Master Data Element Dictionary, version 20240608: NCMMIS 7001 - 7500
Claim Procedure Modifier 1 Code
NCMMIS Number: 7001
Description: Claim Procedure Modifier Code further defines a procedure code.
Data Type: CHARACTER
Size: X(2)
Functional Area Owner: Claims
Valid Values:
Last Update: 1/16/2013 9:19:29 AM
Claim Procedure Modifier 2 Code
NCMMIS Number: 7002
Description: Claim Procedure Modifier Code further defines a procedure code.
Data Type: CHARACTER
Size: X(2)
Functional Area Owner: Claims
Valid Values:
Last Update: 1/16/2013 9:20:38 AM
Claim Procedure Modifier 3 Code
NCMMIS Number: 7003
Description: Claim Procedure Modifier Code further defines a procedure code.
Data Type: CHARACTER
Size: X(2)
Functional Area Owner: Claims
Valid Values:
Last Update: 1/16/2013 9:21:16 AM
Claim Procedure Modifier 4 Code
NCMMIS Number: 7004
Description: Claim Procedure Modifier Code further defines a procedure code.
Data Type: CHARACTER
Size: X(2)
Functional Area Owner: Claims
Valid Values:
Last Update: 1/16/2013 9:22:08 AM
Place Of Service Code
NCMMIS Number: 7005
Description: Claim Place of Service Code identifies the places where a service was or may be rendered by a provider.
Data Type: CHARACTER
Size: X(2)
Functional Area Owner: Claims
Valid Values:
Last Update: 4/18/2013 2:09:39 PM
Render Provider Identifier Number
NCMMIS Number: 7006
Description: Provider Identification Number is a unique number assigned to each provider enrolled to provide services to clients of the Medicaid program. This number is the primary method of identifying a provider.
Data Type: CHARACTER
Size: X(8)
Functional Area Owner: Claims
Valid Values:
Last Update: 4/19/2013 2:57:48 PM
Ordering Provider Identifier Number
NCMMIS Number: 7008
Description: Provider Identification Number is a unique number assigned to each provider enrolled to provide services to clients of the Medicaid program. This number is the primary method of identifying a provider.
Data Type: CHARACTER
Size: X(8)
Functional Area Owner: Claims
Valid Values:
Last Update: 4/19/2013 2:58:31 PM
Rendering Provider Profession Code
NCMMIS Number: 7009
Description: Provider Profession Code specifies the profession of a Provider on an agency file. It is used to cross-match license numbers between various agency license files.
Data Type:
Size:
Functional Area Owner: Claims
Valid Values:
Last Update: 7/29/2010 11:18:49 AM
Rendering Provider License Number
NCMMIS Number: 7010
Description: Provider License Number is an identifying number issued by the state licensing board, authorizing a provider to practice within that state under the specific license type applicable to the provider.
Data Type:
Size:
Functional Area Owner: Claims
Valid Values:
Last Update: 7/29/2010 11:18:49 AM
Line Permanently Denied Indicator
NCMMIS Number: 7011
Description: Permanently Denied Indicator specifies whether or not a claim or claim line is permanently denied.
Data Type: CHARACTER
Size: X(1)
Functional Area Owner: Claims
Valid Values:
Last Update: 4/19/2013 2:59:30 PM
Line Emergency Code
NCMMIS Number: 7012
Description: formerly Line Emergency Code. Emergency Indicator specifies whether or not a service was performed due to emergency conditions.
This list is used by the provider portal and contains only the values supporting 5010. Xrf to NCTracks DE 4250 for 4010 and 5010 values.
Xrf to 5010 837 TR3 list 127 .
Data Type: CHARACTER
Size: X(1)
Functional Area Owner: Claims
Valid Values:
From Value | Thru Value | Short Description | Long Description |
|---|---|---|---|
1 | 1 | IMMEDIATE | IMMEDITATE/URGENT CARE |
2 | 2 | SERVICES R | SERVICES RENDERED IN RETROACTIVE PERIOD |
3 | 3 | EMERGENCY | EMERGENCY CARE |
4 | 4 | CLIENT HAS | CLIENT HAS TEMPORARY MEDICAID AUTH. CARD |
5 | 5 | REQUEST FR | REQUEST FROM COUNTY FOR 2ND OPINION |
6 | 6 | REQUEST FO | REQUEST FOR OVERRIDE PENDING |
7 | 7 | SPECIAL HA | SPECIAL HANDLING |
Last Update: 3/15/2022 11:51:21 AM
Line Begin Date of Service Date
NCMMIS Number: 7013
Description: Claim Service Begin Date is the first date that a service on a claim or claim line was rendered.
Data Type: DATE
Size: X(10)
Functional Area Owner: Claims
Valid Values:
Last Update: 8/29/2012 2:23:25 PM
Line End Date of Service Date
NCMMIS Number: 7014
Description: Claim Service End Date is the last date that a service on a claim or claim line was rendered.
Data Type: DATE
Size: X(10)
Functional Area Owner: Claims
Valid Values:
Last Update: 8/29/2012 2:23:05 PM
Line Submitted Charge Amount
NCMMIS Number: 7015
Description: Claim Charge Amount is the charge amount submitted or billed on a claim or claim line.
Data Type: DECIMAL
Size: S9(9,2)
Functional Area Owner: Claims
Valid Values:
Last Update: 4/18/2013 2:10:45 PM
Line Calculated Allowed Amount
NCMMIS Number: 7016
Description: Claim Calculated Allowed Amount is the allowed charge calculated by the system for a claim or claim line. It is determined by applying the base rate change amounts (DE 0736) to a claim's base rate (DE 0564).
Data Type: DECIMAL
Size: S9(9,2)
Functional Area Owner: Claims
Valid Values:
Last Update: 4/18/2013 2:11:57 PM
Line Reimbursement Amount
NCMMIS Number: 7017
Description: Claim Reimbursement Amount is the total payment or reimbursement amount for a claim or claim line.
Data Type: DECIMAL
Size: S9(9,2)
Functional Area Owner: Claims
Valid Values:
Last Update: 4/18/2013 2:12:57 PM
Line Submitted Unit Number
NCMMIS Number: 7018
Description: Claim Line Quantity or Units Submitted is the total number of units or quantity submitted by a provider for the service rendered.
Data Type: DECIMAL
Size: S9(11,3)
Functional Area Owner: Claims
Valid Values:
Last Update: 4/18/2013 2:14:14 PM
Line Allowed Unit Number
NCMMIS Number: 7019
Description: Claim Line Quantity or Units Allowed is the quantity or number of metric units allowed by NYS Medicaid for the service rendered on the claim line.
Data Type: DECIMAL
Size: S9(11,3)
Functional Area Owner: Claims
Valid Values:
Last Update: 4/18/2013 2:15:20 PM
Line Reimbursement Unit Amount
NCMMIS Number: 7020
Description: Claim Line Quantity or Units Paid specifies the quantity or number of metric units paid for a line item service.
Data Type: NUMERIC
Size: 9(08)V999
Functional Area Owner: Claims
Valid Values:
Last Update: 8/29/2012 2:24:35 PM
Products of Ambulatory Care Weight Number
NCMMIS Number: 7021
Description: Products of Ambulatory Care (PAC) Weight Factor is a weight factor assigned to a PAC group based upon services rendered for claims processing.
Data Type:
Size:
Functional Area Owner: Claims
Valid Values:
Last Update: 7/29/2010 11:18:53 AM
Dental First Cavity Code
NCMMIS Number: 7022
Description: Oral Cavity Designation Code specifies the oral cavity involved in a service
Data Type: CHARACTER
Size: X(2)
Functional Area Owner: Claims
Valid Values:
Last Update: 4/19/2013 10:34:53 AM
Dental Second Cavity Code
NCMMIS Number: 7023
Description: Oral Cavity Designation Code specifies the oral cavity involved in a service
Data Type: CHARACTER
Size: X(2)
Functional Area Owner: Claims
Valid Values:
Last Update: 4/19/2013 10:35:40 AM
Dental Third Cavity Code
NCMMIS Number: 7024
Description: Oral Cavity Designation Code specifies the oral cavity involved in a service
Data Type: CHARACTER
Size: X(2)
Functional Area Owner: Claims
Valid Values:
Last Update: 4/19/2013 10:36:24 AM
Dental Fourth Cavity Code
NCMMIS Number: 7025
Description: Oral Cavity Designation Code specifies the oral cavity involved in a service
Data Type: CHARACTER
Size: X(2)
Functional Area Owner: Claims
Valid Values:
Last Update: 4/19/2013 10:36:55 AM
Dental Fifth Cavity Code
NCMMIS Number: 7026
Description: Oral Cavity Designation Code specifies the oral cavity involved in a service
Data Type: CHARACTER
Size: X(2)
Functional Area Owner: Claims
Valid Values:
Last Update: 4/19/2013 10:37:32 AM
Prior Approval Line Number
NCMMIS Number: 7027
Description: Claim or Prior Authorization/Approval (PA) Line Number specifies the line number for service on a invoice or prior approval. It identifies service lines that can be adjudicated separately when appended to the invoice number or prior approval number.
Data Type:
Size:
Functional Area Owner: Claims
Valid Values:
Last Update: 7/29/2010 11:19:10 AM
Prior Approval Line Used Amount
NCMMIS Number: 7028
Description: Prior Authorization/Approval (PA) Amount (Rendered To Date) is the total dollar amount claimed for a prior approval service to date. This amount is compared to the amount approved (DE 0432) for the service to insure that the amount paid does not exceed t
Data Type:
Size:
Functional Area Owner: Claims
Valid Values:
Last Update: 7/29/2010 11:19:11 AM
Prior Approval Line Used Unit Amount
NCMMIS Number: 7030
Description: Prior Authorization/Approval (PA) Quantity (Rendered To Date) is the total number of units rendered to date for a prior approval service. This quantity is compared to the quantity approved (DE 0434) to insure that payment is not made for service quantiti
Data Type:
Size:
Functional Area Owner: Claims
Valid Values:
Last Update: 7/29/2010 11:19:11 AM
Prior Approval Line Used Times Amount
NCMMIS Number: 7031
Description: Prior Authorization/Approval (PA) Claim Service Count (Rendered) specifies the number of claims processed against a Prior Approval record.
Data Type:
Size:
Functional Area Owner: Claims
Valid Values:
Last Update: 7/29/2010 11:19:11 AM
Benefit Plan Hierarchy Number
NCMMIS Number: 7032
Description: A number indicating the sequence of which 1 benefit plan should pay a claim line versus another benefit plan. The lower the number, the stronger or more likely the benefit plan is to pay the claim.
Data Type: SMALLINT
Size: S9()
Functional Area Owner: Claims
Valid Values:
Last Update: 4/19/2013 3:00:13 PM
Company Account Code
NCMMIS Number: 7033
Description: Company accout code describes how Budgets communicate what monies are spent on claims for a given week
Data Type:
Size:
Functional Area Owner: Claims
Valid Values:
Last Update: 7/29/2010 11:19:14 AM
Allocated Amount
NCMMIS Number: 7034
Description: Allocated amount is how much of the company account code was used on a claim
Data Type: DECIMAL
Size: S9(9,2)
Functional Area Owner: Claims
Valid Values:
Last Update: 4/18/2013 2:16:13 PM
Assisting Surgeon Provider Identification Number
NCMMIS Number: 7035
Description: Provider Identification Number is a unique number assigned to each provider enrolled to provide services to clients of the Medicaid program. This number is the primary method of identifying a provider.
Data Type: CHARACTER
Size: X(08)
Functional Area Owner: Claims
Valid Values:
Last Update: 9/10/2011 8:30:09 AM
Assisting Surgeon Provider Profession Code
NCMMIS Number: 7036
Description: Provider Profession Code specifies the profession of a Provider on an agency file. It is used to cross-match license numbers between various agency license files.
Data Type:
Size:
Functional Area Owner: Claims
Valid Values:
Last Update: 7/29/2010 11:19:15 AM
Assisting Surgeon License Number
NCMMIS Number: 7037
Description: Provider License Number is an identifying number issued by the state licensing board, authorizing a provider to practice within that state under the specific license type applicable to the provider.
Data Type:
Size:
Functional Area Owner: Claims
Valid Values:
Last Update: 7/29/2010 11:19:15 AM
Assisting Surgeon NPI Code
NCMMIS Number: 7038
Description: This Provider NPI Derivation Code indicates the status of a Provider ID after processing within the Provider Derivation program
Data Type:
Size:
Functional Area Owner: Claims
Valid Values:
Last Update: 7/29/2010 11:19:16 AM
Assisting Surgeon NPI Number
NCMMIS Number: 7039
Description: National Provider Identifier (NPI) is the nationally recognized provider identifier assigned by the Center for Medicare & Medicaid Services (CMS).
Data Type:
Size:
Functional Area Owner: Claims
Valid Values:
Last Update: 7/29/2010 11:19:16 AM