Master Data Element Dictionary, version 20240608: NCMMIS 3001 - 3500

Tooth Status 5010

NCMMIS Number: 3001

Description: This code indicates the condition of the tooth.

This list is used by the provider portal and contains only the values supporting 5010. Use DE 8040 for 4010 & 5010 values.

Xref to 5010 TR3 837D list 1368.

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
E	E	TBEXTRACTD	TO BE EXTRACTED
M	M	MISSING	MISSING

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

Claim Attachment Type Code 5010 I P

NCMMIS Number: 3002

Description: Attachment Report Type Code. Code indicating the title or contents of a document, report or supporting item.

This list is used by the provider portal for institutional and professional claim submission and contains only the values supporting 5010. Use DE 1284 for 4010 & 5010 values for all claim types.

Xrf 5010 TR3 837I/P list 755.

Effective 2/5/17, CSR 1258 implemented the use of edits 5102 and 5103 which include Attachment Report Type Code of EB in the criteria. Claim can bypass time limit edits 00008 and 00102 if EB and DRC 7 or 9 (DE #4072) are present on the claim.

Data Type: CHARACTER

Size: X(2)

Functional Area Owner: Claims

Valid Values:

From Value	Thru Value	Short Description	Long Description

From Value	Thru Value	Short Description	Long Description
AM	AM	AMB-CERT	AMBULANCE CERTIFICATION
AS	AS	ADMIT-SUMM	ADMISSION SUMMARY
A3	A3	ALLERGIES	ALLERGIES / SENSITIVITIES DOCUMENT
A4	A4	AUTOPSY	AUTOPSY REPORT
BR	BR	BENCH-TST	BENCHMARK TESTING RESULTS
BS	BS	BASELINE	BASELINE
BT	BT	BLANK-TEST	BLANKET TEST RESULTS
B2	B2	PRESCRIPT	PRESCRIPTION
B3	B3	PHYS-ORDER	PHYSICIAN ORDER
B4	B4	REFERRAL	REFERRAL FORM
CB	CB	CHIRO-JUST	CHIROPRACTIC JUSTIFICATION
CK	CK	CONSENT	CONSENT FORM(S)
CT	CT	CERT	CERTIFICATION
DA	DA	DENT-MODEL	DENTAL MODELS
DB	DB	DME-PRESC	DURABLE MEDICAL EQUIPMENT PRESCRIPTION
DG	DG	DIAG-RPT	DIAGNOSITC REPORT
DJ	DJ	DISCH-MONT	DISCHARGE MONITORING REPORT
DS	DS	DISCH-SUMM	DISCHARGE SUMMARY
D2	D2	DRUG-PROF	DRUG PROFILE DOCUMENT
EB	EB	EOB	EXPLANATION OF BENEFITS (COORDINATION OF BENEFITS OR MEDICARE SECONDARY PAYER)
HC	HC	HLTH-RPT	HEALTH CERTIFICATE
HR	HR	HLTHCLNCRP	HEALTH CLINIC RECORDS
IR	IR	SCHOOLIMUN	STATE SCHOOL IMMUNIZATION RECORDS
I5	I5	IMMUN-RPT	IMMUNIZATION RECORD
LA	LA	LAB-RESULT	LABORATORY RESULTS
MT	MT	MODELS	MODELS
M1	M1	MEDRECATT	MEDICAL RECORD ATTACHMENT
NN	NN	NURSNG-NTE	NURSING NOTES
OB	OB	OPER-NTE	OPERATIVE NOTE
OC	OC	OX-CONT	OXYGEN CONTENT AVERAGING REPORT
OD	OD	ORDR-TRMT	ORDERS AND TREATMENTS DOCUMENT
OE	OE	OBJPHYS-EX	OBJECTIVE PHYSICAL EXAMINATION (INCLUDING VITAL SIGNS) DOCUMENT
OX	OX	OX-THERAPY	OXYGEN THERAPY CERTIFICATION
OZ	OZ	SUPP-DATAC	SUPPORT DATA FOR CLAIM
PE	PE	PARENT-CER	PARENTERAL OR ENTERAL CERTIFICATION
PN	PN	PT-NTES	PHYSICAL THERAPY NOTES
PO	PO	PO-CERT	PROSTHETICS OR ORTHOTIC CERTIFICATION
PQ	PQ	PARAMED	PARAMEDICAL RESULTS
PY	PY	PHYS-RPT	PHYSICIAN REPORT
PZ	PZ	PT-CERT	PHYSICAL THERAPY CERTIFICATION
P4	P4	PATH-RPT	PATHOLOGY REPORT
P5	P5	PATMEDHIS	PATIENT MEDICAL HISTORY DOCUMENT
RB	RB	RAD-FILMS	RADIOLOGY FILMS
RR	RR	RAD-RPTS	RADIOLOGY REPORTS
RT	RT	TSTANALRPT	REPORT OF TESTS AND ANALYSIS REPORT
RX	RX	RENEW-OX	RENEWABLE OXYGEN CONTENT AVERAGING REPORT
SG	SG	SYMPTOMS	SYMPTOMS DOCUMENT
V5	V5	DEATH-CERT	DEATH NOTIFICATION
XP	XP	PHOTOGRPH	PHOTOGRAPHS
3	3	JUST-TREAT	REPORT JUSTIFIYING TREATMENT BEYOND UTILIZATION GUIDELINES
4	4	DRUG-ADM	DRUGS ADMINISTERED
5	5	TRTMT-DIAG	TREATMENT DIAGNOSIS
6	6	INITASSESS	INITIAL ASSESSMENT
7	7	FUNC-GOAL	FUNCATIONAL GOALS
8	8	PLN-TRTMT	PLAN OF TREATMENT
9	9	PROG-RPT	PROGRESS REPORT
10	10	CONT-TRTMT	CONTINUED TREATMENT
11	11	CHEM-ANAL	CHEMICAL ANALYSIS
13	13	CERTTSTRPT	CERTIFIED TEST REPORT
15	15	JUSTADMIN	JUSTIFICATION OF ADMISSION
21	21	RECOV-PLAN	RECOVERY PLAN

Last Update: 3/15/2022 11:51:56 AM

Provider Alternate Phone Number

NCMMIS Number: 3003

Description: Alternate phone number, including area code, at which a specific provider can be reached.

Data Type: CHARACTER

Size: X(10)

Functional Area Owner: Provider

Valid Values:

Last Update: 5/7/2010 9:13:36 AM

Provider After Hours Phone Number

NCMMIS Number: 3004

Description: Non-business hours phone number, including area code, at which a specific provider can be reached.

Data Type: CHARACTER

Size: X(10)

Functional Area Owner: Provider

Valid Values:

Last Update: 5/6/2010 2:03:39 PM

Provider After Hours Coverage Text

NCMMIS Number: 3005

Description: Text describing a provider's after hours coverage (non-business hours)

Data Type: CHARACTER

Size: X(500)

Functional Area Owner: Provider

Valid Values:

Last Update: 4/15/2010 8:50:09 PM

Provider Accept New Patients Indicator

NCMMIS Number: 3006

Description: Indicator maintained by the provider; are they willing to accept new patients.

This indicator is updated by Provider.