Master Data Element Dictionary, version 20240608: NCMMIS 0501-1000
Authorization On Request Report Processed Time
NCMMIS Number: 0501
Description: Authorization On Request Report Processed Time is the time at which the data was extracted for a requested report.
Data Type: TIME
Size: X(8)
Functional Area Owner: Prior Authorization
Valid Values:
Last Update: 5/10/2010 11:25:25 AM
Report Title
NCMMIS Number: 0502
Description: Report Title is the full text name of a report that was requested and/or generated.
Data Type: CHARACTER
Size: X(40)
Functional Area Owner: Reference
Valid Values:
Last Update: 12/16/2009 4:29:38 PM
Provider Billing First Name
NCMMIS Number: 0503
Description: Provider Billing First Name is the first name of a provider
Data Type: CHARACTER
Size: X(50)
Functional Area Owner: Provider
Valid Values:
Last Update: 2/22/2017 8:38:30 PM
Procedure Description Effective Date
NCMMIS Number: 0504
Description: Procedure Description Effective Date is the first date that a Procedure Descriptive Name (DE 2066) became effective.
Data Type: DATE
Size: X(10)
Functional Area Owner: Reference
Valid Values:
Last Update: 12/16/2009 4:31:27 PM
Plan Co-Pay Benefit Category Code
NCMMIS Number: 0505
Description: Plan Co-Pay Benefit Category Code specifies the category of co-payment in effect for retail or mail-order claims.
Data Type: CHARACTER
Size: X(1)
Functional Area Owner: Reference
Valid Values:
From Value | Thru Value | Short Description | Long Description |
|---|---|---|---|
B | B | BRAND | BRAND |
F | F | FAMILY | FAMILY PLANNING |
G | G | GENERIC | GENERIC |
O | O | OTC | OTC |
P | P | PREFERRED | PREFERRED BRAND |
Last Update: 3/12/2021 2:11:07 PM
Plan Co-Pay Type Code
NCMMIS Number: 0506
Description: Plan Co-Pay Type Code identifies whether the co-payment information relates to retail claims or mail-order claims.
Data Type: CHARACTER
Size: X(1)
Functional Area Owner: Reference
Valid Values:
From Value | Thru Value | Short Description | Long Description |
|---|---|---|---|
M | M | MAIL-ORDER | MAIL-ORDER |
R | R | RETAIL | RETAIL |
Last Update: 3/12/2021 2:11:08 PM
Healthcare Common Procedure Coding System HCPCS Text
NCMMIS Number: 0507
Description: Healthcare Common Procedure Coding System (HCPCS) Text is the full HCPCS long description for a procedure as supplied by HCPCS.
Data Type: CHARACTER
Size: X(4000)
Functional Area Owner: Reference
Valid Values:
Last Update: 10/13/2010 9:19:13 AM
Provider Billing Method
NCMMIS Number: 0508
Description: Provider Billing Method is the billing method used
Data Type: CHARACTER
Size: X(5)
Functional Area Owner: Provider
Valid Values:
Last Update: 2/22/2017 8:39:30 PM
Provider Billing Address Line 1
NCMMIS Number: 0509
Description: Provider Billing Address Line 1 is the street address for a provider
Data Type: CHARACTER
Size: X(250)
Functional Area Owner: Provider
Valid Values:
Last Update: 2/22/2017 8:40:40 PM
Provider Billing Address Line 2
NCMMIS Number: 0510
Description: Provider Billing Address Line 2 is the street address for a provider
Data Type: CHARACTER
Size: X(250)
Functional Area Owner: Provider
Valid Values:
Last Update: 2/22/2017 8:41:34 PM
Provider Billing Address Line 3
NCMMIS Number: 0511
Description: Provider Billing Address Line 3 is the street address for a provider
Data Type: CHARACTER
Size: X(250)
Functional Area Owner: Provider
Valid Values:
Last Update: 2/22/2017 8:42:31 PM
Prior Authorization/Approval (PA) Status Date
NCMMIS Number: 0512
Description: Prior Authorization/Approval (PA) Status Date is the date on which the status of a PA was last changed.
Data Type: DATE
Size: X(10)
Functional Area Owner: Reference
Valid Values:
Last Update: 12/16/2009 4:30:01 PM
Provider Billing City
NCMMIS Number: 0513
Description: Provider Billing City is the city in which the provider does business or to which correspondence should be sent
Data Type: CHARACTER
Size: X(80)
Functional Area Owner: Provider
Valid Values:
Last Update: 2/22/2017 8:43:26 PM
Provider Billing State Code
NCMMIS Number: 0514
Description: Provider Billing State Code is the state code for a provider
Data Type: CHARACTER
Size: X(50)
Functional Area Owner: Provider
Valid Values:
Last Update: 2/22/2017 8:44:21 PM
Provider Billing Address Zip
NCMMIS Number: 0515
Description: Provider Billing Address Zip is the Postal Code is a partial or complete U. S. zip code or an international postal code
Data Type: CHARACTER
Size: X(20)
Functional Area Owner: Provider
Valid Values:
Last Update: 2/22/2017 8:45:24 PM
TPL Include HIPP Indicator
NCMMIS Number: 0516
Description: HIPP Include Indicator specifies whether or not a recipient should be included in the Health Insurance Premium Payments (HIPP) based on their association with a commercial insurance policy.
Data Type: CHARACTER
Size: X(1)
Functional Area Owner: Third Party Liability
Valid Values:
From Value | Thru Value | Short Description | Long Description |
|---|---|---|---|
N | N | NOTINCLUDE | NOT INCLUDED IN HIPP |
Y | Y | INCLUDED | INCLUDED IN HIPP |
Last Update: 3/12/2021 1:30:49 PM
Text Page Sequence Number
NCMMIS Number: 0517
Description: Text Page Sequence Number is an application generated sequence number assigned to Edit Resolution Text lines to correctly order the text when it exceeds a single page of text.
Data Type: SMALLINT
Size: S9(3)
Functional Area Owner: Reference
Valid Values:
Last Update: 12/16/2009 4:31:28 PM
Provider Migration Date
NCMMIS Number: 0518
Description: Migration Date is the date that the Provider record was transferred from the Enrollment Tracking database to the Provider database.
Data Type: DATE
Size: X(10)
Functional Area Owner: Provider
Valid Values:
Last Update: 6/3/2010 5:16:02 PM
Interactive Audit Number
NCMMIS Number: 0519
Description: Interactive Audit Number is the audit control number used to track authorization transactions.
Data Type: CHARACTER
Size: X(17)
Functional Area Owner: E-Commerce
Valid Values:
Last Update: 3/4/2021 1:57:25 PM
Provider Billing Phone Number
NCMMIS Number: 0520
Description: Provider Billing Phone Number is the phone number including area code at which a specific provider can be reached
Data Type: CHARACTER
Size: X(20)
Functional Area Owner: Provider
Valid Values:
Last Update: 2/22/2017 8:46:20 PM
Provider Billing E-Mail
NCMMIS Number: 0521
Description: Provider Billing E-Mail is E-mail Address is the address used to send an electronic (email) message
Data Type: CHARACTER
Size: X(225)
Functional Area Owner: Provider
Valid Values:
Last Update: 2/22/2017 8:47:19 PM
Reference ID
NCMMIS Number: 0522
Description: Reference ID
Data Type: CHARACTER
Size: X(12)
Functional Area Owner: Provider
Valid Values:
Last Update: 2/23/2017 12:52:53 PM
Plan Co-Payment Amount
NCMMIS Number: 0523
Description: Plan Co-Payment Amount is the dollar amount that the client is responsible for paying for a claim.
Data Type: CURRENCY
Size: 9(3)V9(2)
Functional Area Owner: Reference
Valid Values:
Last Update: 12/16/2009 4:31:28 PM
Fingerprint Product Type
NCMMIS Number: 0524
Description: PRD TY is Product Type
Data Type: CHARACTER
Size: X(100)
Functional Area Owner: Provider
Valid Values:
Last Update: 2/23/2017 12:56:43 PM
Plan Maximum Units
NCMMIS Number: 0525
Description: Plan Maximum Units is the maximum number of drug units allowed on a claim for a client under this plan.
Data Type: DECIMAL
Size: 9(5)V9(2)
Functional Area Owner: Reference
Valid Values:
Last Update: 12/16/2009 4:31:28 PM
Plan Maximum Days Supply Quantity
NCMMIS Number: 0526
Description: Plan Maximum Days Supply Quantity is the maximum number of days for which maintenance drugs will be supplied on the plan.
Data Type: DECIMAL
Size: 9(3)V
Functional Area Owner: Reference
Valid Values:
Last Update: 12/16/2009 4:31:28 PM
Provider Fingerprint Status Code
NCMMIS Number: 0527
Description: Status of the required fingerprinting application
Data Type: CHARACTER
Size: X(1)
Functional Area Owner: Provider
Valid Values:
From Value | Thru Value | Short Description | Long Description |
|---|---|---|---|
C | C | CANCELED | REQUIRED FINGERPRINTING CANCELED |
L | L | LTRGEN | LETTER HAS BEEN GENERATED - PENDING SUBMISSION OF APPLICATION BY THE PROVIDER |
N | N | NEW | NEWLY IDENTIFIED PROVIDER - LETTER HAS NOT YET BEEN GENERATED |
NO | NO | NOMATCH | NO MATCH FOUND IN NCTRACKS |
RE | RE | RESOLVED | UNRESOLVED CASE ID HAS BEEN RESOLVED MATCHED TO A NCTRACKS CASE ID |
S | S | APPSUBMIT | FINGERPRINTING APPLICATION HAS BEEN SUBMITTED |
UE | UE | UNRESOL-ER | UNRESOLVED CASE ID FROM SBI - WITH AN ERROR |
UF | UF | UNRESOL-NF | UNRESOLVED CASE ID FROM SBI - RESULTS INCLUDED A NEGATIVE FINDING |
UN | UN | UNRESOL-NN | UNRESOLVED CASE ID FROM SBI - RESULTS CONCLUDED NO NEGATIVE FINDING |
Last Update: 3/8/2021 4:22:48 PM
Alternate Identification Number Effective Date
NCMMIS Number: 0528
Description: Alternate identification number effective date
Data Type: DATE
Size: X(10)
Functional Area Owner: Recipient
Valid Values:
Last Update: 4/27/2010 9:03:19 AM
Audit Time
NCMMIS Number: 0529
Description: Audit Time specifies the time an add, update, or delete was performed on a datastore.
Data Type: TIME
Size: X(8)
Functional Area Owner: Reference
Valid Values:
Last Update: 3/19/2012 7:45:13 AM
Audit Update Timestamp
NCMMIS Number: 0530
Description: Audit update Timestamp specifies the date and time of add, update, or delete was performed on a datastore.