Master Data Element Dictionary, version 20240608: NCMMIS A15T - A1FV
Cost Share Family to Individual Association Effective Date
NCMMIS Number: A15T
Description: Start date of when an individual joins a cost share family group.
Data Type: DATE
Size: X(10)
Functional Area Owner: Recipient
Valid Values:
Last Update: 6/28/2019 10:39:34 AM
Cost Share Family to Individual Association End Date
NCMMIS Number: A15U
Description: End date of when an individual leaves a cost share family group.
Data Type: DATE
Size: X(10)
Functional Area Owner: Recipient
Valid Values:
Last Update: 6/28/2019 10:40:30 AM
Proc NDC XWALK IND
NCMMIS Number: A15V
Description: Procedure and NDC crosswalk status indicator
Data Type: CHARACTER
Size: X(01)
Functional Area Owner: Reference
Valid Values:
From Value | Thru Value | Short Description | Long Description |
|---|---|---|---|
A | A | ACTIVE | ACTIVE |
I | I | INACTIVE | INACTIVE |
Last Update: 3/12/2021 2:18:20 PM
Cost Share Individual Fiscal Year Claim Load Indicator
NCMMIS Number: A15W
Description: Indicator used in the claim load process for new recipients added to OOP processing.
Data Type: CHARACTER
Size: X(01)
Functional Area Owner: Recipient
Valid Values:
From Value | Thru Value | Short Description | Long Description |
|---|---|---|---|
N | N | NOTLOAD | CLAIMS NOT LOADED |
Y | Y | LOAD | CLAIM LOADED |
Last Update: 8/18/2022 9:02:14 AM
PA Letter Policy Begin Date
NCMMIS Number: A15X
Description: Start Date of a Prior Authorization Letter Policy.
Data Type: DATE
Size: X(10)
Functional Area Owner: Prior Authorization
Valid Values:
Last Update: 8/1/2019 1:21:38 PM
PA Letter Policy End Date
NCMMIS Number: A15Y
Description: Stop Date of a Prior Authorization Letter Policy
Data Type: DATE
Size: X(10)
Functional Area Owner: Prior Authorization
Valid Values:
Last Update: 8/1/2019 1:22:26 PM
PA Letter Policy Sequence Number
NCMMIS Number: A15Z
Description: Sequence Number generated by DB2 for a Prior Authorization Letter Policy
Data Type: INTEGER
Size: S9(8)
Functional Area Owner: Prior Authorization
Valid Values:
Last Update: 8/1/2019 1:26:18 PM
PA Letter Number
NCMMIS Number: A160
Description: Identification Number of a Prior Authorization Letter
Data Type: INTEGER
Size: S9(8)
Functional Area Owner: Prior Authorization
Valid Values:
Last Update: 8/1/2019 1:27:23 PM
PA Policy Citation ID
NCMMIS Number: A161
Description: Identification Code of a Prior Authorization Policy Citation
Data Type: CHARACTER
Size: X(10)
Functional Area Owner: Prior Authorization
Valid Values:
Last Update: 8/1/2019 1:28:21 PM
PA Policy Citation Text
NCMMIS Number: A162
Description: Text description of a Prior Authorization Policy Citation
Data Type: CHARACTER
Size: X(500)
Functional Area Owner: Prior Authorization
Valid Values:
Last Update: 8/1/2019 1:30:16 PM
PA Denial Reason ID
NCMMIS Number: A163
Description: Identification Code of a Prior Authorization Denial Reason
Data Type: CHARACTER
Size: X(10)
Functional Area Owner: Prior Authorization
Valid Values:
Last Update: 8/1/2019 1:32:32 PM
PA Denial Reason Text
NCMMIS Number: A164
Description: Text description of a Prior Authorization Denial Reason
Data Type: CHARACTER
Size: X(1000)
Functional Area Owner: Prior Authorization
Valid Values:
Last Update: 8/1/2019 1:34:15 PM
PA Policy Name
NCMMIS Number: A165
Description: Name of a Prior Authorization Policy
Data Type: CHARACTER
Size: X(250)
Functional Area Owner: Prior Authorization
Valid Values:
Last Update: 8/1/2019 1:35:27 PM
PA Policy Number
NCMMIS Number: A166
Description: Identification Number of a Prior Authorization Policy
Data Type: CHARACTER
Size: X(10)
Functional Area Owner: Prior Authorization
Valid Values:
Last Update: 8/1/2019 1:36:26 PM
PA Policy Section Level 1 Number
NCMMIS Number: A167
Description: Identification number of a Prior Authorization Policy Level 1 Section
Data Type: CHARACTER
Size: X(10)
Functional Area Owner: Prior Authorization
Valid Values:
Last Update: 8/1/2019 1:38:08 PM
PA Policy Section Level 1 Name
NCMMIS Number: A168
Description: Name of a Prior Authorization Policy Level 1 Section
Data Type: CHARACTER
Size: X(125)
Functional Area Owner: Prior Authorization
Valid Values:
Last Update: 8/1/2019 1:38:58 PM
PA Policy Section Level 2 Number
NCMMIS Number: A169
Description: Identification number of a Prior Authorization Policy Level 2 Section
Data Type: CHARACTER
Size: X(10)
Functional Area Owner: Prior Authorization
Valid Values:
Last Update: 8/1/2019 1:40:01 PM
PA Policy Section Level 2 Name
NCMMIS Number: A16A
Description: Name of a Prior Authorization Policy Level 2 Section
Data Type: CHARACTER
Size: X(125)
Functional Area Owner: Prior Authorization
Valid Values:
Last Update: 8/1/2019 1:41:04 PM
PA Policy Section Level 3 Number
NCMMIS Number: A16B
Description: Identification number of a Prior Authorization Policy Level 3 Section
Data Type: CHARACTER
Size: X(10)
Functional Area Owner: Prior Authorization
Valid Values:
Last Update: 8/1/2019 1:44:48 PM
PA Policy Section Level 3 Name
NCMMIS Number: A16C
Description: Name of a Prior Authorization Policy Level 3 Section
Data Type: CHARACTER
Size: X(125)
Functional Area Owner: Prior Authorization
Valid Values:
Last Update: 8/1/2019 1:45:39 PM
PA Policy Section Number
NCMMIS Number: A16D
Description: Identification number of a Prior Authorization Policy Section
Data Type: CHARACTER
Size: X(10)
Functional Area Owner: Prior Authorization
Valid Values:
Last Update: 8/1/2019 1:46:31 PM
PA Letter Certified Mail Tracking Number
NCMMIS Number: A16E
Description: Mail vendor tracking number of a PA letter sent by Certified Mail
Data Type: CHARACTER
Size: X(30)
Functional Area Owner: Prior Authorization
Valid Values:
Last Update: 8/2/2019 10:24:31 AM
PA Generic Code or Requested Drug Indicator
NCMMIS Number: A16F
Description: PA Generic Code or Requested Drug Indicator identifies if the procedure code on the line is classified as a generic or miscellaneous code or the requested drug is different than the FDB Drug Code value.
Data Type: CHARACTER
Size: X(1)
Functional Area Owner: Prior Authorization
Valid Values:
From Value | Thru Value | Short Description | Long Description |
|---|---|---|---|
N | N | NO | NO |
Y | Y | YES | YES |
Last Update: 11/20/2023 8:49:56 AM
PA Generic Code or Requested Drug Description
NCMMIS Number: A16G
Description: PA Generic Code or Requested Drug Description identifies the service description for known PA related procedure codes or requested drug values.
Data Type: CHARACTER
Size: X(10)
Functional Area Owner: Prior Authorization
Valid Values:
From Value | Thru Value | Short Description | Long Description |
|---|---|---|---|
E1161-01 | E1161-01 | E1161-01 | MANUAL TILT IN SPACE OPTION |
K0007-01 | K0007-01 | K0007-01 | OVERSIZED MANUAL WHEELCHAIRS |
W4047-01 | W4047-01 | W4047-01 | PEDIATRIC SPECIALTY BEDS |
W4047-02 | W4047-02 | W4047-02 | ACTIVITY/POSITIONING CHAIR |
W4047-03 | W4047-03 | W4047-03 | HI LO POSITIONING ACTIVITY CHAIR |
W4047-04 | W4047-04 | W4047-04 | HI LO INDOOR BASE/FRAME |
W4047-05 | W4047-05 | W4047-05 | TUB STAND |
W4047-06 | W4047-06 | W4047-06 | SHOWER TROLLEY |
W4047-07 | W4047-07 | W4047-07 | HAND HELD SHOWER |
W4047-08 | W4047-08 | W4047-08 | BATH SUPPORT |
W4047-09 | W4047-09 | W4047-09 | BATH LIFT |
W4047-10 | W4047-10 | W4047-10 | PEDIATRIC SHOWER/COMMODE CHAIR |
W4047-11 | W4047-11 | W4047-11 | TILT/RECLINE SHOWER/COMMODE CHAIR |
W4047-12 | W4047-12 | W4047-12 | PEDIATRIC BATH SHOWER TRANSFER |
W4047-13 | W4047-13 | W4047-13 | TOILET SEAT REDUCER RING |
W4047-14 | W4047-14 | W4047-14 | LO-BACK TOILET SUPPORT |
W4047-15 | W4047-15 | W4047-15 | POTTY TRAINER |
W4047-16 | W4047-16 | W4047-16 | TOILETING SYSTEM |
99 | 99 | OTHER | OTHER |
Last Update: 11/20/2023 8:49:57 AM
PA Generic Code or Requested Drug Text
NCMMIS Number: A16H
Description: PA Generic Code or Requested Drug Text contains the manually entered service description text of the generic proc code or requested drug. A generic proc code or requested drug text is only added to the PA detail line when the PA Generic Code or Requested Drug Description code is equal to 99-Other.
Data Type: CHARACTER
Size: X(250)
Functional Area Owner: Prior Authorization
Valid Values:
Last Update: 3/29/2022 11:03:17 AM
PA Letter Decision Statement
NCMMIS Number: A16I
Description: PA Letter Decision Statement contains the text that is populated in adverse decision letters for the decision issued by the vendor.
Data Type: CHARACTER
Size: X(1)