASON CODE END DATE

NCMMIS Number: 2501

Description: Last date that an adjustment reason code is active for an edit code.

Data Type: DATE

Size: X(10)

Functional Area Owner: Reference

Valid Values:

Last Update: 6/1/2010 2:39:54 PM

Edit Category Code

NCMMIS Number: 2502

Description: Edit category code that is used to group edits by by each category

Data Type: CHARACTER

Size: X(2)

Functional Area Owner: Reference

Valid Values:

From Value	Thru Value	Short Description	Long Description

From Value	Thru Value	Short Description	Long Description
BG	BG	BUDGET	BUDGET
CC	CC	CCI	CCI
DC	DC	DUPECHK	DUPLICATE CHECK
DV	DV	DATAVAL	DATA VALIDATION
FA	FA	FINALADJ	FINAL ADJUDICATOR
LT	LT	LIFETIME	LIFETIME
PA	PA	PRIORAPP	PRIOR APPROVAL
PE	PE	PROVELIG	PROIVDER ELIGIBILITY
PR	PR	PRICING	PRICING
RE	RE	RECPELIG	RECIPIENT ELIGIBILITY
RF	RF	REF	REFERENCE
SD	SD	SAMEDOS	SAME DATE OF SERVICE
SL	SL	SVCLIM	SERVICE LIMIT
SY	SY	SYSTEM	SYSTEM
TF	TF	TIMFIL	TIMELY FILING
TP	TP	TPL	TPL
UR	UR	UTILREV	UTILREV

Last Update: 3/12/2021 2:15:27 PM

EDIT CLAIM TYPE END DATE

NCMMIS Number: 2503

Description: Last date that a claim type EOB segment is active for an edit code.

Data Type: DATE

Size: X(10)

Functional Area Owner: Reference

Valid Values:

Last Update: 6/1/2010 2:39:56 PM

EDIT CLAIM TYPE START DATE

NCMMIS Number: 2505

Description: First date that a claim type EOB segment is active for an edit code.

Data Type: DATE

Size: X(10)

Functional Area Owner: Reference

Valid Values:

Last Update: 6/1/2010 2:39:58 PM

EDIT REJECT CODE END DATE

NCMMIS Number: 2506

Description: Last date that a reject code is active for an edit code.

Data Type: DATE

Size: X(10)

Functional Area Owner: Reference

Valid Values:

Last Update: 6/1/2010 2:40:00 PM

Provider Licensing State Code

NCMMIS Number: 2507

Description: Provider Licensing State Code specifies the state that issued a provider's license.

Data Type: CHARACTER

Size: X(2)

Functional Area Owner: Provider

Valid Values:

From Value	Thru Value	Short Description	Long Description

From Value	Thru Value	Short Description	Long Description
AB	AB	ALBERTA	ALBERTA
AK	AK	ALASKA	ALASKA
AL	AL	ALABAMA	ALABAMA
AR	AR	ARKANSAS	ARKANSAS
BC	BC	BRIT COL	BRITISH COLUMBIA
CA	CA	CALIFORNIA	CALIFORNIA
CO	CO	COLORADO	COLORADO
CT	CT	CONNECTICU	CONNECTICUT
DC	DC	DC	DISTRICT OF COLUMBIA
DE	DE	DELAWARE	DELAWARE
FL	FL	FLORIDA	FLORIDA
GA	GA	GEORGIA	GEORGIA
GM	GM	GUAM	GUAM
HI	HI	HAWAII	HAWAII
IA	IA	IOWA	IOWA
ID	ID	IDAHO	IDAHO
IL	IL	ILLINOIS	ILLINOIS
IN	IN	INDIANA	INDIANA
KS	KS	KANSAS	KANSAS
KY	KY	KENTUCKY	KENTUCKY
LA	LA	LOUISIANA	LOUISIANA
MA	MA	MASS.	MASSACHUSETTS
MB	MB	MANITOBA	MANITOBA
MD	MD	MARYLAND	MARYLAND
ME	ME	MAINE	MAINE
MI	MI	MICHIGAN	MICHIGAN
MN	MN	MINNESOTA	MINNESOTA
MO	MO	MISSOURI	MISSOURI
MS	MS	MISSISSIPP	MISSISSIPPI
MT	MT	MONTANA	MONTANA
NB	NB	NEW BRNSWK	NEW BRUNSWICK
NC	NC	N CAROLINA	NORTH CAROLINA
ND	ND	N DAKOTA	NORTH DAKOTA
NE	NE	NEBRASKA	NEBRASKA
NF	NF	NEWFOUNDLD	NEWFOUNDLAND
NH	NH	NEW HAMPSH	NEW HAMPSHIRE
NJ	NJ	NEW JERSEY	NEW JERSEY
NM	NM	NEW MEXICO	NEW MEXICO
NS	NS	NOVA SCOT.	NOVA SCOTIA
NT	NT	NW TERRS.	NORTHWEST TERRITORIES
NV	NV	NEVADA	NEVADA
NY	NY	NEW YORK	NEW YORK
OH	OH	OHIO	OHIO
OK	OK	OKLAHOMA	OKLAHOMA
ON	ON	ONTARIO	ONTARIO
OR	OR	OREGON	OREGON
PA	PA	PENNSYLVN	PENNSYLVANIA
PI	PI	PR EDWD IS	PRINCE EDWARD ISLAND
PR	PR	PUERTO RIC	PUERTO RICO
QB	QB	QUEBEC	QUEBEC
RI	RI	RHODE IS	RHODE ISLAND
SC	SC	S CAROLINA	SOUTH CAROLINA
SD	SD	S DAKOTA	SOUTH DAKOTA
SK	SK	SASKATCHWN	SASKATCHEWAN
TN	TN	TENNESSEE	TENNESSEE
TX	TX	TEXAS	TEXAS
UT	UT	UTAH	UTAH
VA	VA	VIRGINIA	VIRGINIA
VI	VI	VIRGIN IS	VIRGIN ISLANDS
VT	VT	VERMONT	VERMONT
WA	WA	WASHINGTON	WASHINGTON
WI	WI	WISCONSIN	WISCONSIN
WV	WV	W VIRGINIA	WEST VIRGINIA
WY	WY	WYOMING	WYOMING
YK	YK	YUKON	YUKON

Last Update: 3/8/2021 4:19:24 PM

EDIT REJECT CODE START DATE

NCMMIS Number: 2508

Description: First date that a reject code is active for an edit code.

Data Type: DATE

Size: X(10)

Functional Area Owner: Reference

Valid Values:

Last Update: 6/1/2010 2:40:02 PM

EDIT REMARK CODE END DATE

NCMMIS Number: 2509

Description: Last date that a remark code is active for an edit code.

Data Type: DATE

Size: X(10)

Functional Area Owner: Reference

Valid Values:

Last Update: 6/1/2010 2:40:04 PM

EDIT REMARK CODE START DATE

NCMMIS Number: 2510

Description: First date that a remark code is active for an edit code.

Data Type: DATE

Size: X(10)

Functional Area Owner: Reference

Valid Values:

Last Update: 6/1/2010 2:40:06 PM

EDIT STATUS CODE END DATE

NCMMIS Number: 2511

Description: Last date that a status code is active for an edit code.

Data Type: DATE

Size: X(10)

Functional Area Owner: Reference

Valid Values:

Last Update: 6/1/2010 2:40:08 PM

EDIT STATUS CODE START DATE

NCMMIS Number: 2512

Description: First date that a status code is active for an edit code.

Data Type: DATE

Size: X(10)

Functional Area Owner: Reference

Valid Values:

Last Update: 6/1/2010 2:40:10 PM

Edit Suspended Claim End Date

NCMMIS Number: 2513

Description: Last date that a suspended claim routing location segment is active for an edit code.

Data Type: DATE

Size: X(10)

Functional Area Owner: Reference

Valid Values:

Last Update: 6/1/2010 2:40:12 PM

Edit Suspended Claim Start Date

NCMMIS Number: 2514

Description: First date that a suspended claim routing location segment is active for an edit code.

Data Type: DATE

Size: X(10)

Functional Area Owner: Reference

Valid Values:

Last Update: 6/1/2010 2:40:14 PM

Enhanced Therapeutic Classification

NCMMIS Number: 2515

Description: Provides attributes for the therapeutic classification and associates it to its parent therapeutic classification.

Data Type: CHARACTER

Size: X(8)

Functional Area Owner: Reference

Valid Values:

Last Update: 4/2/2010 2:27:47 PM

EOB Code

NCMMIS Number: 2516

Description: EOB Code

Data Type: CHARACTER

Size: X(1)

Functional Area Owner: Reference

Valid Values:

Last Update: 2/8/2010 4:09:51 PM

Family Planning Waiver Indicator

NCMMIS Number: 2517

Description: Indicator that inidcates if the service or diagnosis is related to the family planning waiver.

Data Type: CHARACTER

Size: X(1)

Functional Area Owner: Reference

Valid Values:

From Value	Thru Value	Short Description	Long Description

From Value	Thru Value	Short Description	Long Description
N	N	NOTWAVREL	NOT FAMILY PLANNING WAIVER RELATED
Y	Y	FPWAVREL	FAMILY PLANNING WAIVER RELATED

Last Update: 3/12/2021 2:15:28 PM

FDB UPDATES REJECTED

NCMMIS Number: 2518

Description: Indicates if the drug update process should be bypassed for the drug code.

Data Type: CHARACTER

Size: X(1)

Functional Area Owner: Reference

Valid Values:

From Value	Thru Value	Short Description	Long Description

From Value	Thru Value	Short Description	Long Description
N	N	NO	NO
Y	Y	YES	YES

Last Update: 3/12/2021 2:15:29 PM

Former ICD9 Begin Date

NCMMIS Number: 2519

Description: Former ICD9 Begin Date

Data Type: DATE

Size: X(10)

Functional Area Owner: Reference

Valid Values:

Last Update: 2/8/2010 4:10:18 PM

Former ICD9 End Date

NCMMIS Number: 2520

Description: Former ICD9 End Date

Data Type: DATE

Size: X(10)

Functional Area Owner: Reference

Valid Values:

Last Update: 2/8/2010 4:10:27 PM

Former ICD9 Grouper Version

NCMMIS Number: 2521

Description: Former ICD9 Grouper Version

Data Type: CHARACTER

Size: X(1)

Functional Area Owner: Reference

Valid Values:

Last Update: 2/8/2010 4:10:36 PM

Former ICD9 Procedure Code

NCMMIS Number: 2522

Description: Former ICD9 Procedure Code

Data Type: CHARACTER

Size: X(1)

Functional Area Owner: Reference

Valid Values:

Last Update: 2/8/2010 4:10:45 PM

GC3 Group Clerk ID

NCMMIS Number: 2523

Description: User ID of the user that made the last update to the GC3 Group data.

Data Type: CHARACTER

Size: X(8)

Functional Area Owner: Reference

Valid Values:

Last Update: 5/20/2010 4:29:48 PM

GC3 GROUP EFFECTIVE DATE

NCMMIS Number: 2524

Description: First date that a GC3 code is active for a procedure code.

Data Type: DATE

Size: X(10)

Functional Area Owner: Reference

Valid Values:

Last Update: 6/1/2010 2:40:19 PM

GC3 GROUP END DATE

NCMMIS Number: 2525

Description: Last date that a GC3 code is active for a procedure code.

Data Type: DATE

Size: X(10)

Functional Area Owner: Reference

Valid Values:

Last Update: 6/1/2010 2:40:21 PM

GC3 Group GC3

NCMMIS Number: 2526

Description: GC3 or Specific Therapeutic Class.

Data Type: CHARACTER

Size: X(3)

Functional Area Owner: Reference

Valid Values:

Last Update: 5/20/2010 4:29:52 PM

GC3 Group GC3 Memo Number

NCMMIS Number: 2527

Description: Memo number/CSR number that requested the change.

Data Type: CHARACTER

Size: X(18)

Functional Area Owner: Reference

Valid Values:

Last Update: 5/20/2010 4:29:50 PM

GC3 Group GC3-2

NCMMIS Number: 2528

Description: GC3 or Specific Therapeutic Class.

Data Type: CHARACTER

Size: X(3)

Functional Area Owner: Reference

Valid Values:

Last Update: 2/22/2012 3:29:01 PM

GC3 Group Last Change

NCMMIS Number: 2529

Description: GC3 Group Last Change

Data Type: DATE

Size: X(10)

Functional Area Owner: Reference

Valid Values:

Last Update: 2/8/2010 4:11:58 PM

GC4

NCMMIS Number: 2530

Description: Hierarchical Base Ingredient Code

Data Type: CHARACTER

Size: X(4)

Functional Area Owner: Reference

Valid Values:

Last Update: 2/16/2010 6:06:28 PM

Gender

NCMMIS Number: 2531

Description: Gender

Data Type: CHARACTER

Size: X(1)

Functional Area Owner: Reference

Valid Values:

Last Update: 2/8/2010 4:12:18 PM

TPL - Coverage Client Begin Date

NCMMIS Number: 2532

Description: TPL Coverage Client Begin Date is the effective date of the insurance coverage.

Data Type: DATE

Size: X(10)

Functional Area Owner: Third Party Liability

Valid Values:

Last Update: 3/12/2021 1:35:00 PM

TPL - Coverage Client End Date

NCMMIS Number: 2533

Description: TPL Coverage Client End Date is the last date that a insurance coverage is in effect.

Data Type: DATE

Size: X(10)

Functional Area Owner: Third Party Liability

Valid Values:

Last Update: 3/12/2021 1:32:58 PM

TPL - Employer Address Line

NCMMIS Number: 2537

Description: Employer Address Line is a line in the employer's address.

Data Type: CHARACTER

Size: X(40)

Functional Area Owner: Third Party Liability

Valid Values:

Last Update: 3/12/2021 1:33:57 PM

TPL - Employer City

NCMMIS Number: 2539

Description: The city of the employer's mailing address.

Data Type: CHARACTER

Size: X(25)

Functional Area Owner: Third Party Liability

Valid Values:

Last Update: 3/12/2021 1:34:50 PM

TPL - Employer Name

NCMMIS Number: 2540

Description: Employer Name is the name of a company for which the employee in question is employed.

Data Type: CHARACTER

Size: X(30)

Functional Area Owner: Third Party Liability

Valid Values:

Last Update: 3/12/2021 1:33:09 PM

TPL - Employer Contact Phone Number

NCMMIS Number: 2541

Description: The telephone number of an employer, including the area code, and seven-digit number

Data Type: CHARACTER

Size: X(10)

Functional Area Owner: Third Party Liability

Valid Values:

Last Update: 3/12/2021 1:34:09 PM

Generic Name Indicator

NCMMIS Number: 2543

Description: Specifies whether a product is a brand named or generically named

Data Type: CHARACTER

Size: X(1)

Functional Area Owner: Reference

Valid Values:

From Value	Thru Value	Short Description	Long Description

From Value	Thru Value	Short Description	Long Description
0	0	NONDRG	NON-DRUG ITEM, SUCH AS MED SUPPLIES OR BULK CHEMIC
1	1	GENERIC NM	GENERICALLY NAMED
2	2	BRAND NM	BRAND NAMED

Last Update: 3/12/2021 2:15:30 PM

TPL - Policyholder Address Line

NCMMIS Number: 2546

Description: Policyholder Address Line is an address line for the policyholder of a Third Party Liability (TPL) resource.

Data Type: CHARACTER

Size: X(40)

Functional Area Owner: Third Party Liability

Valid Values:

Last Update: 3/12/2021 1:35:03 PM

TPL - Policyholder City

NCMMIS Number: 2548

Description: Policyholder City specifies the city in a policyholder's address.

Data Type: CHARACTER

Size: X(25)

Functional Area Owner: Third Party Liability

Valid Values:

Last Update: 3/12/2021 1:32:58 PM

TPL - Policyholder First Name

NCMMIS Number: 2549

Description: Policyholder First Name is the first name of a policyholder.

Data Type: CHARACTER

Size: X(20)

Functional Area Owner: Third Party Liability

Valid Values:

Last Update: 3/12/2021 1:34:20 PM

TPL - Policyholder Last Name

NCMMIS Number: 2551

Description: Policyholder Last Name is the last name of a policyholder.

Data Type: CHARACTER

Size: X(25)

Functional Area Owner: Third Party Liability

Valid Values:

Last Update: 3/12/2021 1:35:15 PM

TPL - Policyholder Phone Number

NCMMIS Number: 2552

Description: Policyholder Phone Number is the telephone number of a policyholder, including the area code, and seven-digit number.

Data Type: CHARACTER

Size: X(10)

Functional Area Owner: Third Party Liability

Valid Values:

Last Update: 3/12/2021 1:33:26 PM

TPL - Policy Coverage Code

NCMMIS Number: 2558

Description: Indicates the type of coverage the policy provides for the insured recipient

Data Type: CHARACTER

Size: 2

Functional Area Owner: Third Party Liability

Valid Values:

From Value	Thru Value	Short Description	Long Description

From Value	Thru Value	Short Description	Long Description
01	01	PRACT	PRACTIONER
02	02	CLINIC	CLINIC
03	03	RXDRUGS	PRESCRIPTION DRUGS
04	04	HOSP-IN	INPATIENT HOSPITAL
05	05	HOSP-OUT	OUTPATIENT HOSPITAL
06	06	DENTAL	DENTAL
07	07	LAB-XRAY	LAB-XRAY
08	08	DIAGNOS	DIAGNOS
09	09	HOME-HLTH	HOME HEALTH
10	10	NRSNG-HM	NURSING HOME
11	11	TRANSPRT	MEDICALLY NECESSARY TRANSPORTATION
12	12	DME	DURABLE MEDICAL EQUIPMENT
13	13	OPTICAL	VISION
14	14	PRVN-CARE	PREVENTIVE CARE
15	15	PSYCH-IN	INPATIENT PSYCHIATRIC
16	16	BHAVHLTH	BEHAVIORAL HEALTH
17	17	MATERNITY	MATERNITY
18	18	PODIATRY	PODIATRY
19	19	CHIRO	CHIROPRACTOR
20	20	SUPP MED B	MEDICARE SUPPLEMENTB
21	21	SUPP MED A	MEDICARE SUPPLEMENT A
22	22	CANCER	CANCER
23	23	SURGRY	SURGERY
24	24	ACCIDENT	ACCIDENT
25	25	HEART DIS	HEART DISEASE
26	26	INTSV CR	INTENSIVE CARE
27	27	CSLTY TRMA	CASUALTY/TRAUMA
28	28	COMM HMO	COMMERCIAL HMO
29	29	PHY THRPY	PHYSICAL THERAPY
30	30	OCC THRPY	OCCUPATIONAL THERAPY
31	31	SPH THRPY	SPEECH THERAPY
32	32	PT DTY NRS	PRIVATE DUTY NURSING
33	33	HOSPICE	HOSPICE

Last Update: 3/12/2021 1:30:44 PM

TPL - Policy Group ID

NCMMIS Number: 2560

Description: Policy Group Number is the identification number of a Third Party Liability (TPL) group policy.

Data Type: CHARACTER

Size: X(20)

Functional Area Owner: Third Party Liability

Valid Values:

Last Update: 3/12/2021 1:34:21 PM

TPL Insurance Policy Number

NCMMIS Number: 2561

Description: Third party insurance policy number is the policy number of the third party insurance carrier.

Data Type: CHARACTER

Size: X(16)

Functional Area Owner: Recipient

Valid Values:

Last Update: 6/29/2010 12:55:53 PM

Generic Override Indicator

NCMMIS Number: 2563

Description: Specifies whether or not a generic drug must be purchased to qualify for Medicaid coverage

Data Type: CHARACTER

Size: X(1)

Functional Area Owner: Reference

Valid Values:

From Value	Thru Value	Short Description	Long Description

From Value	Thru Value	Short Description	Long Description
N	N	NO	No Generic Not Required
Y	Y	YES	YES Generic Required

Last Update: 3/12/2021 2:15:31 PM

Financial Reason code

NCMMIS Number: 2566

Description: Financial Reason Code specifies the reason why a financial transaction was submitted.

Data Type: CHARACTER

Size: X(03)

Functional Area Owner: Financial

Valid Values:

Last Update: 3/12/2021 1:58:21 PM

CMS DRUG CATEGORY CODE

NCMMIS Number: 2567

Description: Drug Category Code assigned by CMS

Data Type: CHARACTER

Size: X(1)

Functional Area Owner: Reference

Valid Values:

From Value	Thru Value	Short Description	Long Description

From Value	Thru Value	Short Description	Long Description
space	space	UNSPECIFIE	UNSPECIFIED
I	I	INNOV MULT	INNOVATOR MULTI-SOURCE
N	N	NON-INNOV	NON-INNVATOR MULTI-SOURCE
S	S	SINGLE SRC	SINGLE SOURCE

Last Update: 3/12/2021 2:15:31 PM

HIPP Authorization Indicator

NCMMIS Number: 2568

Description: HIPP Authorization Indicator is set if future payments made to the Health Insurance Premium Payment (HIPP) Payee need to be authorized.

Data Type: CHARACTER

Size: X(1)

Functional Area Owner: Third Party Liability

Valid Values:

From Value	Thru Value	Short Description	Long Description

From Value	Thru Value	Short Description	Long Description
N	N	NO	NO AUTHORIZATION IS REQUIRED
Y	Y	YES	YES AUTHORIZATION IS REQUIRED

Last Update: 3/12/2021 1:30:23 PM

HIPP Begin Date

NCMMIS Number: 2569

Description: HIPP Begin Date is the first date on which a Health Insurance Premium Payment (HIPP) payment can be made.

Data Type: DATE

Size: X(10)

Functional Area Owner: Third Party Liability

Valid Values:

Last Update: 3/12/2021 1:32:46 PM

HIPP End Date

NCMMIS Number: 2570

Description: HIPP End Date is the final date that a Health Insurance Premium Payments (HIPP) payment is to be made.

Data Type: DATE

Size: X(10)

Functional Area Owner: Third Party Liability

Valid Values:

Last Update: 3/12/2021 1:33:21 PM

HCPC J Code

NCMMIS Number: 2571

Description: HCPC J Code - Injectible Drug Procedure Code

Data Type: CHARACTER

Size: X(1)

Functional Area Owner: Reference

Valid Values:

Last Update: 3/12/2021 2:18:28 PM

HIPP Premium Amount

NCMMIS Number: 2573

Description: HIPP Premium Amount is the amount Medicaid pays a policyholder, employer, or insurance company for insurance coverage belonging to a client enrolled in Health Insurance Premium Payments (HIPP).

Data Type: CURRENCY

Size: S9(9)V99

Functional Area Owner: Third Party Liability

Valid Values:

Last Update: 3/12/2021 1:34:41 PM

Health Check Reporting Indicator

NCMMIS Number: 2574

Description: Indicates if the service is HealthCheck related.

Data Type: CHARACTER

Size: X(1)

Functional Area Owner: Reference

Valid Values:

From Value	Thru Value	Short Description	Long Description

From Value	Thru Value	Short Description	Long Description
N	N	NO	NOT HEALTHCHECK RELATED
Y	Y	YES	HEALTHCHECK RELATED

Last Update: 3/12/2021 2:15:32 PM

Hierarchical Ingredient Code HIC Sequence

NCMMIS Number: 2576

Description: Hierarchical Ingredient Code Sequence Number.

Data Type: CHARACTER

Size: X(6)

Functional Area Owner: Reference

Valid Values:

Last Update: 4/25/2012 6:01:03 PM

HICL Sequence Number

NCMMIS Number: 2577

Description: The HICL_SEQNO is associated to one (or many) Clinical Formulation ID (GCN_SEQNO) to identify the active ingredients of the clinical formulation.

Data Type: INTEGER

Size: 9(6)

Functional Area Owner: Reference

Valid Values:

Last Update: 2/16/2010 6:06:34 PM

History Retention Indicator

NCMMIS Number: 2579

Description: Indicator that indicates the length of time a claim remains in history before archiving.

Data Type: CHARACTER

Size: X(1)

Functional Area Owner: Reference

Valid Values:

From Value	Thru Value	Short Description	Long Description

From Value	Thru Value	Short Description	Long Description
A	A	18 MONTHS	18 MONTHS
B	B	3 YEARS	3 YEARS
C	C	2 WEEKS	2 WEEKS
D	D	3 WEEKS	3 WEEKS
E	E	4 YEARS	4 YEARS
F	F	7 YEARS	7 YEARS
T	T	10 YEARS	10 YEARS
X	X	UNLIMITED	UNLIMITED
Y	Y	2 MONTHS	2 MONTHS
1	1	1 DAY	1 DAY
2	2	1 WEEK	1 WEEK
3	3	1 MONTH	1 MONTH
4	4	3 MONTHS	3 MONTHS
5	5	6 MONTHS	6 MONTHS
6	6	1 YEAR	1 YEAR
7	7	2 YEARS	2 YEARS
8	8	5 YEARS	5 YEARS
9	9	LIFETIME	LIFETIME

Last Update: 3/12/2021 2:15:32 PM

ICD-9-CM Acceptance

NCMMIS Number: 2581

Description: Indicates the level of acceptance for a code.

Data Type: CHARACTER

Size: X(1)

Functional Area Owner: Reference

Valid Values:

From Value	Thru Value	Short Description	Long Description

From Value	Thru Value	Short Description	Long Description
A	A	ACCEPT	ACCEPTABLE
C	C	NONCOV	NONCOVERED
F	F	SUBDIV	FURTHER SUBDIVISTION REQUIRED
M	M	MANIF	MANIFESTATION
N	N	NONSPEC	NONSPECIFIC
Q	Q	QUESTION	QUESTIONABLE
U	U	UNACCEPT	UNACCEPTABLE

Last Update: 3/12/2021 2:15:34 PM

Case Payment Group CPG Begin Date

NCMMIS Number: 2585

Description: Case Payment Group (CPG) Begin Date is the first date that a case payment group hospital type is in effect.

Data Type: DATE

Size: X(10)

Functional Area Owner: Claims

Valid Values:

From Value	Thru Value	Short Description	Long Description

From Value	Thru Value	Short Description	Long Description
0001-01-01	0001-01-01	DEFAULT	DEFAULT

Last Update: 3/15/2022 11:46:57 AM

Insurance Type Code

NCMMIS Number: 2586

Description: Description Required

Data Type: CHARACTER

Size: X(3)

Functional Area Owner: Claims

Valid Values:

From Value	Thru Value	Short Description	Long Description

From Value	Thru Value	Short Description	Long Description
12	12	Mcare/Work	Medicare Secondary Working Aged Beneficiary or Spouse with Employer Group Health Plan
13	13	Mcare/ESRD	Medicare Secondary End-Stage Renal Disease Beneficiary in the Mandated Coordination Period with an Employer's Group Health Plan
14	14	Mcare/No F	Medicare Secondary, No-fault Insurance including Auto is Primary
15	15	Mcare/Work	Medicare Secondary Worker's Compensation
16	16	Mcare/PHS	Medicare Secondary Public Health Service (PHS) or Other Federal Agency
41	41	Mcare/Blac	Medicare Secondary Black Lung
42	42	Mcare/VA	Medicare Secondary Veteran's Administration
43	43	Mcare/LGHP	Medicare Secondary Disabled Beneficiary Under Age 65 with Large Group Health Plan (LGHP)
47	47	Mcare/Othe	Medicare Secondary, Other Liability Insurance is Primary

Last Update: 3/15/2022 11:51:54 AM

TPL - Policy Source Code

NCMMIS Number: 2587

Description: TPL Policy Source Code specifies the source from which a policy originated.

Data Type: CHARACTER

Size: X(2)

Functional Area Owner: Third Party Liability

Valid Values:

From Value	Thru Value	Short Description	Long Description

From Value	Thru Value	Short Description	Long Description
A	A	DPH	DEPARTMENT OF PUBLIC HEALTH
B	B	DHB	DIVISION OF HEALTH BENEFITS
C	C	DMH	DEPARTMENT OF MENTAL HEALTH
D	D	LME	LOCAL MANAGEMENT ENTITY
E	E	DSS	DEPARTMENT OF SOCIAL SERVICES
F	F	DEERS/VNDR	DEFENSE ENROLLMENT ELIGIBILITY REPORTING SYSTEM/VENDOR
G	G	ACTS	NC AUTOMATED COLLECTION AND TRACKING SYSTEM
H	H	ATTORNEY	ATTORNEY
I	I	TPLVENDOR	TPL VENDOR

Last Update: 3/12/2021 1:30:23 PM

TPL - Policy Sequence Number

NCMMIS Number: 2588

Description: A system-generated counter that uniquely identifies a policy

Data Type: CHARACTER

Size: X(16)

Functional Area Owner: Third Party Liability

Valid Values:

Last Update: 3/12/2021 1:34:26 PM

TPL - Record Transaction Type Code

NCMMIS Number: 2589

Description: TPL Record Transaction Type Code specifies the type of transaction record received from an external entity.

Data Type: CHARACTER

Size: X(2)

Functional Area Owner: Third Party Liability

Valid Values:

From Value	Thru Value	Short Description	Long Description

From Value	Thru Value	Short Description	Long Description
IN	IN	INS	INSURANCE RECORD
M	M	MCARE	MEDICARE RECORD
SPACE	SPACE	NA	NOT APPLICABLE

Last Update: 3/12/2021 1:30:24 PM

TPL - Carrier Address Effective Date

NCMMIS Number: 2591

Description: TPL Carrier Address Effective Date is the date that a carrier address became effective.

Data Type: DATE

Size: X(10)

Functional Area Owner: Third Party Liability

Valid Values:

Last Update: 3/12/2021 1:33:42 PM

TPL - Carrier Address End Date

NCMMIS Number: 2592

Description: TPL Carrier Address Effective Date is the date that a carrier address was no longer effective.

Data Type: DATE

Size: X(10)

Functional Area Owner: Third Party Liability

Valid Values:

Last Update: 3/12/2021 1:34:59 PM

TPL - Mass Change Effective Date

NCMMIS Number: 2595

Description: TPL Mass Change Effective Date is the begin date for a mass change request. It is used to end date existing policies that meet the criteria entered by a user.

Data Type: DATE

Size: X(10)

Functional Area Owner: Third Party Liability

Valid Values:

Last Update: 3/12/2021 1:33:58 PM

TPL - Buy-In Transaction Date

NCMMIS Number: 2597

Description: TPL Buy-In Transaction Date is date that a transaction was created prior to sending it to the Center for Medicare & Medicaid Services (CMS) or the date that a transaction was received from CMS.

Data Type: DATE

Size: X(10)

Functional Area Owner: Third Party Liability

Valid Values:

Last Update: 3/12/2021 1:34:50 PM

Inpatient LOS

NCMMIS Number: 2600

Description: Inpatient Length of Service

Data Type: CHARACTER

Size: X(1)

Functional Area Owner: Reference

Valid Values:

Last Update: 2/8/2010 4:14:08 PM

Internal Modifier Crosswalk

NCMMIS Number: 2601

Description: Used to determine the internal modifier.

Data Type: CHARACTER

Size: X(2)

Functional Area Owner: Reference

Valid Values:

Last Update: 8/30/2011 5:27:20 PM

Label Code

NCMMIS Number: 2602

Description: Label Code

Data Type: CHARACTER

Size: X(1)

Functional Area Owner: Reference

Valid Values:

Last Update: 2/8/2010 4:14:34 PM

Level of Care

NCMMIS Number: 2603

Description: Level of Care

Data Type: CHARACTER

Size: X(1)

Functional Area Owner: Reference

Valid Values:

Last Update: 2/8/2010 4:14:42 PM

Level of Care Begin Date

NCMMIS Number: 2604

Description: Level of Care Begin Date

Data Type: DATE

Size: X(10)

Functional Area Owner: Reference

Valid Values:

Last Update: 2/8/2010 4:14:51 PM

Level of Care End Date

NCMMIS Number: 2605

Description: Level of Care End Date

Data Type: DATE

Size: X(10)

Functional Area Owner: Reference

Valid Values:

Last Update: 2/8/2010 4:14:59 PM

Managed Care Cohort Description

NCMMIS Number: 2606

Description: Managed Care Cohort Description

Data Type: CHARACTER

Size: X(1)

Functional Area Owner: Reference

Valid Values:

Last Update: 2/8/2010 4:15:08 PM

Managed Care Cohort ID

NCMMIS Number: 2607

Description: Cohort ID identifies grouping criteria based upon recipient age, gender, and eligibility program code.

Data Type: INTEGER

Size: 9(4)

Functional Area Owner: Reference

Valid Values:

From Value	Thru Value	Short Description	Long Description

From Value	Thru Value	Short Description	Long Description
1	1	PHPB-AIDFA	AID TO FAMILIES WITH DEPENDENT CHILDREN, (AFDC) AGES 3+
2	2	PHPB-FOSCH	FOSTER CHILDREN, AGES 3+
3	3	PHPB-AGE65	AGED, AGES 65+
4	4	PHPB-BLDA3	BLIND DISABLED, AGES 3-20
5	5	PHPB-BLD21	BLIND DISABLED, AGES 21+
6	6	PHPC	PHPC
7	7	PACE	PACE
8	8	MCAID-NABD	MEDICAID NON-ABD
9	9	NCHC-NABD	NCHC NON-ABD
10	10	MCAID-ABD	MEDICAID ABD
11	11	HCHECK	HEALTHCHECK
12	12	MED-SOL-1	MED-SOLUTIONS-1
13	13	MED-SOL-2	MED-SOLUTIONS-2
14	14	MED-SOL-3	MED-SOLUTIONS-3
15	15	MED-SOL-4	MED-SOLUTIONS-4
16	16	MED-SOL-5	MED-SOLUTIONS-5
17	17	MED-SOL-6	MED-SOLUTIONS-6
18	18	MED-SOL-7	MED-SOLUTIONS-7
19	19	MED-SOL-8	MED-SOLUTIONS-8
20	20	MED-SOL-9	MED-SOLUTIONS-9
21	21	PMH	PREGNANCY MEDICAL HOME
22	22	PREG CARE	PREGNANCY CARE MANAGEMENT
23	23	CC4C	CARE COORDINATION FOR CHILDREN
24	24	TBI	TBI
25	25	ABD-ST-PL	ABD STANDARD PLAN
26	26	TANF ADULT	TANF AND OTHER ADULTS
27	27	TANF CH	TANF AND OTHER CHILDREN AGE 1 - 20
28	28	TANF CH HC	TANF AND OTHER CHILDREN AGE 1 - 20 HEALTH CHOICE
29	29	TANF CH L1	TANF AND OTHER CHILDREN AGE < 1
30	30	TANF CH1HC	TANF AND OTHER CHILDREN AGE < 1 HEALTH CHOICE
31	31	FOSTER-CH	FOSTER CHILDREN, AGES 0+
32	32	STD-NONABD	STANDARD PLAN, NON-ABD LME MCO
33	33	STD-ABD	STANDARD PLAN, ABD LME MCO
34	34	TP-NONABD	TAILORED PLAN, NON-ABD
35	35	TP-BD	TAILORED PLAN, BLIND/DISABLED, 0 - 20
36	36	TP-ABD	TAILORED PLAN, ABD, 21+
37	37	OTHER	OTHER
38	38	TP-INN-ND	TAILORED PLAN INNOVATION NON-DUAL
39	39	TP-INN-DL	TAILORED PLAN INNOVATION DUAL
40	40	TP-TBI-ND	TAILORED PLAN TRAUMATIC BRAIN INJURY NON-DUAL
41	41	TP-TBI-DL	TAILORED PLAN TRAUMATIC BRAIN INJURY DUAL
42	42	TP-BD-CHND	TAILORED PLAN BLIND/DISABLED CHILD NON-DUAL
43	43	TP-BD-HC	TAILORED PLAN BIND/DISABLED CHILD NON-DUAL HEALTH CHOICE
44	44	TP-ABD-AD	TAILORED PLAN AGED/BLIND/DISABLED ADULT NON-DUAL
45	45	TP-TANF-CH	TAILORED PLAN TANF CHILD NON-DUAL
46	46	TP-TF-CHHC	TAILORED PLAN TANF CHILD NON-DUAL HEALTH CHOICE
47	47	TP-TF-AD	TAILORED PLAN TANF ADULT NON-DUAL
48	48	MC-BH-TP	MEDICAID DIRECT BEHAVIORAL HEALTH - MEETING TAILORED PLAN CRITERIA
49	49	MC-BH-NTP	MEDICAID DIRECT BEHAVIORAL HEALTH - NOT MEETING TAILORED PLAN CRITERIA
50	50	MC-BH-INNO	MEDICAID DIRECT BEHAVIORAL HEALTH - INNOVATIONS
51	51	MC-BH-TBI	MEDICAID DIRECT BEHAVIORAL HEALTH - TRAUMATIC BRAIN INJURY
52	52	FST-CH-TP	FOSTER CHILDREN - MEETING TAILORED PLAN CRITERIA
53	53	FST-CH-NTP	FOSTER CHILDREN - NOT MEETING TAILORED PLAN CRITERIA
54	54	MCBH-TP-HC	MEDICAID DIRECT BEHAVIORIAL HEALTH - MEETING TAILORED PLAN CRITERIA HEALTH CHOICE
55	55	MCBHNTP-HC	MEDICAID DIRECT BEHAVIORAL HEALTH - NOT MEETING TAILORED PLAN CRITERIA HEALTH CHOICE
56	56	SPMXP19-24	STANDARD PLAN MEDICAID EXPANSION, AGES 19-24
57	57	SPMXP25-34	STANDARD PLAN MEDICAID EXPANSION, AGES 25-34
58	58	SPMXP35-44	STANDARD PLAN MEDICAID EXPANSION, AGES 35-44
59	59	SPMXP45+	STANDARD PLAN MEDICAID EXPANSION, AGES 45+
60	60	TPMXP19-24	TAILORED PLAN MEDICAID EXPANSION, AGES 19-24
61	61	TPMXP25-34	TAILORED PLAN MEDICAID EXPANSION, AGES 25-34
62	62	TPMXP35-44	TAILORED PLAN MEDICAID EXPANSION, AGES 35-44
63	63	TPMXP45+	TAILORED PLAN MEDICAID EXPANSION, AGES 45+
64	64	PIHP-SPMXP	PIHP SP MEDICAID EXPANSION, AGES 0-999
65	65	PIHP-TPMXP	PIHP TP MEDICAID EXPANSION, AGES 0-999

Last Update: 5/25/2023 3:26:16 PM

Managed Care Cohort ID Begin Date

NCMMIS Number: 2608

Description: Managed Care Cohort ID Begin Date

Data Type: DATE

Size: X(10)

Functional Area Owner: Reference

Valid Values:

Last Update: 2/8/2010 4:15:27 PM

Managed Care Cohort Long Description

NCMMIS Number: 2609

Description: Text description for the cohort ID.

Data Type: CHARACTER

Size: X(320)

Functional Area Owner: Reference

Valid Values:

Last Update: 6/28/2011 7:57:16 AM

Financial 1099 Amount Year to Date (YTD)

NCMMIS Number: 2611

Description: Financial 1099 Amount Year to Date (YTD) is the year-to-date accumulation of monies received by a provider.

Data Type: CURRENCY

Size: S9(11)V99

Functional Area Owner: Financial

Valid Values:

Last Update: 3/12/2021 1:59:10 PM

Managed Care Cohort Short Description

NCMMIS Number: 2612

Description: Short text description for the cohort ID.

Data Type: CHARACTER

Size: X(30)

Functional Area Owner: Reference

Valid Values:

Last Update: 5/20/2010 4:30:03 PM

Timestamp

NCMMIS Number: 2613

Description: Timestamp is the date and time that a transaction occurred.

Data Type: TIMESTAMP

Size: X(26)

Functional Area Owner: Reference

Valid Values:

Last Update: 12/16/2009 4:30:29 PM

Managed Care Group Begin Date

NCMMIS Number: 2615

Description: Managed Care Group Begin Date

Data Type: DATE

Size: X(10)

Functional Area Owner: Reference

Valid Values:

Last Update: 2/8/2010 4:15:56 PM

Managed Care Group End Date

NCMMIS Number: 2616

Description: Managed Care Group End Date

Data Type: DATE

Size: X(10)

Functional Area Owner: Reference

Valid Values:

Last Update: 2/8/2010 4:16:07 PM

Managed Care MC Cohort Maximum Age

NCMMIS Number: 2617

Description: Managed Care Maximum Age

Data Type: CHARACTER

Size: X(1)

Functional Area Owner: Reference

Valid Values:

Last Update: 10/13/2010 10:56:32 AM

Managed Care Plan

NCMMIS Number: 2618

Description: The managed care plan code.

Data Type: CHARACTER

Size: X(1)

Functional Area Owner: Reference

Valid Values:

From Value	Thru Value	Short Description	Long Description

From Value	Thru Value	Short Description	Long Description
1	1	CAACCESS	CAROLINA ACCESS
2	2	CCNC	CCNC/CA
3	3	PACE	PACE
4	4	PIHP	PIHP

Last Update: 3/12/2021 2:15:35 PM

Reference Medication Name Identifier

NCMMIS Number: 2619

Description: Identifies a unique product or generic name.

Data Type: CHARACTER

Size: X(8)

Functional Area Owner: Reference

Valid Values:

Last Update: 2/15/2012 7:26:39 AM

Medicaid Classification Account Number

NCMMIS Number: 2620

Description: Account Number within Medicaid Classification (R_COS_ACCT_NBR)

Data Type: CHARACTER

Size: X(1)

Functional Area Owner: Reference

Valid Values:

Last Update: 3/12/2021 2:18:25 PM

Medicare Covered Services Indicator

NCMMIS Number: 2621

Description: Indicates if the service is covered by Medicare.

Data Type: CHARACTER

Size: X(1)

Functional Area Owner: Reference

Valid Values:

From Value	Thru Value	Short Description	Long Description

From Value	Thru Value	Short Description	Long Description
N	N	NO	NO
Y	Y	YES	YES

Last Update: 3/12/2021 2:15:36 PM

Prior Approval Quantity Requested

NCMMIS Number: 2624

Description: Prior Approval Quantity Requested specifies the number of units of service requested to be performed by a provider seeking prior approval.

Data Type: DECIMAL

Size: 9(3)

Functional Area Owner: Prior Authorization

Valid Values:

Last Update: 5/10/2010 11:28:21 AM

MAR Abortion Procedure Period Begin Date

NCMMIS Number: 2626

Description: MAR Abortion Procedure Period Begin Date is the date, 45 days before an abortion procedure, that begins the 90 day window during which any other abortion procedures claimed will be counted as the same abortion.

Data Type: DATE

Size: X(10)

Functional Area Owner: MAR

Valid Values:

Last Update: 9/29/2011 7:38:25 AM

Medicare Part B Coverage Indicator

NCMMIS Number: 2627

Description: Indicates if the service or drug is covered by Medicare Part B.

Data Type: CHARACTER

Size: X(1)

Functional Area Owner: Reference

Valid Values:

From Value	Thru Value	Short Description	Long Description

From Value	Thru Value	Short Description	Long Description
N	N	NO	NOT COVERED BY MEDICARE PART B
Y	Y	YES	COVERED BY MEDICARE PART B

Last Update: 3/12/2021 2:15:36 PM

Transaction Creation Time

NCMMIS Number: 2629

Description: Transaction Creation Time specifies the time of day that a transaction record was created.

Data Type: TIME

Size: X(8)

Functional Area Owner: Reference

Valid Values:

Last Update: 12/16/2009 4:30:29 PM

Medicare Part D Coverage Indicator

NCMMIS Number: 2630

Description: Indicates if the service or drug is covered by Medicare Part D.

Data Type: CHARACTER

Size: X(1)

Functional Area Owner: Reference

Valid Values:

From Value	Thru Value	Short Description	Long Description

From Value	Thru Value	Short Description	Long Description
N	N	NO	NOT COVERED BY MEDICARE PART D
Y	Y	YES	COVERED BY MEDICARE PART D

Last Update: 3/12/2021 2:15:37 PM

Modifier Code Short Description

NCMMIS Number: 2631

Description: Text description of the modifier.

Data Type: CHARACTER

Size: X(40)

Functional Area Owner: Reference

Valid Values:

Last Update: 5/20/2010 4:30:07 PM

Modifier Edit

NCMMIS Number: 2632

Description: Modifier Edit

Data Type: CHARACTER

Size: X(1)

Functional Area Owner: Reference

Valid Values:

Last Update: 2/8/2010 4:17:39 PM

Modifier Effective Date

NCMMIS Number: 2633

Description: First date that a procedure code modifier is active.

Data Type: DATE

Size: X(10)

Functional Area Owner: Reference

Valid Values:

Last Update: 6/1/2010 2:40:52 PM

Modifier End Date

NCMMIS Number: 2634

Description: Last date that a procedure code modifier is active.

Data Type: DATE

Size: X(10)

Functional Area Owner: Reference

Valid Values:

Last Update: 10/19/2011 10:36:40 AM

Modifier Percentage

NCMMIS Number: 2635

Description: Percentage that should be applied during claims processing for the modifier.

Data Type: DECIMAL

Size: S9(3)V9(3)

Functional Area Owner: Reference

Valid Values:

Last Update: 5/20/2010 4:30:09 PM

Modifier Pricing Indicator

NCMMIS Number: 2636

Description: Indicates if the modifier is a pricing modifier.

Data Type: CHARACTER

Size: X(1)

Functional Area Owner: Reference

Valid Values:

From Value	Thru Value	Short Description	Long Description

From Value	Thru Value	Short Description	Long Description
N	N	NO	NO
Y	Y	YES	Yes

Last Update: 3/12/2021 2:15:38 PM

Modifier Remarks

NCMMIS Number: 2637

Description: Text area for making comments or notes about a modifier.

Data Type: CHARACTER

Size: X(320)

Functional Area Owner: Reference

Valid Values:

Last Update: 5/20/2010 4:30:11 PM

Provider Address State Code

NCMMIS Number: 2638

Description: Provider Address State Code is the state code for a provider.

Valid values are same as DE# 9808

Data Type: CHARACTER

Size: X(2)

Functional Area Owner: Provider

Valid Values:

Last Update: 4/18/2016 10:40:14 AM

Deleted - Use DE 0250 Provider County Code

NCMMIS Number: 2639

Description: County Code is the 3 digit representation of a county

Valid values are same se DE#0250

Data Type: CHARACTER

Size: X(3)

Functional Area Owner: Provider

Valid Values:

Last Update: 2/21/2013 2:09:29 PM

Modifier Type

NCMMIS Number: 2640

Description: Indicates the type of modifier.

Data Type: CHARACTER

Size: X(1)

Functional Area Owner: Reference

Valid Values:

From Value	Thru Value	Short Description	Long Description

From Value	Thru Value	Short Description	Long Description
I	I	INFO	INFORMATIONAL
L	L	PLUGGED	PLUGGED MODIFIER
N	N	INTRNL	INTERNAL MODIFIER
P	P	PROCESS	PROCESSING
R	R	PRICING	PRICING
X	X	MCARE	MEDICARE CROSSOVER ONLY

Last Update: 3/12/2021 2:15:38 PM

NDA Indicator

NCMMIS Number: 2641

Description: New Drug Application Status Indicator

Data Type: INTEGER

Size: 9(1)

Functional Area Owner: Reference

Valid Values:

From Value	Thru Value	Short Description	Long Description

From Value	Thru Value	Short Description	Long Description
0	0	NOTAPPROV	Non-approved New Drug Application Status
1	1	APPROVED	Approved New Drug Application Status

Last Update: 3/12/2021 2:15:39 PM

NDC Crosswalk Begin Date

NCMMIS Number: 2642

Description: NDC Crosswalk Begin Date

Data Type: DATE

Size: X(10)

Functional Area Owner: Reference

Valid Values:

Last Update: 2/8/2010 4:19:00 PM

NDC Crosswalk End Date

NCMMIS Number: 2643

Description: NDC Crosswalk End Date

Data Type: DATE

Size: X(10)

Functional Area Owner: Reference

Valid Values:

Last Update: 2/8/2010 4:19:11 PM

NDC Crosswalk NDC Code

NCMMIS Number: 2644

Description: NDC code that can be billed with the associated procedure code.

Data Type: CHARACTER

Size: X(11)

Functional Area Owner: Reference

Valid Values:

Last Update: 5/20/2010 4:30:13 PM

NDC Required Indicator

NCMMIS Number: 2645

Description: Indicates if an NDC drug code is required to be billed with the procedure code.

Data Type: CHARACTER

Size: X(1)

Functional Area Owner: Reference

Valid Values:

From Value	Thru Value	Short Description	Long Description

From Value	Thru Value	Short Description	Long Description
N	N	NO	NO
Y	Y	YES	YES

Last Update: 3/12/2021 2:15:39 PM

Over the Counter Indicator

NCMMIS Number: 2646

Description: Over the Counter Indicator

Data Type: CHARACTER

Size: X(1)

Functional Area Owner: Reference

Valid Values:

From Value	Thru Value	Short Description	Long Description

From Value	Thru Value	Short Description	Long Description
N	N	NO	OTC NOT AVAILABLE
Y	Y	YES	OTC AVAILABLE

Last Update: 3/12/2021 2:15:40 PM

Pay Cycle

NCMMIS Number: 2647

Description: Date of a payment cycle.

Data Type: DATE

Size: X(10)

Functional Area Owner: Reference

Valid Values:

Last Update: 5/20/2010 4:30:15 PM

Post Op Days

NCMMIS Number: 2648

Description: Procedure Post-Operation Visit Days Limit Count

Data Type: CHARACTER

Size: X(3)

Functional Area Owner: Reference

Valid Values:

From Value	Thru Value	Short Description	Long Description

From Value	Thru Value	Short Description	Long Description
ZZZ	ZZZ	ZZZ	RELATED TO ANOTHER PROC
000	000	000	ZERO POST OP DAYS
010	010	010	TEN POST OP DAYS
060	060	060	SIXTY POST OP DAYS
090	090	090	NINETY POST OP DAYS

Last Update: 3/12/2021 2:15:40 PM

Claim Enhanced Fee Code

NCMMIS Number: 2649

Description: Claim Enhanced Fee Code specifies whether or not a claim qualifies for enhanced fees.

Data Type: CHARACTER

Size: X(1)

Functional Area Owner: Claims

Valid Values:

From Value	Thru Value	Short Description	Long Description

From Value	Thru Value	Short Description	Long Description
N	N	NOENHCND	NO ENHANCED FEE
Y	Y	ENHCDFEEY	ENHANCED FEE ALLOWED

Last Update: 3/15/2022 11:46:57 AM

Precare Days

NCMMIS Number: 2650

Description: Number of precare days allowed for a procedure.

Data Type: NUMERIC

Size: S3(9)

Functional Area Owner: Reference

Valid Values:

Last Update: 7/9/2011 4:49:12 PM

CLIA Certification Type Code

NCMMIS Number: 2651

Description: CLIA Certification Type Code specifies the Clinical Laboratory Improvement Amendments (CLIA) certification classification for a laboratory.

Data Type: CHARACTER

Size: X(1)

Functional Area Owner: Reference

Valid Values:

From Value	Thru Value	Short Description	Long Description

From Value	Thru Value	Short Description	Long Description
1	1	COW	CERTIFICATE OF WAIVER
2	2	PPM	CERTIF PROVIDER PERFORM MICROSCOPY
3	3	COR	CERTIFICATE OF REGISTRATION
4	4	COC	CERTIFICATE OF COMPLIANCE
5	5	COA	CERTIFICATE OF ACCREDITATION

Last Update: 3/12/2021 2:03:56 PM

Precare Post Operative Days Begin Date

NCMMIS Number: 2652

Description: Precare/Post Operative Days Begin Date

Data Type: DATE

Size: X(10)

Functional Area Owner: Reference

Valid Values:

Last Update: 2/22/2012 3:38:33 PM

Precare Post Operative Days End Date

NCMMIS Number: 2653

Description: Precare/Post Operative Days End Date

Data Type: DATE

Size: X(10)

Functional Area Owner: Reference

Valid Values:

Last Update: 2/22/2012 3:39:40 PM

Precare Post Operative Days Payment Percent

NCMMIS Number: 2655

Description: Precare/Post Operative Days Payment %

Data Type: DECIMAL

Size: S9V99

Functional Area Owner: Reference

Valid Values:

Last Update: 3/12/2021 2:18:26 PM

Pricing Action Code

NCMMIS Number: 2656

Description: The pricing action code is a NC legacy data element that is informational only. The pricing action code was used to drive the claim pricing methologies.

Data Type: CHARACTER

Size: X(1)

Functional Area Owner: Reference

Valid Values:

From Value	Thru Value	Short Description	Long Description

From Value	Thru Value	Short Description	Long Description
B	B	B	BUNDLED PROCEDURE, NOT REIMBURSED AS A SEPARATE PR
C	C	C	NON COVERED MODIFIER
F	F	F	PAY AS BILLED
G	G	G	DRG PRICING WAS APPLIED
H	H	H	PAY 80% OF FEE SCHEDULE PRICE FOR POS 2
L	L	L	PAY 60% OF BILLED AMOUNT FOR NEW LAB SERVICE
N	N	N	PRICED OFF PRICING PROCEDURE FOUND ON LEVEL III
P	P	P	PHARMACY - SUSPEND FOR DRUG MANUAL PRICE
R	R	R	PAY RATIO COST TO CHARGE (PR FILE)
T	T	T	PAY MAXIMUM FEE SCHEDULE AMOUNT (MAY EXCEED PROVID
U	U	U	PAY MAXIMUM LEVEL III AMOUNT (MAY EXCEED PROVIDER
1	1	1	SUSPEND FOR MANUAL PRICE
2	2	2	DENY AS NON-COVERED PROCEDURE PLUG DETAIL EOB 009
3	3	3	PAY LESSER OF BILLED AMOUNT OR INSTITUTIONAL PRICI
4	4	4	PAY LESSER OF BILLED AMOUNT OR FEE SCHEDULE
6	6	6	ANESTHESIA CALCULATION
7	7	7	PAY LESSER OF BILLED AMOUNT OR LEVEL III MAXIMUM A
8	8	8	PAY LESSER OF BILLED AMOUNT OR LEVEL III MAXIMUM A
9	9	9	A NEW VALUE THAT IS USED IN PRICING OUTPATIENT BEH

Last Update: 3/12/2021 2:15:41 PM

Pricing Action Code Date Type

NCMMIS Number: 2657

Description: Pricing Action Code Date Type

Data Type: CHARACTER

Size: X(1)

Functional Area Owner: Reference

Valid Values:

Last Update: 2/8/2010 4:21:03 PM

Pricing Action Code Effective Date

NCMMIS Number: 2658

Description: Pricing Action Code Effective Date

Data Type: DATE

Size: X(10)

Functional Area Owner: Reference

Valid Values:

Last Update: 2/8/2010 4:21:13 PM

Pricing Action Code End Date

NCMMIS Number: 2659

Description: Pricing Action Code End Date

Data Type: DATE

Size: X(10)

Functional Area Owner: Reference

Valid Values:

Last Update: 2/8/2010 4:21:24 PM

Pricing Facility Rate

NCMMIS Number: 2660

Description: Rate for a procedure performed in a facility setting.

Data Type: CURRENCY

Size: S9(5)V99

Functional Area Owner: Reference

Valid Values:

Last Update: 5/20/2010 4:30:23 PM

Pricing Methodology

NCMMIS Number: 2661

Description: System Generated

Data Type: CHARACTER

Size: X(1)

Functional Area Owner: Reference

Valid Values:

Last Update: 2/8/2010 4:21:44 PM

Pricing Non Facility Rate

NCMMIS Number: 2662

Description: Rate for a procedure performed in a non-facility setting.

Data Type: CURRENCY

Size: S9(5)V99

Functional Area Owner: Reference

Valid Values:

Last Update: 5/20/2010 4:30:25 PM

RA Print Indicator

NCMMIS Number: 2663

Description: Indicates if the claim error should print on the provider's remittance advice.

Data Type: CHARACTER

Size: X(1)

Functional Area Owner: Reference

Valid Values:

From Value	Thru Value	Short Description	Long Description

From Value	Thru Value	Short Description	Long Description
N	N	NO	DO NOT PRINT ON RA
Y	Y	YES	PRINT ON RA

Last Update: 3/12/2021 2:15:43 PM

RA Text

NCMMIS Number: 2664

Description: RA Text

Data Type: CHARACTER

Size: X(1)

Functional Area Owner: Reference

Valid Values:

Last Update: 2/8/2010 4:22:17 PM

MC Plan Rate Cohort Amount

NCMMIS Number: 2665

Description: Rate associated with a cohort.

Data Type: CURRENCY

Size: S9(5)V99

Functional Area Owner: Reference

Valid Values:

Last Update: 10/13/2010 10:59:10 AM

Rate Type

NCMMIS Number: 2666

Description: The type of managed care cohort rate. Types of rates include management fees and capitation.

Data Type: CHARACTER

Size: X(1)

Functional Area Owner: Reference

Valid Values:

From Value	Thru Value	Short Description	Long Description

From Value	Thru Value	Short Description	Long Description
1	1	CA MNGMNT	CAROLINA ACCESS MANAGEMENT FEE
2	2	CCNC MNGMT	CCNC/CA MANAGEMENT FEE
3	3	CCNC ADMIN	CCNC/CA ADMINISTRATIVE ENTITY
4	4	HC MNGMNT	HEALTHCHECK MANAGEMENT FEE
5	5	CAP	CAPITATION

Last Update: 3/12/2021 2:15:43 PM

Reference Confidential Indicator

NCMMIS Number: 2667

Description: Indicates if a service is confidential and therefore would not be included in the Recipient Explanation of Medical Benefits (REOMB) process.

Data Type: CHARACTER

Size: X(1)

Functional Area Owner: Reference

Valid Values:

From Value	Thru Value	Short Description	Long Description

From Value	Thru Value	Short Description	Long Description
N	N	NO	NOT CONFIDENTIAL
Y	Y	YES	CONFIDENTIAL

Last Update: 3/12/2021 2:15:44 PM

Reference Plan Name

NCMMIS Number: 2668

Description: Reference Plan Name

Data Type: CHARACTER

Size: X(1)

Functional Area Owner: Reference

Valid Values:

Last Update: 2/8/2010 4:22:57 PM

Reimbursement Amount

NCMMIS Number: 2669

Description: Reimbursement Amount Status

Data Type: CURRENCY

Size: S9(9)V99

Functional Area Owner: Reference

Valid Values:

Last Update: 2/16/2010 6:06:56 PM

Federal Shares Percentage

NCMMIS Number: 2670

Description: Federal Shares Percentage is the percentage of a claim payment amount, reimbursable by federal funding.

Data Type: DECIMAL

Size: S9V9(6)

Functional Area Owner: MAR

Valid Values:

From Value	Thru Value	Short Description	Long Description

From Value	Thru Value	Short Description	Long Description
ZERO	ZERO	DEFAULT	DEFAULT

Last Update: 9/29/2011 7:34:25 AM

Client Category of Eligibility COE Medicaid Reimbursement Code

NCMMIS Number: 2673

Description: Client Category of Eligibility (COE) Medicaid Reimbursement Code specifies the reason why the state or federal government assumes fiscal responsibility for an individual.

Data Type: CHARACTER

Size: X(2)

Functional Area Owner: Recipient

Valid Values:

From Value	Thru Value	Short Description	Long Description

From Value	Thru Value	Short Description	Long Description
SPACE	SPACE	UNKNOWN	UNKNOWN
01	01	NATIVE RES	NATIVE AMERICAN RESIDING ON NY STATE RESERVATION
02	02	RELEASEE F	RELEASEE FROM DEPT. OF MENTAL HYGIENE FACILITY
03	03	NEEDY PERS	NEEDY PERSON WITHOUT STATE RESIDENCE
04	04	DMH PATIEN	DMH PATIENT
05	05	DMH FAMILY	DMH FAMILY CARE (OBSOLETE AS OF AUGUST 1,1980)
06	06	ODAS INPAT	ODAS INPATIENT
07	07	ODAS OUTPA	ODAS OUTPATIENT
08	08	OTHER STAT	OTHER STATE CHG. (INCL. REMOV. FROM STATE & CASES)
09	09	CUBAN REF	CUBAN REFUGEES (18 CRR 349.1; RF-6/DSS- 1047)
10	10	INDOCHINES	INDOCHINESE REFUGEE (DSS-2557)
11	11	AMERICAN C	AMERICAN CITIZEN REPATRIATE (RF-7 / DSS-931)
12	12	OTHER FEDE	OTHER FEDERAL CHARGE
15	15	INDOCHINE2	INDOCHINESE REFUGEES UNACCOMPANIED MINOR
16	16	DMH/OMH FA	DMH/OMH FAMILY CARE (EF.8/1/80)
17	17	DMH/OMRDD	DMH/OMRDD FAM.CARE (EF.8/1/80)
18	18	ICF-DD STA	ICF-DD STATE OPERATED
19	19	ICF-DD OR	ICF-DD OR RTF PRIVATELY OPERATED
20	20	REFUGEES (	REFUGEES (REFUGEE ASSISTANCE PROGRAM)
21	21	UNACCOMPAN	UNACCOMPANIED REFUGEE MINOR
22	22	CUBANREFPD	CUBAN REFUGEE PHASEDOWN
23	23	CUBANS (10	CUBANS (100%MA-SSI)
24	24	CUBAN HAIT	CUBAN HAITIAN ENTRANTS
25	25	CUBAN HUM	CUBAN HAITIAN UNACCOMPANIED MINOR
26	26	HAITIAN EN	HAITIAN ENTRANTS
27	27	NYSDOH INP	NYSDOH INPATIENT
28	28	RCCA - STA	RCCA - STATE OPERATED
29	29	RCCA-VOLUN	RCCA-VOLUNTARY-MENTAL HYGIENE
30	30	VOFC - VOL	VOFC - VOLUNTARY FAMILY CARE
31	31	VOCR (NON-	VOCR (NON-621)-VOLUNTARY COMMUNITY
32	32	VOCR (621)	VOCR (621)-VOLUNTARY COMMUNITY
33	33	SOCR(KEYS)	SOCR(KEYS)-STATE OPERATED COMMUNITY RESIDENCE
34	34	SOCR(NON-K	SOCR(NON-KEYS)-STATE OPERATED
35	35	SOCR(NON-6	SOCR(NON-621)-STATE OPERATED COMMUNITY RES.
36	36	VORCCA(NON	VORCCA(NON-621)-VOL OPER. RES.
37	37	RELOCATED	RELOCATED RELATIVES OF AN INST. VETERAN
40	40	LEGALIZED	LEGALIZED ALIEN (PRE-1982)
41	41	SPECIAL AG	SPECIAL AGRICULTURAL WORKERS (SAW)
42	42	ADDITIONAL	ADDITIONAL SPECIAL AGRICULTURAL WORKERS
50	50	PRESUMPTIV	PRESUMPTIVE ELIGIBILITY - HOME
51	51	OMRDD - CA	OMRDD - CAH
60	60	TANF IN AL	TANF INELIGIBLE ALIEN
63	63	TANF GT 5	TANF INDIVIDUAL EXCEEDING 5 YEAR LIMIT
64	64	TANF NTV 5	TANF NATIVE AMER ON NYS RESER EXCEEDING 5 YR LMT
67	67	QUAL ALIEN	QUALIFIED ALIEN/PRUCOL
68	68	QA NOT MOE	QUALIFIED ALIEN NOT MOE (MAINT. OF EFFRT) ELIGIBLE

Last Update: 8/18/2022 8:54:15 AM

TPL - Response Code

NCMMIS Number: 2674

Description: Response code that is received after sending a MSQ

Data Type: CHARACTER

Size: X(1)

Functional Area Owner: Third Party Liability

Valid Values:

Last Update: 3/12/2021 1:33:31 PM

Reverse Edit End Date

NCMMIS Number: 2675

Description: Reverse Edit End Date

Data Type: DATE

Size: X(10)

Functional Area Owner: Reference

Valid Values:

Last Update: 2/8/2010 4:23:30 PM

Relationship to Payee Code

NCMMIS Number: 2676

Description: Relationship to payee code is recipient relationship with the payee. This is also the Case head identifier.

Data Type: CHARACTER

Size: X(1)

Functional Area Owner: Recipient

Valid Values:

From Value	Thru Value	Short Description	Long Description

From Value	Thru Value	Short Description	Long Description
A	A	Spouse	Spouse
B	B	Son	Son
C	C	Daughter	Daughter
D	D	Step Son	Step Son
E	E	Step Daug	Step Daughter
F	F	Mother	Mother
G	G	Father	Father
H	H	Motin-law	Mother-in-law
I	I	Fatin-law	Father-in-law
J	J	Grandchild	Grandchild
K	K	Student	Student
L	L	Self	Self
M	M	Brother	Brother
N	N	Sister	Sister
O	O	Nephew	Nephew
P	P	Niece	Niece
Q	Q	FosChild	Foster Child
R	R	ChiLegGua	Child Under Legal Guardianship/Custody
S	S	Other	Other

Last Update: 8/18/2022 8:54:24 AM

Reverse Edit Last Update Date

NCMMIS Number: 2677

Description: Reverse Edit Last Update Date

Data Type: DATE

Size: X(10)

Functional Area Owner: Reference

Valid Values:

Last Update: 2/8/2010 4:23:41 PM

Client Category of Eligibility COE Medicaid Coverage Code

NCMMIS Number: 2678

Description: Client Category of Eligibility (COE) Medicaid Coverage Code defines the medical services to which a client is entitled.

Data Type: CHARACTER

Size: X(2)

Functional Area Owner: Recipient

Valid Values:

From Value	Thru Value	Short Description	Long Description

From Value	Thru Value	Short Description	Long Description
01	01	ALL BENEFI	ALL BENEFITS (A)
02	02	OUTPATIENT	OUTPATIENT CARE ONLY (C)
04	04	NOT ELIGIB	NOT ELIGIBLE (N)
05	05	SANCTIONED	SANCTIONED (K)
06	06	PROVISIONA	PROVISIONAL ELIGIBILITY (V)
07	07	EMERGENCY	EMERGENCY SERVICES ONLY (E)
08	08	PRESUMPT H	PRESUMPTIVE ELIGIBILITY - HOME CARE (H)
09	09	MSP	MEDICARE SAVINGS PROGRAM
10	10	ELG NO NFS	ELIGIBLE EXCEPT NFS (B)
11	11	LEG ALEN F	LEGAL ALIEN - FULL COVERAGE
13	13	PRESUMPT A	PRESUMPTIVE ELIGIBILITY - PRENATAL A (I)
14	14	PRESUMPT B	PRESUMPTIVE ELIGIBILITY - PRENATAL B (J)
15	15	PERINATAL	PERINATAL CARE (L)
16	16	HOME RELIE	HOME RELIEF (HR) (T)
17	17	NO MA - HI	HEALTH INSURANCE CONT ONLY
18	18	FAMILY PLA	FAMILY PLANNING SERVICES ONLY (F)
19	19	COMM CBLTC	COMMUNITY COV W COMMUNITY LTC
20	20	COMM NOLTC	COMMUNITY COV NO LTC
21	21	OUTP CBLTC	OUTPATIENT WITH COMMUNITY LTC
22	22	OUTP NOLTC	OUPTPATIENT WITH NO LTC
23	23	OUTP NONFS	OUTPATIENT NO NURSING FACILITY
24	24	COM NOLTC5	COMM COV NO LTC ALIEN 5YR BAN
30	30	MCAID PCP	CLIENT IS ELIG FOR MCAID AND ENROLLED IN A PCP (P)
31	31	CAP GUAR O	CLIENT IS ELIG FOR CAPITN GUARANTEE SERVS ONLY (G)
32	32	HR ENR PCP	HR CLIENT ENROLLED IN A PCP (Q)
33	33	HR CAP GUA	HR CLIENT ELIG FOR CAPITN GUARANTEE SERVS ONLY( R
34	34	FAM HLTH P	FAMILY HEALTH PLUS (U)
36	36	FAM HLTH G	FAMILY HEALTH PLUS GUARANTEE (W)

Last Update: 8/18/2022 8:54:28 AM

Reverse Edit Start Date

NCMMIS Number: 2679

Description: Reverse Edit Start Date

Data Type: DATE

Size: X(10)

Functional Area Owner: Reference

Valid Values:

Last Update: 2/8/2010 4:23:50 PM

Provider Address Type Code

NCMMIS Number: 2680

Description: Provider Address Type Code specifies a type of address for a provider.

This is a System Derived code.

Data Type: CHARACTER

Size: X(1)

Functional Area Owner: Provider

Valid Values:

From Value	Thru Value	Short Description	Long Description

From Value	Thru Value	Short Description	Long Description
C	C	CORSPNDNCE	Correspondence
P	P	1099-PayTo	1099 Reporting/Pay-to Address
S	S	Service	Service

Last Update: 3/8/2021 4:19:29 PM

Federal Funding Amount

NCMMIS Number: 2682

Description: Federal Funding Amount is the dollar amount of payment rendered towards a claim by the federal government.

Data Type: CURRENCY

Size: S9(7)V9(8)

Functional Area Owner: MAR

Valid Values:

Last Update: 9/29/2011 7:38:39 AM

Hospital Length of Stay Days Count Total

NCMMIS Number: 2683

Description: Hospital Length of Stay Days Count Total is the number of elapsed days between admission date and the discharge date.

Data Type: DECIMAL

Size: S9(3)

Functional Area Owner: Claims

Valid Values:

From Value	Thru Value	Short Description	Long Description

From Value	Thru Value	Short Description	Long Description
ZERO	ZERO	DEFAULT	DEFAULT

Last Update: 3/15/2022 11:46:58 AM

MAR Accumulator 30 Code

NCMMIS Number: 2684

Description: MAR Accumulator 30 Code specifies the general funding status for share reporting.

Data Type: CHARACTER

Size: X(1)

Functional Area Owner: MAR

Valid Values:

From Value	Thru Value	Short Description	Long Description

From Value	Thru Value	Short Description	Long Description
A	A	FED CHRG	FEDERAL CHARGE
B	B	STA CHRG	STATE CHARGE
0	0	LCL CHRG	LOCAL CHARGE

Last Update: 9/29/2011 7:34:26 AM

Claim Note Reference Code

NCMMIS Number: 2695

Description: 5010 DE363 Code identifying the functional area or purpose for which the note applies

Data Type: CHARACTER

Size: X(3)

Functional Area Owner: Provider

Valid Values:

From Value	Thru Value	Short Description	Long Description

From Value	Thru Value	Short Description	Long Description
ALG	ALG	ALLERGIES	ALLERGIES
DCP	DCP	DISCHGPLN	GOALS, REHABILITATION POTENTIAL, OR DISCHARGE PLANS
DGN	DGN	DIAGDESC	DIAGNOSIS DESCRIPTION
DME	DME	DMESUPPLY	DURABLE MEDICAL EQUIPMENT (DME) AND SUPPLIES
MED	MED	MEDICATION	MEDICATIONS
NTR	NTR	NUTRITION	NUTRITIONAL REQUIREMENTS
ODT	ODT	ORDERS	ORDERS FOR DISCIPLINES AND TREATMENTS
RHB	RHB	FUNCTLIMIT	FUNCTIONAL LIMITATIONS, REASON HOMEBOUND, OR BOTH
RLH	RLH	PATLVHOME	REASONS PATIENT LEAVES HOME
RNH	RNH	PATNOTHOME	TIMES AND REASONS PATIENT NOT AT HOME
SET	SET	SOCENVIRON	UNUSUAL HOME, SOCIAL ENVIRONMENT, OR BOTH
SFM	SFM	SAFETYMEAS	SAFETY MEASURES
SPT	SPT	PLANTREATM	SUPPLEMENTARY PLAN OF TREATMENT
UPI	UPI	UPDINFO	UPDATED INFORMATION

Last Update: 3/8/2021 4:22:39 PM

Hospital Length of Stay Days Count Medical

NCMMIS Number: 2700

Description: Hospital Length of Stay Days Count Medical is the number of elapsed days between admission date and the alternate care date.

Data Type: DECIMAL

Size: S9(2)

Functional Area Owner: Claims

Valid Values:

Last Update: 12/16/2009 4:29:50 PM

Provider Category of Service COS Long Description

NCMMIS Number: 2708

Description: Provider Category of Service (COS) Long Description is a long text description of a type of service for which a provider is enrolled within NCTracks and may submit claims.

Data Type: CHARACTER

Size: X(50)

Functional Area Owner: Provider

Valid Values:

Last Update: 10/13/2010 4:00:59 PM

MAR Client Age Months

NCMMIS Number: 2733

Description: MAR Client Age (Months) is the age of a client on the date of service, calculated in whole months.

Data Type: SMALLINT

Size: S9(5)

Functional Area Owner: MAR

Valid Values:

Last Update: 9/29/2011 7:38:21 AM

Reviewer Unit

NCMMIS Number: 2734

Description: Unit Classification Code

Data Type: CHARACTER

Size: X(1)

Functional Area Owner: Reference

Valid Values:

Last Update: 2/8/2010 4:24:11 PM

MAR Deductible Coinsurance Part A Or Part B Code

NCMMIS Number: 2735

Description: MAR Deductible Coinsurance Part A Or Part B Code indicates whether Medicare Part A or Part B applies to a claim based on the claim type.

Data Type: CHARACTER

Size: X(1)

Functional Area Owner: MAR

Valid Values:

From Value	Thru Value	Short Description	Long Description

From Value	Thru Value	Short Description	Long Description
A	A	PART A	PART A DEDUCTIBLE/COINSURANCE AMOUNT
B	B	PART B	PART B DEDUCTIBLE/COINSURANCE AMOUNT

Last Update: 9/29/2011 7:34:27 AM

Route Dosage Form DF Med Identification

NCMMIS Number: 2739

Description: Medication Routed dosage form medication identifier - identifies the product or generic name,route of administration,and dosage form

Data Type: CHARACTER

Size: X(8)

Functional Area Owner: Reference

Valid Values:

Last Update: 4/25/2012 6:15:49 PM

MAR Aid Category Code

NCMMIS Number: 2740

Description: MAR Aid Category Code specifies a client aid category for the purpose of MARS reporting.

Data Type: CHARACTER

Size: X(5)

Functional Area Owner: MAR

Valid Values:

From Value	Thru Value	Short Description	Long Description

From Value	Thru Value	Short Description	Long Description
01110	01110	SSI AGED	SOCIAL SECURITY INSURANCE - AGED
01120	01120	SSI BLIND	SOCIAL SECURITY INSURANCE - BLIND
01130	01130	SSI DSABLD	SOCIAL SECURITY INSURANCE - DISABLED
01160	01160	SSI PEND A	SOCIAL SECURITY INSURANCE PENDING - AGED
01170	01170	SSI PEND B	SOCIAL SECURITY INSURANCE PENDING - BLIND
01180	01180	SSI PEND D	SOCIAL SECURITY INSURANCE PENDING - DISABLED
01210	01210	CHILD FC	CHILD - FOSTER CARE
01220	01220	CHILD FA	CHILD - FAMILY ASSISTANCE
01300	01300	FA ADULTS	FAMILY ASSISTANCE ADULTS
01400	01400	SN CHILD	SAFETY NET CHILD
01500	01500	CHILD PG	CHILD - PG-ADC
01600	01600	SN W DEP	SAFETY NET WITH DEPRIVATION
02110	02110	MED AGED	MEDICALLY NEEDY - AGED (OBS)
02120	02120	SN BLIND	SAFETY NET - BLIND
02130	02130	SN DSABLD	SAFETY NET - DISABLED
02210	02210	FOSTER	FOSTER (OBSOLETE)
02220	02220	CHILD SN	CHILD - SAFETY NET
02230	02230	MA DISBLDO	MEDICALLY NEEDY - DISABLED - AID CAT 66(OBS)
02300	02300	SN ADULTS	SAFETY NET - ADULTS
02400	02400	ALL OTHER	ALL OTHER (OBSOLETE)
02500	02500	MA DISABLD	MEDICALLY NEEDY - DISABLED
03100	03100	MA AGED	MEDICALLY NEEDY - AGED
03200	03200	MN BLIND	MEDICALLY NEEDY - BLIND
03300	03300	MA DSBLDOB	MEDICALLY NEEDY - DISABLED - AID CAT 26(OBS)
03400	03400	ADC ADULTS	AID FOR DEPENDENT CHILDREN - ADULTS
03500	03500	ADC CHILD	AID FOR DEPENDENT CHILDREN - CHILD
03600	03600	CW CHILD	CHILD WELFARE - CHILDREN
03700	03700	OTH CHILD	OTHER TITLE XIX CHILDREN
03710	03710	LIF WO D C	LOW INCOME FAMILY WITHOUT DEPRIVATION - CHILD
03720	03720	LIF W D C	LOW INCOME FAMILY WITH DEPRIVATION - CHILD
03803	03803	TANF ADWD	TEMPORARY AID TO NEEDY FAMILIES ADULTS WITH DEPRIV
03804	03804	TANF AWOD	TEMPORARY AID TO NEEDY FAMILIES ADULTS WITHOUT DEP
03805	03805	TANF CHILD	CHILD - TEMPORARY AID TO NEEDY FAMILIES
03815	03815	DISAS < 21	MEDICAID NYC DISASTER RELIEF - AGE < 21
03820	03820	DISA 21-64	MEDICAID NYC DISASTER RELIEF - AGE 21 - 64
03825	03825	DISAS 65+	MEDICAID NYC DISASTER RELIEF - AGE 65+
03830	03830	FP NYC 1	FP NYC DISAS TRANS 0-20
03835	03835	FP NYC 2	FP NYC DISAS TRANS 21-64
03840	03840	FP NYC 3	FP NYC DISAS TRANS 65+
03900	03900	PE PREG	PRESUMPTIVE ELIGIBILITY - PREGNANT WOMAN
03910	03910	PE PNA	PRESUMPTIVE ELIGIBILITY - PRENATAL A
03920	03920	PE PNB	PRESUMPTIVE ELIGIBILITY - PRENATAL B
03930	03930	PERINATAL	PERINATAL CARE
03940	03940	INFANT 185	INFANTS (185% FEDERAL POVERTY LEVEL)
03950	03950	CHILD 1-6	CHILDREN 1 - 6 (133% FEDERAL POVERTY LEVEL)
03960	03960	FFP ALIENS	FEDERAL FUNDING PARTICIPATION ALIENS
03970	03970	PE CHILD	PRESUMPTIVE ELIGIBILITY - CHILD
03980	03980	POV EL C	POVERTY ELIGIBLE CHILDREN
03985	03985	CHIP	POVERTY ELIGIBLE CHILDREN - CHILD HEALTH INS. PROG
03990	03990	LIF REL	LOW INCOME FAMILY RELATED - ADULT WITH DEPRIVATION
04095	04095	CHILD 6-18	CHILD 6 - 18 (133% FPL)
04100	04100	ECC CHIP	EXPANDED CONTINUOUS COVERAGE - CHIP
04110	04110	ECC NCHIP	EXPANDED CONTINUOUS COVERAGE - NON-CHIP
04115	04115	CON CHILD1	CONTINUOUS CHILD 6-19 < 133% FPL
04120	04120	CHILD CC	CHILD - CONTINUOUS COVERAGE
04130	04130	INFANT CC	INFANT CONTINUOUS COVERAGE (185% FEDERAL POVERTY L
04140	04140	POV LVL I	POVERTY LEVEL INFANT
04200	04200	FAM PLAN	FAMILY PLANNING COVERAGE
04210	04210	F.PLAN 21+	FAMILY PLANNING COVERAGE 21+ (FFP)
04305	04305	FHP SCC<21	FAMILY HEALTH PLUS SINGLE/CHILDLESS COUPLE < 21
04310	04310	FHP SCC>20	FAMILY HEALTH PLUS SINGLE/CHILDLESS COUPLE > 20
04315	04315	FHP PAR<21	FAMILY HEALTH PLUS PARENTS < 21
04320	04320	FHP PAR>20	FAMILY HEALTH PLUS PARENTS > 20
04325	04325	FHP PW <21	FAMILY HEALTH PLUS PREGNANT WOMEN < 21
04330	04330	FHP PW >20	FAMILY HEALTH PLUS PREGNANT WOMEN >20
04335	04335	FHP PW+<21	FAMILY HEALTH PLUS PREG WOMEN < 21 (200% FPL)
04340	04340	FHP PW+>20	FAMILY HEALTH PLUS PREG WOMEN > 20 (200% FPL)
04405	04405	PRES ELIG4	PRESUMPTIVE ELIG. - HWP BR.CANCER - WOMEN < 21
04410	04410	PRES ELIG1	PRESUMPTIVE ELIG. - HWP BR.CANCER - WOMEN < 65
04420	04420	PRES ELIG2	PRESUMPTIVE ELIG. - HWP BR.CANCER - WOMEN 65+
04425	04425	PRES ELIG5	PRESUMPTIVE ELIG. - HWP BR.CANCER - MEN < 21
04430	04430	PRES ELIG3	PRESUMPTIVE ELIG. - HWP BR.CANCER - MEN
04435	04435	PRES ELIG6	PRESUMPTIVE ELIG. - HWP BR.CANCER - MEN 65+
04440	04440	WORKING DI	WORKING DISABLED BUY-IN
04450	04450	B(FP) 0-20	MA BUY-IN DISABLED BASIC (FP) 0 - 20
04455	04455	B(FP)21-64	MA BUY-IN DISABLED BASIC (FP) 21 - 64
04460	04460	B(FP)65+	MA BUY-IN DISABLED BASIC (FP) 65+
04465	04465	(FP) 0-20	MA BUY-IN MEDICALLY IMPROVED (FP) 0 - 20
04470	04470	(FP) 21-64	MA BUY-IN MEDICALLY IMPROVED (FP) 21 - 64
04475	04475	(FP) 65+	MA BUY-IN MEDICALLY IMPROVED (FP) 65+
04510	04510	SNA CASH	SNA CASH 60 MO TL
04520	04520	SNA N/CASH	SNA NON-CASH 60 MO TL
04530	04530	SNA CASH 2	SNA CASH 60 MO TL 21 - 64
04540	04540	SNA N/CSH2	SNA NON-CASH 60 MO TL 21-64
04550	04550	SNA CASH 3	SNA CASH 60 MO TL 65+
04560	04560	SNA N/CSH3	SNA NON-CASH 60 MO TL 65+
04900	04900	DEFAULT FP	DEFAULT - FEDERALLY PARTICIPATING
05100	05100	CATSTR-FNP	CATASTROPHIC - FNP
05200	05200	HR ADLT B	HOME RELIEF ADULTS (1115 WVR RELATED BEFORE REF)
05300	05300	SNWOD B	SAFETY NET WO DPRVTN (1115 WVR RELATED BEFORE REF)
05400	05400	LIF 1115	LOW INCOME FAMILY WITHOUT DEPRIVATION (FNP)
05500	05500	PUB HOME	PUBLIC HOME RESIDENT
05600	05600	PE HCARE	PRESUMPTIVE ELIGIBILITY - HOME CARE
05610	05610	FNP NYC 1	FNP NYC DISAS 0-20
05615	05615	FNP NYC 2	FNP NYC DISAS 21-64
05620	05620	FNP NYC 3	FNP NYC DISAS 65+
05700	05700	PUB SHELT	PUBLIC SHELTER RESIDENT
05740	05740	FNP PARNTS	FEDERAL NON PARTICIPATING PARENTS WITH CHILDREN
05800	05800	FNP ALIENS	FEDERAL NON PARTICIPATING ALIENS
05805	05805	ALIESSA	FNP ALIENS (ALIESSA)
05810	05810	POV ELIG 1	POVERTY ELIGIBLE CHILDREN ALIESSA (CHIP)
05815	05815	EXP CONT 1	EXPANDED CONTINUOUS COVERAGE ALIESSA (CHIP)
05820	05820	POV ELIG 2	POVERTY ELIGIBLE CHILDREN ALIESSA
05825	05825	EXP CONT 2	EXPANDED CONTINUOUS COVERAGE ALIESSA
05830	05830	ALIESA CH	ALIESSA CHILDREN (FNP)
05835	05835	CHILD 6-19	CHILD 6-19 < 133% FPL (ALIESSA)
05840	05840	EXP COVER	EXPANDED COVERAGE INFANT < 200% FPL (ALIESSA) < 1
05845	05845	ALIESA 1-6	CHILD 1-6 < 133% FPL (ALIESSA)
05850	05850	CON CHILD2	CONTINUOUS CHILD 6 - 19 < 133% FPL (ALIESSA)
05860	05860	FHP ALIENS	FHP ALIENS
05870	05870	PRST/CRCTL	HW PARTNERSHIP W CLRCTL/PRSTE CANCER
05900	05900	FNP DFLT B	FNP - DEFAULT (1115 WIVR RELATED - BEFORE REF)
05950	05950	CW LCL	CHILD WELFARE LOCAL
05970	05970	F.PL A <21	FAMILY PLANNING COVERAGE ALIENS < 21(FNP)
05975	05975	F.PL A 21+	FAMILY PLANNING COVERAGE ALIENS 21+ (FNP)
05999	05999	SUPP	SUPPLEMENTAL PAYMENT
06000	06000	FNP UNC	FEDERAL NON PARTICIPATING - UNCLASSIFIED
08000	08000	PG ADC B	PG-ADC ADULTS (1115 WAIVER RELATED BEFORE REF)
09000	09000	PG ADC A	PG-ADC ADULTS ( 1115 WAIVER RELATED AFTER REF)
09100	09100	CATSTR-FP	CATASTROPHIC (1115 WAIVER RELATED)
09200	09200	HR ADLT A	HOME RELIEF ADULTS (1115 WVR RELATED AFTER REF)
09250	09250	VET ADM	VETERANS ADMINISTRATION
09300	09300	SNWOD A	SAFETY NET WO DPRVTN (1115 WVR RELATED AFTER REF)
09400	09400	LIF WO1115	LOW INCOME FAMILY WO DEPRIVATION (1115 WAIVER
09740	09740	FNP PAR	FNP PARENTS WITH CHILDREN (1115 WAIVER)
09900	09900	FNP DFLT A	FNP - DEFAULT (1115 WIVR RELATED) - AFTER REF)
88000	88000	CITICAID	CITICAID
91000	91000	FFP-RECEIV	FFP - RECEIVING CASH
91150	91150	SSI PEND	SSI PEND (OBSOLETE)
92000	92000	FFP CATEGO	FFP CATEGORICALLY NEEDY (FFP MONEY PMT) (OBSOLETE)
92100	92100	HR (OBS)	HR (OBSOLETE)
92200	92200	CHILDREN	CHILDREN (OBSOLETE)
92999	92999	CAT T(OBS)	CATEGORY TOTAL (OBSOLETE 1)
96000	96000	FNP SERVIC	FNP (SERVICE PRIOR TO 10-01-97)
96998	96998	CAT TOTAL	CATEGORY TOTAL
97000	97000	TOT FFP-FN	TOTAL FFP-FNP (OBSOLETE)
98000	98000	NON-REIMBU	NON-REIMBURSABLE (OBSOLETE)
98999	98999	CAT T(OBS	CATEGORY TOTAL (OBSOLETE 2)

Last Update: 9/29/2011 7:34:28 AM

MAR Client Dual Eligibility Code

NCMMIS Number: 2742

Description: MAR Client Dual Eligibility Code specifies a client's status relative to dual eligibility in Medicare and Medicaid.

Data Type: CHARACTER

Size: X(2)

Functional Area Owner: MAR

Valid Values:

From Value	Thru Value	Short Description	Long Description

From Value	Thru Value	Short Description	Long Description
00	00	NOT MCARE	NOT A MEDICARE BENEFICIARY
01	01	QMB ONLY	QUALIFIED MEDICARE BENEFICIARY ONLY
02	02	QMB+	QUALIFIED MEDICARE BENEFICIARY PLUS FULL MEDICAID
03	03	SLMB ONLY	SPECIFIED LOW-INCOME MEDICARE BENEFICIARY ONLY
04	04	SLMB+	SLMB PLUS FULL MEDICAID
05	05	QDWI	QUALIFIED DISABLED WORKING INDIVIDUAL
06	06	QI 1	QUALIFYING INDIVIDUAL CLASS 1
07	07	QI 2	QUALIFYING INDIVIDUAL CLASS 2
08	08	OTHER	MEDICARE OTHER THEN QMB, SLMB, QDWI, QI1, QI2
09	09	UNKNOWN	MEDICARE STATUS IS UNKNOWN

Last Update: 9/29/2011 7:35:09 AM

Routed Medication Identification

NCMMIS Number: 2743

Description: Identifies the product or generic name and route of administration.

Data Type: CHARACTER

Size: X(8)

Functional Area Owner: Reference

Valid Values:

Last Update: 2/15/2012 7:24:34 AM

Secondary Pricing Action Code

NCMMIS Number: 2744

Description: The secondary pricing action code is a NC legacy data element that is informational only. The secondary pricing action code was used to help drive the claim pricing methologies.

Data Type: CHARACTER

Size: X(1)

Functional Area Owner: Reference

Valid Values:

From Value	Thru Value	Short Description	Long Description

From Value	Thru Value	Short Description	Long Description
X	X	X	PAYMENT OF PERCENTAGE ON LEVEL III BASED ON RATE O
Y	Y	Y	PAYMENT PERCENTAGE BASED ON LEVEL III DIVIDED BY P
5	5	5	PRICING RULES FOR MODIFIERS - PERCENTAGE CARRIED O

Last Update: 3/12/2021 2:15:45 PM

MAR Federal Fiscal Year Quarter

NCMMIS Number: 2745

Description: MAR Federal Fiscal Year Quarter specifies the federal fiscal year and quarter for which data is being supplied.

Data Type: CHARACTER

Size: X(5)

Functional Area Owner: MAR

Valid Values:

From Value	Thru Value	Short Description	Long Description

From Value	Thru Value	Short Description	Long Description
CCYY1	CCYY1	FFYQ1	FEDERAL FISCAL YEAR QUARTER 1 (OCT - DEC)
CCYY2	CCYY2	FFYQ2	FEDERAL FISCAL YEAR QUARTER 2 (JAN - MAR)
CCYY3	CCYY3	FFYQ3	FEDERAL FISCAL YEAR QUARTER 3 (APR - JUN)
CCYY4	CCYY4	FFYQ4	FEDERAL FISCAL YEAR QUARTER 4 (JUL - SEP)

Last Update: 9/29/2011 7:35:11 AM

MAR Type of Eligibility Record Code

NCMMIS Number: 2746

Description: MAR Type of Eligibility Record Code specifies a type of record on the eligibility file.

Data Type: CHARACTER

Size: X(1)

Functional Area Owner: MAR

Valid Values:

From Value	Thru Value	Short Description	Long Description

From Value	Thru Value	Short Description	Long Description
1	1	CURRENT	CURRENT ELIGIBILITY RECORD
2	2	RETRO	RETROACTIVE ELIGIBILITY RECORD
3	3	CORRECTION	CORRECTION TO PREVIOUSLY SUBMITTED ELIGIBILITY REC
9	9	UNKNOWN	TYPE OF RECORD UNKNOWN

Last Update: 9/29/2011 7:35:13 AM

MAR New York City Funding Code

NCMMIS Number: 2747

Description: MAR New York City Funding Code specifies the budget area for a New York City claim.

Data Type: CHARACTER

Size: X(1)

Functional Area Owner: MAR

Valid Values:

From Value	Thru Value	Short Description	Long Description

From Value	Thru Value	Short Description	Long Description
SPACE	SPACE	NOT NYC	NOT NEW YORK CITY CLAIM
1	1	HHC	HEALTH & HOSPITALS CORPORATION
2	2	DSS	DEPARTMENT OF SOCIAL SERVICES
3	3	DOH	DEPARTMENT OF HEALTH
4	4	CIB	CHARITABLE INSTITUTIONS BUDGET
5	5	CHILD CARE	CHILD CARE
6	6	HOME CARE	HOME CARE

Last Update: 9/29/2011 7:35:14 AM

MAR Claim Family Planning Indicator

NCMMIS Number: 2748

Description: MAR Claim Family Planning Indicator specifies whether or not a claim was for a family planning service.

Data Type: CHARACTER

Size: X(1)

Functional Area Owner: MAR

Valid Values:

From Value	Thru Value	Short Description	Long Description

From Value	Thru Value	Short Description	Long Description
N	N	NO	NOT A FAMILY PLANNING SERVICE
Y	Y	YES	FAMILY PLANNING SERVICE

Last Update: 9/29/2011 7:35:16 AM

MAR Maintenance Assistance Status Code

NCMMIS Number: 2751

Description: MAR Maintenance Assistance Status Code specifies the type of assistance for which a client is qualified.

Data Type: CHARACTER

Size: X(1)

Functional Area Owner: MAR

Valid Values:

From Value	Thru Value	Short Description	Long Description

From Value	Thru Value	Short Description	Long Description
0	0	NOT ELIG	NOT A MEDICAID ELIGIBLE THIS MONTH
1	1	CASH	RECIPIENT CASH OR ELIGIBLE UNDER SEC 1931 OF ACT
2	2	MN	MEDICALLY NEEDY
3	3	PR	POVERTY RELATED
4	4	OTHER	OTHER
5	5	1115 WVR	1115 DEMONSTRATION EXPANSION ELIGIBLE
9	9	UNKNOWN	STATUS UNKNOWN

Last Update: 9/29/2011 7:35:17 AM

Summarized Payment Amount

NCMMIS Number: 2752

Description: Summarized Payment Amount is the total payment amount summarized for records having equal keys.

Data Type: CURRENCY

Size: S9(11)V99

Functional Area Owner: MAR

Valid Values:

Last Update: 9/29/2011 7:38:22 AM

Summarized Service Units Count

NCMMIS Number: 2754

Description: Summarized Service Units Count is the total number of service units summarized for records having equal keys.

Data Type: DECIMAL

Size: S9(11)V

Functional Area Owner: MAR

Valid Values:

Last Update: 9/29/2011 7:38:34 AM

MAR Program Type Code

NCMMIS Number: 2755

Description: MAR Program Type Code specifies the special programs for which a client is eligible.

Data Type: CHARACTER

Size: X(1)

Functional Area Owner: MAR

Valid Values:

From Value	Thru Value	Short Description	Long Description

From Value	Thru Value	Short Description	Long Description
0	0	NONE	NO SPECIAL PROGRAM
1	1	EPSDT	EARLY & PERIODIC SCREENING DIAGNOSIS & TREATMENT
2	2	FAM PLAN	FAMILY PLANNING
3	3	RHC	RURAL HEALTH CLINIC
4	4	FQHC	FEDERALLY QUALIFIED HEALTH CENTER
5	5	IND-HLTH	INDIAN HEALTH SERVICES
6	6	HCB-CARE	HCBS CARE FOR DISA ELDERLY & INDIVIDUALS AGE 65+
7	7	HCBS	HOME AND COMMUNITY BASED SERVICES WAIVER
9	9	UNKNOWN	SPECIAL PROGRAM IS UNKNOWN

Last Update: 9/29/2011 7:35:20 AM

MAR Detailed Category of Service DETCAT Code

NCMMIS Number: 2757

Description: MAR Detailed Category of Service (DETCAT) Code is the MARS detailed definition of a service provided.

Data Type: CHARACTER

Size: X(10)

Functional Area Owner: MAR

Valid Values:

Last Update: 9/29/2011 7:38:31 AM

MAR Federal Participatory Fund Code

NCMMIS Number: 2758

Description: MAR Federal Participatory Fund Code specifies whether the funding status of a claim being processed has federal participation.

Data Type: CHARACTER

Size: X(1)

Functional Area Owner: MAR

Valid Values:

From Value	Thru Value	Short Description	Long Description

From Value	Thru Value	Short Description	Long Description
1	1	FFP	FEDERAL FUNDING PARTICIPATION
2	2	FNP	FEDERALLY NON-PARTICIPATING
3	3	NR	NON REIMBURSABLE - ELECTIVE ABORTION (100% LOCAL)
4	4	PG-ADC	OBSOLETE
5	5	EMERG ELIG	EMERGENCY ELIGIBLE LOCAL (100% LOCAL)

Last Update: 9/29/2011 7:35:24 AM

MAR Title XIX Category Code

NCMMIS Number: 2759

Description: MAR Title XIX Category Code specifies the Title XIX aid category classification by client aid category and age.

Data Type: CHARACTER

Size: X(2)

Functional Area Owner: MAR

Valid Values:

From Value	Thru Value	Short Description	Long Description

From Value	Thru Value	Short Description	Long Description
01	01	SSI	SUPPLEMENTARY SECURITY INCOME -TOTAL
02	02	SSI 0-20	SUPPLEMENTARY SECURITY INCOME -AGES 0 - 20
03	03	SSI 21-64	SUPPLEMENTARY SECURITY INCOME -AGES 21 - 64
04	04	SSI 65+	SUPPLEMENTARY SECURITY INCOME- AGES 65 +
05	05	TANF	TEMPORARY ASSISTANCE FOR NEEDY FAMILIES-TOTAL
06	06	TANF 0-20	TEMPORARY ASSISTANCE FOR NEEDY FAMILIES- AGES 0-20
07	07	TANF 21-64	TEMPORARY ASSISTANCE FOR NEEDY FAMILIES -AGES21-64
08	08	TANF 65+	TEMPORARY ASSISTANCE FOR NEEDY FAMILIES -AGES 65+
09	09	SNET	SAFETY NET -TOTAL
10	10	SNET 0-20	SAFETY NET - AGES 0-20
11	11	SNET 21-64	SAFETY NET - AGES 21-64
12	12	SNET 65+	SAFETY NET - AGES 65+
13	13	MA ONLY	MEDICAL ASSISTANCE ONLY - TOTAL
14	14	MA 0-20	MEDICAL ASSISTANCE ONLY -AGES 0-20
15	15	MA 21-64	MEDICAL ASSISTANCE ONLY - AGES 21-64
16	16	MA 65+	MEDICAL ASSISTANCE ONLY - AGES 65+
17	17	MA ABD	MA ONLY AGED, BLIND & DISABLED - TOTAL
18	18	MAABD 0-20	MA ONLY AGED, BLIND & DISABLED - AGES 0-20
19	19	MAABD21-64	MA ONLY AGED, BLIND & DISABLED - AGES 21-64
20	20	MAABD 65+	MA ONLY AGED, BLIND & DISABLED - AGES 65+
21	21	MA OTH	MA ONLY OTHER - TOTAL
22	22	MAOTH 0-20	MA ONLY OTHER - AGES 0 - 20
23	23	MAOTH21-64	MA ONLY OTHER - AGES 21-64
24	24	MAOTH 65+	MA ONLY OTHER - AGES 65+
25	25	ALL OTHER	ALL OTHER - TOTAL
26	26	OTH 0-20	ALL OTHER - AGES 0-20
27	27	OTH 21-64	ALL OTHER - AGES 21-64
28	28	OTH 65+	ALL OTHER - AGES 65+
29	29	TOTAL	TOTAL - ALL AGES
30	30	TOTAL 0-20	TOTAL - AGES 0-20
31	31	TOTAL21-64	TOTAL - AGES 21-64
32	32	TOTAL 65+	TOTAL - AGES 65+

Last Update: 9/29/2011 7:35:25 AM

MAR Record Type Code

NCMMIS Number: 2761

Description: MAR Record Type Code specifies the type of transaction.

Data Type: CHARACTER

Size: X(2)

Functional Area Owner: MAR

Valid Values:

From Value	Thru Value	Short Description	Long Description

From Value	Thru Value	Short Description	Long Description
10	10	ORIGINAL	ORIGINAL CLAIM
21	21	POS RETRO	POSITIVE RETROACTIVE RATE ADJUSTMENT
22	22	NEG RETRO	NEGATIVE RETROACTIVE RATE ADJUSTMENT
23	23	ADJ DEBIT	ADJUSTMENT DEBIT
24	24	ADJ CREDIT	ADJUSTMENT CREDIT
25	25	VOID DEBIT	VOID DEBIT
26	26	VOID CRDT	VOID CREDIT

Last Update: 9/29/2011 7:35:33 AM

MAR Local Funding Amount

NCMMIS Number: 2762

Description: MAR Local Funding Amount is the amount of payment rendered towards a claim by the local government.

Data Type: CURRENCY

Size: S9(7)V9(8)

Functional Area Owner: MAR

Valid Values:

Last Update: 9/29/2011 7:38:44 AM

Claim Prior Authorization/Medical Certification Number

NCMMIS Number: 2766

Description: Claim Prior Authorization/Medical Certification Number provides a prior approval or medical certification number along with the co-payment exemptions associated with the number.

Data Type: CHARACTER

Size: X(12)

Functional Area Owner: Claims

Valid Values:

From Value	Thru Value	Short Description	Long Description

From Value	Thru Value	Short Description	Long Description
ZERO	ZERO	DEFAULT	DEFAULT

Last Update: 3/15/2022 11:48:15 AM

Encounter Transaction Beneficiary Identifier

NCMMIS Number: 2767

Description: Encounter Transaction Beneficiary Identifier is an identifier given to an individual by the pre-paid capitation plan (PCP) or health maintenance organization (HMO) for their internal purposes.

Data Type: CHARACTER

Size: X(25)

Functional Area Owner: Claims

Valid Values:

Last Update: 12/16/2009 4:29:50 PM

MAR State Funding Amount

NCMMIS Number: 2769

Description: MAR State Funding Amount is the amount of payment rendered towards a claim by the North Carolina State government.

Data Type: CURRENCY

Size: S9(7)V9(8)

Functional Area Owner: MAR

Valid Values:

Last Update: 9/29/2011 7:38:37 AM

MAR Eligible Days Count

NCMMIS Number: 2770

Description: MAR Eligible Days Count is the accumulated number of days during a month that a client was eligible for Medicaid benefits.

Data Type: CHARACTER

Size: S9(2)

Functional Area Owner: MAR

Valid Values:

From Value	Thru Value	Short Description	Long Description

From Value	Thru Value	Short Description	Long Description
00	00	NOT ELIG	NOT ELIGIBLE THIS MONTH
01	31	ELIG. DAYS	NUMBER OF DAYS CLIENT ELIGIBLE IN MONTH

Last Update: 9/29/2011 7:35:36 AM

SUR Encounter Status Type Code

NCMMIS Number: 2771

Description: SUR Encounter Status Type Code defines the type of encounter record submitted. It is used in pharmacy editing and history updating.

Data Type: CHARACTER

Size: X(1)

Functional Area Owner: Claims

Valid Values:

From Value	Thru Value	Short Description	Long Description

From Value	Thru Value	Short Description	Long Description
1	1	ORIG ENC	ORIGINAL ENCOUNTER
2	2	ADJSENC-RR	ADJUSTMENT ENCOUNTER - REPLACEMENT RECORD
3	3	ADJSENC-HR	ADJUSTMENT ENCOUNTER - HISTORY RECORD
4	4	VD ENC-DR	VOID ENCOUNTER - DELETION RECORD
5	5	VD ENC-HR	VOID ENCOUNTER - HISTORY RECORD

Last Update: 3/15/2022 11:48:15 AM

Medicaid Statistical Information System (MSIS) Child Health Insurance Program (CHIP) Code

NCMMIS Number: 2773

Description: Medicaid Statistical Information System (MSIS) Child Health Insurance Program (CHIP) Code specifies the eligibility status of a client for the CHIP program.

Data Type: CHARACTER

Size: X(1)

Functional Area Owner: MAR

Valid Values:

From Value	Thru Value	Short Description	Long Description

From Value	Thru Value	Short Description	Long Description
0	0	NOT ELIG	NOT MEDICAID ELIGBLE AND NOT CHIP ELIGIBLE
1	1	NOT CHIP	MEDICAID ELIGIBLE BUT NOT CHIP ELIGIBLE
2	2	CHIP PLUS	MEDICAID EXPANSION ELIGIBLE FOR ENHANCED FUNDING
3	3	CHIP ONLY	NON-MEDICAID EXPANSION TITLE XXI CHIP ELIGIBLE
9	9	UNKNOWN	CHIP STATUS IS UNKNOWN

Last Update: 9/29/2011 7:35:37 AM

MAR Sterilization Abortion Code

NCMMIS Number: 2775

Description: MAR Sterilization Abortion Code specifies whether a claim was for a sterilization or abortion service.

Data Type: CHARACTER

Size: X(1)

Functional Area Owner: MAR

Valid Values:

From Value	Thru Value	Short Description	Long Description

From Value	Thru Value	Short Description	Long Description
A	A	ABORT PROC	ABORTION PROCEDURE
N	N	NEITHER	NOT RELATED TO STERILIZATION OR ABORTION
R	R	ABORT REL	ABORTION RELATED SERVICE
S	S	STERILIZAT	STERILIZATION PROCEDURE OR RELATED SERVICE

Last Update: 9/29/2011 7:35:39 AM

MAR Cycle Number

NCMMIS Number: 2776

Description: MAR Cycle Number is the MAR control file cycle number.

Data Type: SMALLINT

Size: 9(4)

Functional Area Owner: MAR

Valid Values:

Last Update: 9/29/2011 7:38:20 AM

MAR Restricted Benefits Code

NCMMIS Number: 2777

Description: MAR Restricted Benefits Code specifies the reason why a client was not entitled to the full range of Medicaid benefits.

Data Type: CHARACTER

Size: X(1)

Functional Area Owner: MAR

Valid Values:

From Value	Thru Value	Short Description	Long Description

From Value	Thru Value	Short Description	Long Description
0	0	NOT ELIG	INDIVIDUAL NOT ELIGIBLE FOR MEDICAID DURING MONTH
1	1	NONE	ENTITLED TO FULL SCOPE OF MEDICAID BENEFITS
2	2	ALIEN	RESTRICTED BASED ON ALIEN STATUS
3	3	MEDICARE	RESTRICTED BASED ON MEDICARE DUAL ELIGIBILITY STAT
4	4	PREGNANT	RESTRICTED BASED ON PREGNANCY RELATED STATUS
5	5	OTHER	RESTRICTED BASED ON OTHER THAN 2, 3 OR 4
6	6	FAMLY PLN	RESTRICTED BASED ON FAMILY PLANNING ONLY
8	8	MFP	MONEY FOLLOWS PERSON CLIENT
9	9	UNKNOWN	RESTRICTIONS UNKNOWN

Last Update: 9/29/2011 7:35:40 AM

MAR CMS Client Birth Date

NCMMIS Number: 2779

Description: MAR CMS Client Birth Date is the date of birth of a client or the Center for Medicare & Medicaid Services (CMS) default date.

Data Type: DATE

Size: X(10)

Functional Area Owner: MAR

Valid Values:

Last Update: 9/29/2011 7:38:41 AM

MAR Temporary Assistance for Needy Families (TANF) Cash Code

NCMMIS Number: 2781

Description: MAR Temporary Assistance for Needy Families (TANF) Cash Code specifies if an eligible client recieved TANF benefits.

Data Type: CHARACTER

Size: X(1)

Functional Area Owner: MAR

Valid Values:

From Value	Thru Value	Short Description	Long Description

From Value	Thru Value	Short Description	Long Description
0	0	NOT ELIG	INDIVIDUAL NOT ELIGIBLE FOR MEDICAID DURING MONTH
1	1	NOT TANF	ELIGIBLE DID NOT RECEIVE TANF BENEFITS DURING MONT
2	2	TANF	ELIGIBLE DID RECEIVE TANF BENEFITS DURING MONT
9	9	UNKNOWN	ELIGIBLE'S TANF STATUS IS UNKNOWN

Last Update: 9/29/2011 7:35:43 AM

MAR Health Insurance Code

NCMMIS Number: 2782

Description: MAR Health Insurance Code specifies if a client had third party insurance other than Medicare or enrollment in a Capitation plan through Medicaid.

Data Type: CHARACTER

Size: X(1)

Functional Area Owner: MAR

Valid Values:

From Value	Thru Value	Short Description	Long Description

From Value	Thru Value	Short Description	Long Description
0	0	NOT ELIG	INDIVIDUAL NOT ELIGIBLE FOR MEDICAID DURING MONTH
1	1	NONE	ELIGIBLE DID NOT HAVE PRIVATE INSURANCE COVERAGE
2	2	STATE	ELIGIBLE HAD PRIVATE INSURANCE PURCHASED BY STATE
3	3	THRD PRTY	ELIGIBLE HAD PRIVATE INSURANCE PRCHSD BY 3RD PARTY
4	4	BOTH	BOTH 2 AND 3 APPLY
9	9	INVALID	STATE HAD ONLY INVALID OR MISSING INFORMATION

Last Update: 9/29/2011 7:35:45 AM

MAR Report Year and Month

NCMMIS Number: 2783

Description: MAR Report Year and Month is the year and month of processing for a MAR report.

Data Type: CHARACTER

Size: X(4)

Functional Area Owner: MAR

Valid Values:

Last Update: 9/29/2011 7:38:24 AM

Shipment Tracking Identifier

NCMMIS Number: 2789

Description: Shipment Tracking Identifier is the tracking number assigned by a vendor to a shipment. It is used to track the delivery of a shipment.

Data Type: CHARACTER

Size: X(40)

Functional Area Owner: E-Commerce

Valid Values:

Last Update: 3/4/2021 2:02:32 PM

Unit or Basis for Measurement Code Duplicate for 5010

NCMMIS Number: 2791

Description: 5010 DE 355. Code specifying the units in which a value is being expressed, or manner in which a measurement has been taken

Data Type: CHARACTER

Size: X(2)

Functional Area Owner: Provider

Valid Values:

From Value	Thru Value	Short Description	Long Description

From Value	Thru Value	Short Description	Long Description
DA	DA	Days	Days
UN	UN	Unit	Unit

Last Update: 3/8/2021 4:22:40 PM

Shipping Contact Name

NCMMIS Number: 2793

Description: Shipping Contact Name is the full name of the person who should be contacted regarding shipment of an order.

Data Type: CHARACTER

Size: X(35)

Functional Area Owner: E-Commerce

Valid Values:

Last Update: 3/4/2021 1:52:06 PM

Provider Phone Number Extension

NCMMIS Number: 2795

Description: Phone Number extension

Data Type: CHARACTER

Size: X(5)

Functional Area Owner: Provider

Valid Values:

Last Update: 3/10/2010 4:39:47 PM

Drug Utilization Review DUR Precaution Code - Geriatric

NCMMIS Number: 2801

Description: Drug Utilization Review (DUR) Precaution Code (Geriatric) specifies the precaution for drug usage by geriatric clients.

Data Type: CHARACTER

Size: X(6)

Functional Area Owner: Reference

Valid Values:

Last Update: 9/29/2010 8:45:22 AM

Drug Utilization Review (DUR) Precaution Severity Level Code (Lactation)

NCMMIS Number: 2802

Description: Drug Utilization Review (DUR) Precaution Severity Level Code (Lactation) specifies the severity level of a precaution code for lactation.

Data Type: CHARACTER

Size: X(1)

Functional Area Owner: Reference

Valid Values:

From Value	Thru Value	Short Description	Long Description

From Value	Thru Value	Short Description	Long Description
1	1	ABSLTCNTRN	ABSOLUTE CONTRAINDICATION
2	2	PRECAUTN	PRECAUTION
3	3	NORSKNRSNG	STUDIES HAVE SHOWN NO RISK TO NURSING INFANT

Last Update: 3/12/2021 2:05:48 PM

Drug Utilization Review DUR Precaution Code - Pregnancy

NCMMIS Number: 2803

Description: Drug Utilization Review (DUR) Precaution Code (Pregnancy) specifies the precaution for drug usage by pregnant clients.

Data Type: CHARACTER

Size: X(6)

Functional Area Owner: Reference

Valid Values:

Last Update: 10/13/2010 6:57:27 AM

Provider Audit and Quality Control (AQC) Code

NCMMIS Number: 2806

Description: Provider Audit and Quality Control (AQC) Code specifies whether or not a provider is an AQC provider, or a card swipe provider.

Data Type: CHARACTER

Size: X(1)

Functional Area Owner: E-Commerce

Valid Values:

From Value	Thru Value	Short Description	Long Description

From Value	Thru Value	Short Description	Long Description
F	F	SWIPE	CARD SWIPE
N	N	NON A&QC	NON A&QC PROVIDER
P	P	A&QC POST	A&QC PROVIDER (POST ONLY)
Y	Y	A&QC	A&QC PROVIDER

Last Update: 3/4/2021 1:48:59 PM

Terminal Management System (TMS) Contact Phone Number

NCMMIS Number: 2814

Description: Terminal Management System (TMS) Contact Phone Number is the ten digit phone number for the person to contact regarding an order or a device.

Data Type: CHARACTER

Size: X(10)

Functional Area Owner: E-Commerce

Valid Values:

Last Update: 3/4/2021 1:54:10 PM

Terminal Management System (TMS) Contact Phone Number (Extension)

NCMMIS Number: 2815

Description: Terminal Management System (TMS) Contact Phone Number (Extension) is the four digit phone number extension for the person to contact regarding an order or a device.

Data Type: CHARACTER

Size: X(4)

Functional Area Owner: E-Commerce

Valid Values:

Last Update: 3/4/2021 2:00:00 PM

Terminal Management System (TMS) Device Ownership Code

NCMMIS Number: 2816

Description: Terminal Management System (TMS) Device Ownership Code specifies the ownership class for a Point-of-Service (POS) device.

Data Type: CHARACTER

Size: X(1)

Functional Area Owner: E-Commerce

Valid Values:

From Value	Thru Value	Short Description	Long Description

From Value	Thru Value	Short Description	Long Description
P	P	PROVIDER	PROVIDER OWNED DEVICE
S	S	STATE	STATE OWNED DEVICE

Last Update: 3/4/2021 1:48:59 PM

Terminal Management System TMS Device Status Code

NCMMIS Number: 2817

Description: Terminal Management System (TMS) Device Status Code reflects the disposition and location of the device.

Data Type: CHARACTER

Size: X(3)

Functional Area Owner: E-Commerce

Valid Values:

From Value	Thru Value	Short Description	Long Description

From Value	Thru Value	Short Description	Long Description
DMG	DMG	DAMAGED	DEVICE IS REPORTED AS DAMAGED
INV	INV	INVENTORY	DEVICE IS IN STATE INVENTORY
INZ	INZ	INV DMG	DEVICE IS IN STATE INVENTORY AND BEYOND REPAIR
LST	LST	LOST	DEVICE IS REPORTED AS LOST
OSP	OSP	ONSITE PRV	DEVICE IS ON-SITE AT A PROVIDER LOCATION
OSS	OSS	ONSITE GOV	DEVICE IS ON-SITE AT A GOVERNMENT LOCATION
RPL	RPL	REPLACED	VERIFONE ARRANGED EXPEDITED REPLACEMENT SERVICE
SHP	SHP	SHIPPED	DEVICE HAS BEEN SHIPPED
STN	STN	STOLEN	DEVICE IS REPORTED AS STOLEN
TFR	TFR	TRANSFER	DEVICE HAS BEEN TRANSFERRED TO A NEW OWNER

Last Update: 3/4/2021 1:49:00 PM

Terminal Management System (TMS) Verification Transaction Date (Latest)

NCMMIS Number: 2829

Description: Terminal Management System (TMS) Verification Transaction Date (Latest) is the date that the last verification transaction was processed for a provider.

Data Type: DATE

Size: X(10)

Functional Area Owner: E-Commerce

Valid Values:

Last Update: 3/4/2021 2:00:56 PM

Shipping Address Line

NCMMIS Number: 2848

Description: Shipping Address Line is a line in the address to which the order will be shipped.

Data Type: CHARACTER

Size: X(40)

Functional Area Owner: E-Commerce

Valid Values:

Last Update: 3/4/2021 2:08:55 PM

Terminal Management System TMS Device Shipping Timestamp

NCMMIS Number: 2849

Description: Terminal Management System (TMS) Device Shipping Timestamp is the date and time that a device was shipped to a provider location.

Data Type: TIMESTAMP

Size: X(26)

Functional Area Owner: E-Commerce

Valid Values:

Last Update: 3/4/2021 1:56:04 PM

Terminal Management System TMS Device Type Code

NCMMIS Number: 2857

Description: Terminal Management System (TMS) Device Type Code identifies a type of device.

Data Type: CHARACTER

Size: X(8)

Functional Area Owner: E-Commerce

Valid Values:

From Value	Thru Value	Short Description	Long Description

From Value	Thru Value	Short Description	Long Description
OMNI3750	OMNI3750	OMNI-3750	VERIFONE OMNI-3750 POS TERMINAL
VX570	VX570	VX570	VERIFONE VX570 POS TERMINAL

Last Update: 3/4/2021 1:49:01 PM

TPL - Carrier Contact First Name

NCMMIS Number: 2879

Description: Carrier Contact First Name specifies the first name of the person to be contacted at the insurance carrier’s office.

Data Type: CHARACTER

Size: X(20)

Functional Area Owner: Third Party Liability

Valid Values:

Last Update: 3/12/2021 1:34:07 PM

Terminal Management System TMS Order Timestamp

NCMMIS Number: 2890

Description: Terminal Management System (TMS) Order Timestamp is the date and time that an order was recorded in the terminal management system.

Data Type: TIMESTAMP

Size: X(26)

Functional Area Owner: E-Commerce

Valid Values:

Last Update: 3/4/2021 2:07:51 PM

Terminal Management System (TMS) Device Quantity Ordered

NCMMIS Number: 2892

Description: Terminal Management System (TMS) Device Quantity Ordered is the number of devices on order by a provider.

Data Type: SMALLINT

Size: S9(5)

Functional Area Owner: E-Commerce

Valid Values:

Last Update: 3/4/2021 1:57:21 PM

Terminal Management System (TMS) Received Confirmation Timestamp

NCMMIS Number: 2896

Description: Terminal Management System (TMS) Received Confirmation Timestamp is the date and time of confirmation that a device was received by a provider.

Data Type: TIMESTAMP

Size: X(26)

Functional Area Owner: E-Commerce

Valid Values:

Last Update: 3/4/2021 2:03:21 PM

Special Inpatient Pricing Begin Date

NCMMIS Number: 2898

Description: Special Inpatient Pricing Begin Date

Data Type: DATE

Size: X(10)

Functional Area Owner: Reference

Valid Values:

Last Update: 2/8/2010 4:25:04 PM

Special Inpatient Pricing End Date

NCMMIS Number: 2900

Description: Special Inpatient Pricing End Date

Data Type: DATE

Size: X(10)

Functional Area Owner: Reference

Valid Values:

Last Update: 2/8/2010 4:25:13 PM

Special Inpatient Pricing Payment Method Code

NCMMIS Number: 2901

Description: Indicates the pricing methodology for the special inpatient pricing segment.

Data Type: CHARACTER

Size: X(1)

Functional Area Owner: Reference

Valid Values:

From Value	Thru Value	Short Description	Long Description

From Value	Thru Value	Short Description	Long Description
P	P	PERDIEM	PER DIEM
R	R	RCC	RATIO COST TO CHARGE

Last Update: 3/12/2021 2:15:46 PM

Assignment of Benefits

NCMMIS Number: 2904

Description: 5010 DE 1073. Benefits Assignment Certification Indicator or Yes/No Condition or Response Code. Indicates if the insured or authorized person is has authorized benefits to be assigned to the provider

Data Type: CHARACTER

Size: X(01)

Functional Area Owner: Claims

Valid Values:

From Value	Thru Value	Short Description	Long Description

From Value	Thru Value	Short Description	Long Description
N	N	NO	BENEFITS HAVE NOT BEEN ASSIGNED TO THE PROVIDER
W	W	NA	NOT APPLICABLE OR USED WHEN THE PATIENT REFUSES TO SIGN BENEFITS
Y	Y	YES	INSURED OR AUTHORIZED PERSON AUTHORIZES BENEFITS TO BE ASSIGNED TO THE PROVIDER

Last Update: 3/15/2022 11:51:55 AM

Terminal Management System TMS Software Download Timestamp

NCMMIS Number: 2907

Description: Terminal Management System (TMS) Software Download Timestamp is the date and time that the most recent software version was downloaded to a Point of Service (POS) device.

Data Type: TIMESTAMP

Size: X(26)

Functional Area Owner: E-Commerce

Valid Values:

Last Update: 3/4/2021 1:53:02 PM

Claim Dispensing Validation System (DVS) Prior Authorization (PA) Indicator

NCMMIS Number: 2909

Description: Claim Dispensing Validation System (DVS) Prior Authorization (PA) Indicator specifies whether or not a claim created a Dispensing Validation System (DVS) Prior Authorization (PA).

Data Type: CHARACTER

Size: X(1)

Functional Area Owner: Claims

Valid Values:

From Value	Thru Value	Short Description	Long Description

From Value	Thru Value	Short Description	Long Description
N	N	NO	NO
Y	Y	YES	YES

Last Update: 3/15/2022 11:48:16 AM

Claim Processor Control Number

NCMMIS Number: 2910

Description: Claim Processor Control Number is a composite data element used on National Council for Prescription Drug Programs (NCPDP) input transactions.

Data Type: CHARACTER

Size: X(10)

Functional Area Owner: Claims

Valid Values:

Last Update: 12/16/2009 4:30:30 PM

Interactive Claim Denial Clarification Code

NCMMIS Number: 2911

Description: Interactive Claim Denial Clarification Code specifies the reason why a claim was denied.

Data Type: CHARACTER

Size: X(2)

Functional Area Owner: E-Commerce

Valid Values:

From Value	Thru Value	Short Description	Long Description

From Value	Thru Value	Short Description	Long Description
SPACE	SPACE	NOT SPCFD	NOT SPECIFIED
1	1	NO OVRRD	NO OVERRIDE
2	2	OVERRIDE	OVERRIDE
3	3	FT STUDNT	FULL TIME STUDENT
4	4	DSBL DEP	DISABLED DEPENDENT
5	5	DEP PARENT	DEPENDENT PARENT
6	6	SGFNT OTHR	SIGNIFICANT OTHER

Last Update: 3/4/2021 1:49:02 PM

Drug Daily Dosage Form Quantity Adult

NCMMIS Number: 2912

Description: Drug Daily Dosage Form Quantity (Adult) is the number of units (DE 6242) in a daily adult dose of a drug.

Data Type: DECIMAL

Size: 9(4)V9(3)

Functional Area Owner: Reference

Valid Values:

Last Update: 10/12/2010 10:12:11 AM

Drug Generic Sources Code

NCMMIS Number: 2913

Description: Drug Generic Sources Code specifies whether there are other sources for the product.

Data Type: CHARACTER

Size: X(1)

Functional Area Owner: Reference

Valid Values:

From Value	Thru Value	Short Description	Long Description

From Value	Thru Value	Short Description	Long Description
1	1	MULT	MULTIPLE SOURCE
2	2	SINGLE	SINGLE SOURCE

Last Update: 3/12/2021 2:05:49 PM

Drug Allergy Code

NCMMIS Number: 2914

Description: Drug Allergy Code specifies the potential allergic reactions to a drug.

Data Type: CHARACTER

Size: X(2)

Functional Area Owner: Reference

Valid Values:

From Value	Thru Value	Short Description	Long Description

From Value	Thru Value	Short Description	Long Description
00	00	NONE	NONE
01	01	PENICIL	PENICIL;CEPHAL;CARBAP;AZTREONA
02	02	GLUCOCORT	GLUCOCORTICOIDS
03	03	SALICYLATE	SALICYLATES;NSAID;PYRAZOLES
04	04	CODEINE	CODEINE
05	05	MORPHINE	MORPHINE
06	06	BARBITURAT	BARBITURATES
07	07	TETRACYCL	TETRACYCLINES
08	08	PHENOTHIAZ	PHENOTHIAZINES
09	09	MICROLIDE	MICROLIDE ANTIBIOTICS
10	10	AMINOGLYCO	AMINOGLYCOSIDES
11	11	NITROFURAN	NITROFURANS
12	12	MEPERIDINE	MEPERIDINE;FENTANYL
13	13	CARBAMAZEP	CARBAMAZEP;TRICYCLIC ANTI-DEP
14	14	HTDANTOINS	HTDANTOINS
15	15	THIAZIDES	THIAZIDES;SULFON;BUMET;FUROSE
16	16	HEPARIN	HEPARIN
17	17	ACETAMINOP	ACETAMINOPHEN
18	18	ALLOPURINO	ALLOPURINOL
19	19	BENZODIAZE	BENZODIAZEPINES
20	20	ISONIAZID	ISONIAZID;NIACIN;ETHION;PYRAZ
21	21	INSULINS	INSULINS EXCEPT HUMAN
22	22	XANTHINES	XANTHINES
23	23	OXYCODONE	OXYCODONE
24	24	PENTAZOCIN	PENTAZOCINE
25	25	PROPOXYPHE	PROPOXYPHENE
26	26	QUINIDINE	QUINIDINE;QUININE
27	27	PYRIMETHAM	PYRIMETHAMINE
28	28	TETANUS TO	TETANUS TOXOID
29	29	IODINE	IODINE
30	30	CLINIDAMYC	CLINIDAMYCIN;LINCOMYCIN
31	31	PROBENECID	PROBENECID
32	32	PAPAVERINE	PAPAVERINE
33	33	HYDRALAZIN	HYDRALAZINE
34	34	BETA ADREN	BETA-ADRENERGIC BLOCKERS
35	35	CHLORAL HY	CHLORAL HYDRATE
36	36	FOLIC ACID	FOLIC ACID
37	37	ANTICHOLIN	ANTICHOLINERGICS
38	38	METHYLPHEN	METHYLPHENIDATE
39	39	NITROGEN M	NITROGEN MUSTARDS
40	40	DOXORUBICI	DOXORUBICIN
41	41	ASPARAGINA	ASPARAGINASE
42	42	MUSCLE REL	SKELETAL MUSCLE RELAXANTS
43	43	DANTROLENE	DANTROLENE
44	44	RAUWOLFIA	RAUWOLFIA ALKALOIDS
45	45	METHYLDOPA	METHYLDOPA;METHYLDOPATE
46	46	ANES AMIDE	LOCAL ANESTHETICS - AMIDE TYP
47	47	ANES ESTER	LOCAL ANESTHETICS - ESTER TYP
48	48	ANES UNCLA	LOCAL ANESTHETICS - UNCLASSIF
49	49	OPIOID NAR	OPIOID NARCOTICS (OTHER)
50	50	ACE INHIBI	ACE INHIBITORS
51	51	FOUR AMINO	4 AMINOQUINOLONES
52	52	PRIMAQUINE	PRIMAQUINE;IODOQUINOL
53	53	CHLORAMPHE	CHLORAMPHENICOL
54	54	HETASTARCH	HETASTARCH
55	55	IRON DEXTR	IRON DEXTRAN
56	56	IMMUNE SER	IMMUNE SERUMS
57	57	DEFEROXAMI	DEFEROXAMINE
58	58	VACCINES	VACCINES
59	59	GOLD SALTS	GOLD SALTS
60	60	HALOPERIDO	HALOPERIDOL
61	61	QUINOLONE	QUINOLONE ANTI INFECTIVES
62	62	TRIMETHOPR	TRIMETHOPRIM
63	63	VANCOMYCIN	VANCOMYCIN
64	64	CALCITONIN	CALCITONIN (HUMAN, SALMON)
65	65	CALCIUM	CALCIUM CHANNEL BLOCKERS
66	66	ANTIHIST	ANTIHISTAMIN TOPICAL, SYSTEMIC
67	67	METRONIDAZ	MATRONIDAZOLE
68	68	WARFARIN	WARFARIN
69	69	ZIDOVUDINE	ZIDOVUDINE
70	70	FLUOXETINE	FLUOXETINE
71	71	CYCLOSPOR	CYCLOSPORINE
72	72	ETOPO TENI	ETOPSIDE, TENIPOSIDE
73	73	PACLITAXEL	PACLITAXEL
74	74	H2 ANTAGS	H2 ANTAGONISTS
75	75	POT SPARE	POTASSIUM SPARING DIRURETICS
76	76	NICOTINE	NICOTINE
77	77	ONDAN GRAN	ONDANSETRON AND GRANISETRON
78	78	SYMPATHOMI	SYMPATHOMIMETICS
79	79	PHENAZOPYR	PHENAZOPYRIDINE
80	80	STREPTOKIN	STREPTOKINASE
81	81	AMPHOTER B	AMPHOTERICIN B
82	82	DESMOPRESS	DESMOPRESSIN
83	83	ATRACURIUM	ATRACURIUM AND REL ISOMERS
84	84	OMEPRAZOLE	OMEPRAZOLE/LANSOPRAZOLE
85	85	ACYCLOVIR	ACYCLOVIR/VALACYCLOVIR
86	86	FENFLURAMN	FENFLURAMINE/DEXFENFLURAMINE
87	87	NEVIRAPINE	NEVIRAPINE
88	88	NITROGLYC	NITROGLYCERIN
89	89	TERBINAFIN	TERBINAFINE/BUTENAFINE
90	90	LAMIVUDINE	LAMIVUDINE
91	91	VIT A DER	VITAMIN A DRIVATIVE
92	92	FACTOR IX	FACTOR IX (HAMSTER)
93	93	DELAVIRDIN	DELAVIRDINE
94	94	TACROLIMUS	TACROLIMUS
95	95	MURINE ANT	MURINE ANTIBODY-CONT PRODUCTS
96	96	GADOLINIUM	GADOLINIUM-CONTAINING AGENTS
97	97	PHENYLTRIA	PHENYLTRIAZINE ANTICONVULSANT
98	98	HYALURONAT	HYALURONATE SODIUM

Last Update: 3/12/2021 2:05:49 PM

Record Key Identifier

NCMMIS Number: 2917

Description: Record Key Identifier is the unique key identifier to a file.

Data Type: CHARACTER

Size: X(60)

Functional Area Owner: Reference

Valid Values:

Last Update: 12/16/2009 4:30:30 PM

Security Access Type Code

NCMMIS Number: 2918

Description: Security Access Type Code identifies the type of access a user has been granted on a user interface page.

Data Type: CHARACTER

Size: X(1)

Functional Area Owner: Reference

Valid Values:

From Value	Thru Value	Short Description	Long Description

From Value	Thru Value	Short Description	Long Description
R	R	READ	READ
U	U	UPDATE	UPDATE

Last Update: 3/12/2021 2:05:55 PM

User Location Group Code

NCMMIS Number: 2919

Description: User Location Group Code identifies the high-level group with which a user (DE 2411) or a location (DE 0192) is associated.

Data Type: CHARACTER

Size: 1

Functional Area Owner: Reference

Valid Values:

From Value	Thru Value	Short Description	Long Description

From Value	Thru Value	Short Description	Long Description
A	A	AUTO	AUTO RECYCLE
B	B	BOTH FA ST	BOTH FA STATE REROUTE LOCS
F	F	FA	FISCAL AGENT
S	S	STATE	STATE

Last Update: 3/12/2021 2:05:56 PM

Pend Action Code

NCMMIS Number: 2926

Description: Pend Action Code specifies the nature of the action performed by a user on a pended claim for reporting purposes.

Data Type: CHARACTER

Size: X(1)

Functional Area Owner: Claims

Valid Values:

From Value	Thru Value	Short Description	Long Description

From Value	Thru Value	Short Description	Long Description
L	L	LOC CHANGE	LOCATION CHANGE
V	V	VIEWED	VIEWED
W	W	WORKED	WORKED

Last Update: 3/15/2022 11:48:16 AM

Transaction Receipt Date (Julian)

NCMMIS Number: 2928

Description: Transaction Receipt Date (Julian) specifies the Julian date that a transaction was received or entered the NCTracks system.

Data Type: CHARACTER

Size: X(5)

Functional Area Owner: E-Commerce

Valid Values:

Last Update: 3/4/2021 2:07:03 PM

CICS Transaction Absolute Start Time

NCMMIS Number: 2929

Description: CICS Transaction Absolute Start Time is the time of day that a transaction started in the CICS absolute time format.

Data Type: DECIMAL

Size: S9(15)

Functional Area Owner: E-Commerce

Valid Values:

Last Update: 3/4/2021 1:54:30 PM

CICS Transaction Absolute End Time

NCMMIS Number: 2930

Description: CICS Transaction Absolute End Time is the time of day that a transaction ended in the CICS absolute time format.

Data Type: DECIMAL

Size: S9(15)

Functional Area Owner: E-Commerce

Valid Values:

Last Update: 3/4/2021 1:59:56 PM

Provider Device Statistics (PDS) Segment Date

NCMMIS Number: 2940

Description: Provider Device Statistics (PDS) Segment Date is the date that identifies the period of time for which device statistics have been collected.

Data Type: DATE

Size: X(10)

Functional Area Owner: E-Commerce

Valid Values:

Last Update: 3/4/2021 2:07:58 PM

Provider Device Statistics (PDS) Transaction Count

NCMMIS Number: 2941

Description: Provider Device Statistics (PDS) Transaction Count is the total count of transactions for a provider during a month specified by the PDS segment date (DE 2940).

Data Type: INTEGER

Size: S9(7)

Functional Area Owner: E-Commerce

Valid Values:

From Value	Thru Value	Short Description	Long Description

From Value	Thru Value	Short Description	Long Description
ZERO	ZERO	DEFAULT	DEFAULT

Last Update: 3/4/2021 1:49:03 PM

Dispensing Validation System DVS Reason Code

NCMMIS Number: 2942

Description: Dispensing Validation System (DVS) Reason Code is the reason code returned by Medicaid Eligibility Verification System (MEVS) after processing a prior approval request.

Data Type: CHARACTER

Size: X(3)

Functional Area Owner: Reference

Valid Values:

Last Update: 10/12/2010 9:38:04 AM

Reference Frequency Time Code

NCMMIS Number: 2943

Description: Reference Frequency Time Code specifies the time period defined for a frequency (number of occurrences (DE 2944) per time period) of a specific drug or procedure.

Data Type: CHARACTER

Size: X(1)

Functional Area Owner: Reference

Valid Values:

From Value	Thru Value	Short Description	Long Description

From Value	Thru Value	Short Description	Long Description
A	A	18 MONTHS	18 MONTHS
B	B	3 YEARS	3 YEARS
C	C	2 WEEKS	2 WEEKS
D	D	3 WEEKS	3 WEEKS
E	E	4 YEARS	4 YEARS
F	F	3.5 YEARS	3.5 YEARS
G	G	10 YEARS	10 YEARS
H	H	6 CAL MTH	6 CALENDAR MONTHS
I	I	12 CAL MTH	12 CALENDAR MONTHS
X	X	UNLIMITED	UNLIMITED
Y	Y	2 MONTHS	2 MONTHS
1	1	1 DAY	1 DAY
2	2	1 WEEK	1 WEEK
3	3	1 MONTH	1 MONTH
4	4	3 MONTHS	3 MONTHS
5	5	6 MONTHS	6 MONTHS
6	6	1 YEAR	1 YEAR
7	7	2 YEARS	2 YEARS
8	8	5 YEARS	5 YEARS
9	9	LIFETIME	LIFETIME

Last Update: 3/12/2021 2:05:57 PM

Reference Frequency Occur Code

NCMMIS Number: 2944

Description: Reference Frequency Occur Code specifies the number of occurrences per time period (DE 2943) defined for a frequency of a specific drug or procedure.

Data Type: CHARACTER

Size: X(1)

Functional Area Owner: Reference

Valid Values:

From Value	Thru Value	Short Description	Long Description

From Value	Thru Value	Short Description	Long Description
A	A	24 TIMES	24 TIMES
X	X	UNLIMITED	UNLIMITED
1	1	ONCE	ONCE
2	2	TWICE	TWICE
3	3	3 TIMES	3 TIMES
4	4	4 TIMES	4 TIMES
5	5	6 TIMES	6 TIMES
6	6	8 TIMES	8 TIMES
7	7	12 TIMES	12 TIMES
8	8	15 TIMES	15 TIMES
9	9	20 TIMES	20 TIMES

Last Update: 3/12/2021 2:05:58 PM

Audio Response Unit (ARU) Call Identification Number (CID)

NCMMIS Number: 2948

Description: Audio Response Unit (ARU) Call Identification Number (CID) is a unique record number of a call made to the voice system.

Data Type: CHARACTER

Size: X(7)

Functional Area Owner: E-Commerce

Valid Values:

Last Update: 3/4/2021 2:02:29 PM

Audio Response Unit (ARU) Channel

NCMMIS Number: 2949

Description: Audio Response Unit (ARU) Channel specifies the channel that was used by a call to the voice system.

Data Type: CHARACTER

Size: X(3)

Functional Area Owner: E-Commerce

Valid Values:

Last Update: 3/4/2021 1:52:14 PM

Audio Response Unit (ARU) Call Begin Timestamp

NCMMIS Number: 2950

Description: Audio Response Unit (ARU) Call Begin Timestamp is the date and time when a call was connected to the voice system.

Data Type: TIMESTAMP

Size: X(26)

Functional Area Owner: E-Commerce

Valid Values:

Last Update: 3/4/2021 1:55:44 PM

Audio Response Unit (ARU) Call End Timestamp

NCMMIS Number: 2951

Description: Audio Response Unit (ARU) Call End Timestamp is the date and time when a call through the voice system was disconnected.

Data Type: TIMESTAMP

Size: X(26)

Functional Area Owner: E-Commerce

Valid Values:

Last Update: 3/4/2021 2:03:49 PM

Audio Response Unit (ARU) Service Identification Number (SID)

NCMMIS Number: 2953

Description: Audio Response Unit (ARU) Service Identification Number (SID) is a unique identifier associating a defined script event with the service used to handle the call.

Data Type: CHARACTER

Size: X(7)

Functional Area Owner: E-Commerce

Valid Values:

Last Update: 3/4/2021 1:51:14 PM

Audio Response Unit (ARU) Service Name

NCMMIS Number: 2954

Description: Audio Response Unit (ARU) Service Name is the name of the service (application) run by the voice system in response to a call.

Data Type: CHARACTER

Size: X(16)

Functional Area Owner: E-Commerce

Valid Values:

Last Update: 3/4/2021 1:59:13 PM

Audio Response Unit (ARU) Service Begin Timestamp

NCMMIS Number: 2955

Description: Audio Response Unit (ARU) Service Begin Timestamp is the date and time that a service run began during a call to the voice system.

Data Type: TIMESTAMP

Size: X(26)

Functional Area Owner: E-Commerce

Valid Values:

Last Update: 3/4/2021 2:06:15 PM

Audio Response Unit (ARU) Service End Timestamp

NCMMIS Number: 2956

Description: Audio Response Unit (ARU) Service End Timestamp is the date and time that a service run ended during a call to the voice system.

Data Type: TIMESTAMP

Size: X(26)

Functional Area Owner: E-Commerce

Valid Values:

Last Update: 3/4/2021 1:51:14 PM

Audio Response Unit (ARU) Summary Identification Number (SUMID)

NCMMIS Number: 2957

Description: Audio Response Unit (ARU) Summary Identification Number (SUMID) is a number that uniquely identifies each hour and service for statistical summaries.

Data Type: CHARACTER

Size: X(7)

Functional Area Owner: E-Commerce

Valid Values:

Last Update: 3/4/2021 1:59:08 PM

Audio Response Unit (ARU) Summary Period Begin Timestamp

NCMMIS Number: 2958

Description: Audio Response Unit (ARU) Summary Period Begin Timestamp is the date and time when collection of summary call statistics began.

Data Type: TIMESTAMP

Size: X(26)

Functional Area Owner: E-Commerce

Valid Values:

Last Update: 3/4/2021 2:05:01 PM

Audio Response Unit (ARU) Duration

NCMMIS Number: 2959

Description: Audio Response Unit (ARU) Duration is the total run time, in seconds, of a service within the summary period.

Data Type: INTEGER

Size: 9(7)

Functional Area Owner: E-Commerce

Valid Values:

Last Update: 3/4/2021 1:54:34 PM

Audio Response Unit (ARU) Usage Count

NCMMIS Number: 2960

Description: Audio Response Unit (ARU) Usage Count is the total number of times a service was run during the summary period.

Data Type: INTEGER

Size: 9(7)

Functional Area Owner: E-Commerce

Valid Values:

Last Update: 3/4/2021 2:00:22 PM

Audio Response Unit (ARU) Traffic Call Total Count

NCMMIS Number: 2961

Description: Audio Response Unit (ARU) Traffic Call Total Count is the total number of calls made to the voice system on a given channel during a one-hour period.

Data Type: INTEGER

Size: 9(5)

Functional Area Owner: E-Commerce

Valid Values:

Last Update: 3/4/2021 2:06:00 PM

Audio Response Unit (ARU) Traffic Duration Total

NCMMIS Number: 2962

Description: Audio Response Unit (ARU) Traffic Duration Total is the total duration, in seconds, of all calls made to the voice system on a given channel during a given period.

Data Type: INTEGER

Size: 9(5)

Functional Area Owner: E-Commerce

Valid Values:

Last Update: 3/4/2021 1:53:26 PM

Audio Response Unit (ARU) Message Log Priority

NCMMIS Number: 2963

Description: Audio Response Unit (ARU) Message Log Priority specifies the priority classification of an error message logged to the voice system.

Data Type: CHARACTER

Size: X(2)

Functional Area Owner: E-Commerce

Valid Values:

Last Update: 3/4/2021 2:01:11 PM

Audio Response Unit (ARU) Error Message Text

NCMMIS Number: 2964

Description: Audio Response Unit (ARU) Error Message Text is the error message logged by the voice system.

Data Type: CHARACTER

Size: X(240)

Functional Area Owner: E-Commerce

Valid Values:

Last Update: 3/4/2021 2:06:56 PM

Audio Response Unit (ARU) Error Message Log Timestamp

NCMMIS Number: 2965

Description: Audio Response Unit (ARU) Error Message Log Timestamp is the date and time that an error message was generated by the voice system.

Data Type: TIMESTAMP

Size: X(26)

Functional Area Owner: E-Commerce

Valid Values:

Last Update: 3/4/2021 1:56:31 PM

Audio Response Unit (ARU) Error Message Log Source

NCMMIS Number: 2966

Description: Audio Response Unit (ARU) Error Message Log Source is the name of the software system that generated an error message on the voice response system.

Data Type: CHARACTER

Size: X(12)

Functional Area Owner: E-Commerce

Valid Values:

Last Update: 3/4/2021 2:00:13 PM

Audio Response Unit (ARU) Error Message Log Identifier

NCMMIS Number: 2967

Description: Audio Response Unit (ARU) Error Message Log Identifier is a unique identifier for each error message generated by the voice response system.

Data Type: CHARACTER

Size: X(8)

Functional Area Owner: E-Commerce

Valid Values:

Last Update: 3/4/2021 2:07:55 PM

Audio Response Unit (ARU) Summary Period End Timestamp

NCMMIS Number: 2969

Description: Audio Response Unit (ARU) Summary Period End Timestamp is the date and time when collection of summary call statistics ended.

Data Type: TIMESTAMP

Size: X(26)

Functional Area Owner: E-Commerce

Valid Values:

Last Update: 3/4/2021 1:55:30 PM

Interactive Redundant Indicator

NCMMIS Number: 2970

Description: Interactive Redundant Indicator specifies whether or not a transaction is a duplicate transaction.

Data Type: CHARACTER

Size: X(1)

Functional Area Owner: E-Commerce

Valid Values:

From Value	Thru Value	Short Description	Long Description

From Value	Thru Value	Short Description	Long Description
N	N	NO	NO
Y	Y	YES	YES

Last Update: 3/4/2021 1:49:03 PM

Prior Approval PA Edit Code

NCMMIS Number: 2972

Description: PA Edit Code specifies the edit logic that was applied during editing of a PA.

Data Type: CHARACTER

Size: X(4)

Functional Area Owner: Prior Authorization

Valid Values:

Last Update: 3/19/2012 9:37:21 AM

Interactive Formulary Response Price

NCMMIS Number: 2977

Description: Interactive Formulary Response Price is the formulary price returned to a provider.

Data Type: CURRENCY

Size: S9(6)V9(5)

Functional Area Owner: E-Commerce

Valid Values:

Last Update: 3/4/2021 1:57:15 PM

Ordering Provider Key Information

NCMMIS Number: 2980

Description: Ordering Provider Key Information is a number used to identify the provider that ordered the service, referred the client to another provider for service, or issued a prescription.

Data Type: CHARACTER

Size: X(11)

Functional Area Owner: E-Commerce

Valid Values:

Last Update: 3/4/2021 2:03:13 PM

Primary Key Sequence Number

NCMMIS Number: 2984

Description: Generic Primary Key Sequence Number is an integer to uniquely identify a row in the data table

Data Type: INTEGER

Size: S9()

Functional Area Owner: Reference

Valid Values:

Last Update: 2/15/2013 4:09:56 PM

Standard Therapeutic Classification

NCMMIS Number: 2985

Description: Classifies drugs according to the most common intended use.

Data Type: CHARACTER

Size: X(2)

Functional Area Owner: Reference

Valid Values:

Last Update: 4/25/2012 6:31:22 PM

Standard Therapeutic Class Description

NCMMIS Number: 2986

Description: Text description for the standard therapeutic class.

Data Type: CHARACTER

Size: X(50)

Functional Area Owner: Reference

Valid Values:

Last Update: 5/20/2010 4:30:59 PM

State Memo CSR

NCMMIS Number: 2987

Description: Number that uniquely identifies a State Memo/CSR.

Data Type: CHARACTER

Size: X(18)

Functional Area Owner: Reference

Valid Values:

Last Update: 2/22/2011 8:53:38 AM

State Memo CSR Description

NCMMIS Number: 2988

Description: Description of a State Memo/CSR.

Data Type: CHARACTER

Size: X(2048)

Functional Area Owner: Reference

Valid Values:

Last Update: 10/4/2011 7:26:45 AM

State Policy Description

NCMMIS Number: 2989

Description: Description of the State Policy number.

Data Type: CHARACTER

Size: X(30)

Functional Area Owner: Reference

Valid Values:

Last Update: 5/20/2010 4:31:01 PM

State Policy Number

NCMMIS Number: 2990

Description: Number associated with a State policy.

Data Type: CHARACTER

Size: X(20)

Functional Area Owner: Reference

Valid Values:

Last Update: 7/14/2010 5:19:45 PM

State Policy Update User ID

NCMMIS Number: 2991

Description: User ID of the user that last updated the association of a State policy to Reference data such as procedure code, diagnosis code, etc.

Data Type: CHARACTER

Size: X(32)

Functional Area Owner: Reference

Valid Values:

Last Update: 7/22/2010 8:47:23 AM

State LME Indicator

NCMMIS Number: 2992

Description: Indicates if a budget is specific to an LME or is valid across all LMES, i.e. a State-wide budget.

Data Type: CHARACTER

Size: X(1)

Functional Area Owner: Reference

Valid Values:

From Value	Thru Value	Short Description	Long Description

From Value	Thru Value	Short Description	Long Description
L	L	LME	LOCAL MANAGEMENT ENTITY (LME)
S	S	STATE	STATE

Last Update: 3/12/2021 2:15:46 PM

Universal Product Code

NCMMIS Number: 2993

Description: Universal Product Code

Data Type: INTEGER

Size: 9(10)

Functional Area Owner: Reference

Valid Values:

Last Update: 2/16/2010 6:06:41 PM

Sub Specialty Code

NCMMIS Number: 2994

Description: Code representing the lowest level of the provider taxonomy hierarchy

Data Type: CHARACTER

Size: X(11)

Functional Area Owner: Provider

Valid Values:

Last Update: 7/14/2010 2:15:16 PM

Provider Accreditation Number

NCMMIS Number: 2995

Description: The accreditation number assigned to the provider .

Data Type: CHARACTER

Size: X(15)

Functional Area Owner: Provider

Valid Values:

Last Update: 5/6/2010 2:03:38 PM

Provider Accreditation Begin Date

NCMMIS Number: 2996

Description: Start date of the accreditation

Data Type: DATE

Size: X(10)

Functional Area Owner: Provider

Valid Values:

Last Update: 4/18/2016 10:37:05 AM

Provider Accreditation End Date

NCMMIS Number: 2997

Description: End date of the accreditation

Data Type: DATE

Size: X(10)

Functional Area Owner: Provider

Valid Values:

Last Update: 4/18/2016 10:37:19 AM

Record Active Indicator

NCMMIS Number: 2998

Description: Generic indicator to identify records that are currently active for transaction or other processing. Records indicating inactive are maintained for historical and reporting purposes.

Data Type: CHARACTER

Size: X()

Functional Area Owner: Reference

Valid Values:

Last Update: 2/15/2013 1:35:35 PM

Provider Primary Address Indicator

NCMMIS Number: 2999

Description: A yes.no indicator indicating whether the address/service location is the provider's primary service location or not. Must have 1 and only 1 active primary service location at a time.

This is a System Derived indicator.

Data Type: CHARACTER

Size: X(1)

Functional Area Owner: Provider

Valid Values:

From Value	Thru Value	Short Description	Long Description

From Value	Thru Value	Short Description	Long Description
N	N	No	No
Y	Y	Yes	Yes

Last Update: 3/8/2021 4:20:02 PM

Present on Admission POA Code 5010

NCMMIS Number: 3000

Description: "Used to identify the diagnosis onset as it relates to the diagnosis reported diagnosis reported.

This list is used by the provider portal and contains only the values supporting 5010. Use DE 2254 for 4010 & 5010 values.

Xref to 5010 837I TR3 list 1073."

Data Type: CHARACTER

Size: X(1)

Functional Area Owner: Claims

Valid Values:

From Value	Thru Value	Short Description	Long Description

From Value	Thru Value	Short Description	Long Description
N	N	NO	DIAGNOSIS WAS NOT PRESENT
U	U	DOC-UNDEF	DOCUMENTATION INSUFFICIENT
W	W	CLIN-UNDEF	CLINICALLY UNDETERMINED IF DIAG WAS PRESENT
Y	Y	YES	DIAGNOSIS WAS PRESENT

Last Update: 3/15/2022 11:51:55 AM