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)
Functional Area Owner: Prior Authorization
Valid Values:
From Value | Thru Value | Short Description | Long Description |
|---|---|---|---|
1 | 1 | DENY - I | denied your request. |
2 | 2 | REDUCE - I | denied some of your request. |
3 | 3 | DENY - R | denied your request and your services will stop. |
4 | 4 | REDUCE - R | denied some of your request and your services will be reduced. |
Last Update: 11/20/2023 8:49:59 AM
PA Letter Service Type Category
NCMMIS Number: A16J
Description: The PA Letter Service Type Category defines if the service type value for PA letter sequence criteria is an individual service type/drug name code value or a group that represents multiple service types or drug names.
Data Type: CHARACTER
Size: X(1)
Functional Area Owner: Prior Authorization
Valid Values:
From Value | Thru Value | Short Description | Long Description |
|---|---|---|---|
G | G | GROUP | GROUP OF MULTIPLE SERVICE TYPE OF DRUG NAME CODES |
I | I | INDIVIDUAL | INDIVIDUAL SERVICE TYPE OR DRUG NAME CODE |
Last Update: 11/20/2023 8:50:00 AM
PA Letter Proc Code Category
NCMMIS Number: A16K
Description: The PA Letter Proc Code Category defines if the procedure code value for PA letter sequence criteria is an individual code, a generic/miscellaneous proc code, or a group that represents multiple proc codes.
Data Type: CHARACTER
Size: X(1)
Functional Area Owner: Prior Authorization
Valid Values:
From Value | Thru Value | Short Description | Long Description |
|---|---|---|---|
G | G | GROUP | GROUP OF MULTIPLE PROC CODES |
I | I | INDIVIDUAL | INDIVIDUAL PROC CODE |
M | M | MISCELL | GENERIC/MISCELLANEOUS PROC CODE |
Last Update: 11/20/2023 8:50:01 AM
PA Letter Vendor Name
NCMMIS Number: A16L
Description: PA Letter Decision Statement contains the text that is populated for the Vendor Name in adverse decision letters.
Data Type: CHARACTER
Size: X(1)
Functional Area Owner: Prior Authorization
Valid Values:
From Value | Thru Value | Short Description | Long Description |
|---|---|---|---|
1 | 1 | CSRA | CSRA |
2 | 2 | DHB | N.C. Medicaid Division of Health Benefits (DHB) |
Last Update: 11/20/2023 8:50:02 AM
PA Letter Web Links
NCMMIS Number: A16M
Description: PA Letter Web Links contains the web address of the link populated in adverse decision letters.
Data Type: CHARACTER
Size: X(1)
Functional Area Owner: Prior Authorization
Valid Values:
From Value | Thru Value | Short Description | Long Description |
|---|---|---|---|
A | A | HC REVIEWS | https://medicaid.ncdhhs.gov/hc-health-choice-recipients-1st-and-2nd-level-reviews |
B | B | MCAID PROG | https://medicaid.ncdhhs.gov/medicaid/get-started/find-programs-and-services-right-you/medicaids-benefit-children-and-adolescents |
C | C | APL RIGHTS | https://medicaid.ncdhhs.gov/medicaid/your-rights |
D | D | OAH INFO | https://www.oah.nc.gov/Hearings-division/medicaid-recipient-appeals |
1 | 1 | STATE PLAN | https://medicaid.ncdhhs.gov/get-involved/nc-health-choice-state-plan |
2 | 2 | POLICY | https://medicaid.ncdhhs.gov/providers/clinical-coverage-policies |
3 | 3 | PHARMACY | https://medicaid.ncdhhs.gov/providers/clinical-coverage-policies/pharmacy-services-clinical-coverage-policies |
4 | 4 | TITLE XIX | https://www.ssa.gov/OP_Home/ssact/title19/1900.htm |
5 | 5 | CODE 42 | http://www.gpo.gov/fdsys/search/pagedetails.action?st=citation%3A42+USC+1396&granuleId=USCODE-2010-title42-chap7-subchapXIX-sec1396d&packageId=USCODE-2010-title42&bread=true |
6 | 6 | TITLE XX1 | https://www.ssa.gov/OP_Home/ssact/title21/2103.htm |
7 | 7 | NCGS 108A | https://www4.ncleg.net/enactedlegislation/statutes/html/bysection/chapter_108a/gs_108a-70.21.html |
8 | 8 | HC PLAN | https://files.nc.gov/ncdma/NC_Health_Choice_State_Plan_2017_04.pdf |
9 | 9 | CMS EPSDT | https://www.medicaid.gov/medicaid/benefits/downloads/epsdt_coverage_guide.pdf |
Last Update: 11/20/2023 8:50:02 AM
PA Letter Agency Names
NCMMIS Number: A16N
Description: PA Letter Agency Names and Addresses contains the names and addresses of all agencies or agency staff positions included in the multiple adverse decision letter attachments.
Data Type: CHARACTER
Size: X(2)
Functional Area Owner: Prior Authorization
Valid Values:
From Value | Thru Value | Short Description | Long Description |
|---|---|---|---|
1 | 1 | OAH–LONG 1 | Office of Administrative Hearings (OAH) |
2 | 2 | DHHS-LONG | North Carolina Department of Health and Human Services (DHHS) |
3 | 3 | OAH-ACRNM | OAH |
4 | 4 | MED-LONG | Mediation Network of North Carolina |
5 | 5 | OAH-LONG 2 | NC Office of Administrative Hearings (OAH) |
6 | 6 | LEGAL AID | Legal Aid of North Carolina |
7 | 7 | DIS RIGHTS | Disability Rights of North Carolina |
8 | 8 | MED-SHORT | Mediation Network |
9 | 9 | OAH-NAME | Office of Administrative Hearings |
10 | 10 | APL-NAME | Appeals Unit |
11 | 11 | SVC CTR LG | Department of Health and Human Services Customer Service Hotline |
12 | 12 | DHB NAME | Division of Health Benefits |
13 | 13 | SVC CTR | DHHS Customer Service Center |
14 | 14 | OAH ATTN | Clerk of Court |
15 | 15 | OAH ADRS 1 | 1711 New Hope Church Road |
16 | 16 | OAH ADRS 2 | Raleigh, NC 27609 |
17 | 17 | DHHS APL | Department of Health and Human Services (DHHS) |
18 | 18 | DHHS ATTN | Appeals Section |
19 | 19 | DHHS ADRS1 | 2501 Mail Service Center |
20 | 20 | DHHS ADRS2 | Raleigh, NC 27699-2501 |
21 | 21 | HC APL | NC Health Choice |
22 | 22 | HC ATTN | Review Coordinator |
23 | 23 | HC COORD | Health Choice Review Coordinator |
24 | 24 | DHHS-LONG2 | NC Department of Health and Human Services |
25 | 25 | DRCTR LONG | Clinical Medical Director |
26 | 26 | DRCTR SHRT | Director |
27 | 27 | HEAR OFF | DHHS Hearing Office |
28 | 28 | HEAR OFF 2 | Department of Health and Human Services (DHHS) Hearing Office |
29 | 29 | DHHS-ACRNM | DHHS |
30 | 30 | COURT-LONG | North Carolina Superior Court |
31 | 31 | COURT NAME | Superior Court |
32 | 32 | OAH-LONG 3 | North Carolina Office of Administrative Hearings |
33 | 33 | MCAID NAME | NC Medicaid |
34 | 34 | MCAID-LONG | NC State Medicaid Offices |
Last Update: 11/20/2023 8:50:04 AM
Provider Enrollment Tracking Batch Type
NCMMIS Number: A16O
Description: Type of batch enrollment file.
Data Type: CHARACTER
Size: X(2)
Functional Area Owner: Provider
Valid Values:
From Value | Thru Value | Short Description | Long Description |
|---|---|---|---|
01 | 01 | INDIV | INDIVIDUAL PROVIDER ENROLLMENT APPLICATION |
Last Update: 3/8/2021 4:25:31 PM
Provider Enrollment Tracking Process Timestamp
NCMMIS Number: A16P
Description: Time when batch processing started.
Data Type: TIMESTAMP
Size: X(26)
Functional Area Owner: Provider
Valid Values:
Last Update: 8/20/2019 2:05:30 PM
Provider Enrollment Tracking Record Status
NCMMIS Number: A16Q
Description: Status of the application that was part of the batch enrollment file.
Data Type: CHARACTER
Size: X(1)
Functional Area Owner: Provider
Valid Values:
From Value | Thru Value | Short Description | Long Description |
|---|---|---|---|
E | E | ERROR | THERE WAS AN ERROR WITH THE APPLICATION |
P | P | PENDING | APPLICATION IS PENDING PROCESSING |
S | S | SUCCESS | FILE WAS COMPLETED SUCCESSFULLY |
Last Update: 3/8/2021 4:25:33 PM
Provider Enrollment Tracking Index
NCMMIS Number: A16R
Description: Primary key.
Data Type: SMALLINT
Size: S9(4)
Functional Area Owner: Provider
Valid Values:
Last Update: 8/20/2019 1:58:56 PM
Provider Enrollment Tracking Field Identification
NCMMIS Number: A16S
Description: Unique ID of field from the layout file.
Data Type: CHARACTER
Size: X(72)
Functional Area Owner: Provider
Valid Values:
Last Update: 8/20/2019 2:04:41 PM
Provider Enrollment Tracking Field Metadata
NCMMIS Number: A16T
Description: Provider Enrollment Tracking Field Metadata.
Data Type: CHARACTER
Size: X(256)
Functional Area Owner: Provider
Valid Values:
Last Update: 8/20/2019 2:04:16 PM
Provider Enrollment Tracking Error
NCMMIS Number: A16U
Description: Error in free text.
Data Type: CHARACTER
Size: X(256)
Functional Area Owner: Provider
Valid Values:
Last Update: 8/20/2019 2:07:40 PM
Provider Appeal Initial Source
NCMMIS Number: A16V
Description: Who made the termination decision
Data Type: CHARACTER
Size: X(1)
Functional Area Owner: Provider
Valid Values:
From Value | Thru Value | Short Description | Long Description |
|---|---|---|---|
1 | 1 | DHB | DHB MADE THE DECISION |
2 | 2 | FAOPS | FA OPS MADE THE DECISION |
Last Update: 3/8/2021 4:25:34 PM
Provider Appeal Received Date
NCMMIS Number: A16W
Description: Provider Appeal Received Date
Data Type: DATE
Size: X(10)
Functional Area Owner: Provider
Valid Values:
Last Update: 9/10/2019 4:46:53 PM
Provider Appleal Termination Date
NCMMIS Number: A16X
Description: Provider Appleal termination date identifies original termination effective date on the provider record.
Data Type: DATE
Size: X(10)
Functional Area Owner: Provider
Valid Values:
Last Update: 9/10/2019 4:46:19 PM
Provider Appeal adverse status code
NCMMIS Number: A16Y
Description: Provider Appeal adverse status code
Data Type: CHARACTER
Size: X(1)
Functional Area Owner: Provider
Valid Values:
From Value | Thru Value | Short Description | Long Description |
|---|---|---|---|
1 | 1 | IN REVIEW | READY FOR FA OPS TO REVIEW |
2 | 2 | VALID | FA OPS HAS DETERMINED THE DECISION WAS VALID OR PROPER |
3 | 3 | INVALID | FA OPS HAS DETERMINED THE DECISION WAS INVALID OR IMPROPER |
Last Update: 3/8/2021 4:25:35 PM
Provider Appeal submitted to Hearing Office date
NCMMIS Number: A16Z
Description: Provider Appeal submitted to Hearing Office date
Data Type: DATE
Size: X(10)
Functional Area Owner: Provider
Valid Values:
Last Update: 9/10/2019 4:51:56 PM
Provider Appeal adverse action decision date
NCMMIS Number: A170
Description: Provider Appeal adverse action decision date
Data Type: DATE
Size: X(10)
Functional Area Owner: Provider
Valid Values:
Last Update: 9/10/2019 4:54:07 PM
Provider Appeal outreach date
NCMMIS Number: A171
Description: Provider Appeal outreach date
Data Type: DATE
Size: X(10)
Functional Area Owner: Provider
Valid Values:
Last Update: 9/10/2019 4:55:02 PM
Provider Appeal respond to OAH date
NCMMIS Number: A172
Description: Provider Appeal respond to OAH date
Data Type: DATE
Size: X(10)
Functional Area Owner: Provider
Valid Values:
Last Update: 9/10/2019 4:55:57 PM
Provider Appeal final decision date
NCMMIS Number: A173
Description: Provider Appeal final decision date
Data Type: DATE
Size: X(10)
Functional Area Owner: Provider
Valid Values:
Last Update: 9/10/2019 4:57:02 PM
Provider Appeal final decision received date
NCMMIS Number: A174
Description: Provider Appeal final decision received date
Data Type: DATE
Size: X(10)
Functional Area Owner: Provider
Valid Values:
Last Update: 9/10/2019 4:58:04 PM
Provider Appeal hearing office email
NCMMIS Number: A175
Description: Provider Appeal hearing office email
Data Type: CHARACTER
Size: X(75)
Functional Area Owner: Provider
Valid Values:
Last Update: 9/10/2019 4:59:38 PM
Provider Notice date
NCMMIS Number: A176
Description: Provider Notice date
Data Type: DATE
Size: X(10)
Functional Area Owner: Provider
Valid Values:
Last Update: 9/10/2019 5:00:44 PM
Provider Agency type code
NCMMIS Number: A177
Description: Provider Agency type code
Data Type: CHARACTER
Size: X(3)
Functional Area Owner: Provider
Valid Values:
From Value | Thru Value | Short Description | Long Description |
|---|---|---|---|
001 | 001 | NCT2CMS | NCTRACKS NOTIFIES CMS |
002 | 002 | NCT2OIG | NCTRACKS NOTIFIES OFFICE OF INSPECTOR GENERAL |
003 | 003 | NPDB | NCTRACKS NOTIFIES NATIONAL PRACTITIONER DATA BANK |
004 | 004 | NC2CMSRESC | NCTRACKS UPDATES THE ENROLLMENT BAR EXPIRATION DATE IN THE CMS DEX SYSTEM |
014 | 014 | DHSR | NOTIFICATION RECEIVED FROM DIVISION OF HEALTH AND SERVICE REGULATION |
101 | 101 | NCMB | NOTIFICATION RECEIVED FROM NORTH CAROLINA MEDICAL BOARD |
102 | 102 | NCDENT | NOTIFICATION RECEIVED FROM NORTH CAROLINA DENTAL BOARD |
103 | 103 | CMSLIST | NOTIFICATION RECEIVED FROM CMS LIST SERVE |
Last Update: 3/8/2021 4:25:35 PM
Provider Notice type code
NCMMIS Number: A178
Description: Provider Notice type code
Data Type: CHARACTER
Size: X(2)
Functional Area Owner: Provider
Valid Values:
From Value | Thru Value | Short Description | Long Description |
|---|---|---|---|
01 | 01 | PROVTERM | PROVIDER TERMINATION |
02 | 02 | APPDEN | PROVIDER APPLICATION DENIED |
Last Update: 3/8/2021 4:25:36 PM
Provider Notice status code
NCMMIS Number: A179
Description: Provider Notice status code
Data Type: CHARACTER
Size: X(2)
Functional Area Owner: Provider
Valid Values:
From Value | Thru Value | Short Description | Long Description |
|---|---|---|---|
01 | 01 | INREV | IN REVIEW |
02 | 02 | NOACTREQ | NO ACTION REQUIRED |
03 | 03 | PROVTERM | PROVIDER TERMINATED |
04 | 04 | NOTIFIED | ENTITY NOTIFIED |
Last Update: 3/8/2021 4:25:37 PM
Provider Notice reason code
NCMMIS Number: A17A
Description: Provider Notice reason code
Data Type: CHARACTER
Size: X(2)
Functional Area Owner: Provider
Valid Values:
From Value | Thru Value | Short Description | Long Description |
|---|---|---|---|
12 | 12 | DENIEDAPP | DENIED APPLICATION |
19 | 19 | PROVTERM | PROVIDER TERMINATED |
Last Update: 3/8/2021 4:25:37 PM
Provider Notice Notes Text
NCMMIS Number: A17B
Description: Provider Notice Notes Text
Data Type: CHARACTER
Size: X(30)
Functional Area Owner: Provider
Valid Values:
Last Update: 9/10/2019 5:18:00 PM
Provider Notice received date
NCMMIS Number: A17C
Description: Provider Notice received date
Data Type: DATE
Size: X(10)
Functional Area Owner: Provider
Valid Values:
Last Update: 9/10/2019 5:18:53 PM
Provider Notice effective date
NCMMIS Number: A17D
Description: Provider Notice effective date
Data Type: DATE
Size: X(10)
Functional Area Owner: Provider
Valid Values:
Last Update: 9/10/2019 5:19:47 PM
Provider Action effective date
NCMMIS Number: A17E
Description: Provider Action effective date
Data Type: DATE
Size: X(10)
Functional Area Owner: Provider
Valid Values:
Last Update: 9/10/2019 5:20:40 PM
Provider Agency action date
NCMMIS Number: A17F
Description: Provider Agency action date
Data Type: DATE
Size: X(10)
Functional Area Owner: Provider
Valid Values:
Last Update: 9/10/2019 5:21:34 PM
Provider NCTracks action date
NCMMIS Number: A17G
Description: Provider NCTracks action date
Data Type: DATE
Size: X(10)
Functional Area Owner: Provider
Valid Values:
Last Update: 9/10/2019 5:22:20 PM
PHP Call Center Contact Phone Numbers
NCMMIS Number: A17H
Description: PHP Call Center Contact Numbers for Provider, Pharmacy, and Recipient
Data Type: CHARACTER
Size: X(10)
Functional Area Owner: Provider
Valid Values:
Last Update: 9/13/2019 11:33:58 AM
Proc NDC XWALK SEQ NUM
NCMMIS Number: A17I
Description: Procedure and NDC crosswalk sequence number.
Data Type: INTEGER
Size: S9(09)
Functional Area Owner: Reference
Valid Values:
Last Update: 10/2/2019 2:59:39 PM
Spell Check Override Word Text
NCMMIS Number: A17K
Description: Spell Check Override Word Text is the word overridden by the user during application of the PA letter spellcheck/grammar tool.
Data Type: CHARACTER
Size: X(50)
Functional Area Owner: Prior Authorization
Valid Values:
Last Update: 11/4/2019 9:33:37 AM
PA Letter Page ID
NCMMIS Number: A17L
Description: The PA Letter Page ID is the Operations portal page that contains text fields with spell check/grammar tool functionality.
Data Type: CHARACTER
Size: X(01)
Functional Area Owner: Prior Authorization
Valid Values:
From Value | Thru Value | Short Description | Long Description |
|---|---|---|---|
1 | 1 | DETAIL | DETAIL PAGES |
2 | 2 | LTC HEADER | LTC HEADER PAGE |
3 | 3 | COMM LTR | COMMENTS LETTER PAGE |
4 | 4 | PLCY DNL | LETTER POLICY AND DENIAL REASON DETAIL PAGE |
Last Update: 11/20/2023 8:50:07 AM
PA Text Field
NCMMIS Number: A17M
Description: The PA Text Field identifies the text fields on pages in the Operations portal with spellcheck/grammar tool functionality.
Data Type: CHARACTER
Size: X(02)
Functional Area Owner: Prior Authorization
Valid Values:
From Value | Thru Value | Short Description | Long Description |
|---|---|---|---|
01 | 01 | GENERIC CD | GENERIC CODE |
02 | 02 | ADD INFO | ADDITIONAL INFORMATION REQUESTED |
03 | 03 | POLICY | POLICY NAME |
04 | 04 | PLCY SCTN1 | POLICY SECTION LEVEL 1 |
05 | 05 | PLCY SCNT2 | POLICY SECTION LEVEL 2 |
06 | 06 | PLCY SCNT3 | POLICY SECTION LEVEL 3 |
07 | 07 | PLCY CIT | POLICY CITATION |
08 | 08 | DENIAL RSN | DENIAL REASON |
09 | 09 | EPSDT 2 | EPSDT 2 |
10 | 10 | EPSDT3 EFF | EPSDT 3 - NOT EFFECTIVE |
11 | 11 | EPSDT3 CST | EPSDT 3 - LESS COSTLY TREATMENTS |
12 | 12 | EPSDT3 SAF | EPSDT 3 - NOT SAFE |
13 | 13 | SERV REQ | SERVICE REQUESTED |
14 | 14 | SERV APP | SERVICE APPROVED |
15 | 15 | LETTER TXT | LETTER TEXT |
16 | 16 | EPSDT RSN2 | EPSDT REASON 2 |
17 | 17 | EPSDT RSN3 | EPSDT REASON 3 |
18 | 18 | EPSDT RSN4 | EPSDT REASON 4 |
19 | 19 | EPSDT RSN5 | EPSDT REASON 5 |
20 | 20 | EPSDT RSN6 | EPSDT REASON 6 |
21 | 21 | EPSDT RSN7 | EPSDT REASON 7 |
Last Update: 11/20/2023 8:50:08 AM
Spell Check Override Status
NCMMIS Number: A17N
Description: The Spell Check Override Status defines the status of the override word.
Data Type: CHARACTER
Size: X(01)
Functional Area Owner: Prior Authorization
Valid Values:
From Value | Thru Value | Short Description | Long Description |
|---|---|---|---|
A | A | ACCEPT | ACCEPT - REVIEW COMPLETE |
I | I | IND ACCEPT | INDIRECT ACCEPT - REVIEW COMPLETE |
J | J | IND REJECT | INDIRECT REJECT - REVIEW COMPLETE |
N | N | NEW | NEW - WORD STILL TO BE REVIEWED |
R | R | REJECT | REJECT - REVIEW COMPLETE |
V | V | VOID | VOID - LETTER DELETE |
Z | Z | NO WORDS | NO OVERRIDE WORDS |
Last Update: 11/20/2023 8:50:10 AM
PA Letter QA Status
NCMMIS Number: A17O
Description: The PA Letter QA Status value defines the status of the letter review.
Data Type: CHARACTER
Size: X(01)
Functional Area Owner: Prior Authorization
Valid Values:
From Value | Thru Value | Short Description | Long Description |
|---|---|---|---|
1 | 1 | DATA NEW | NEW - LETTER DATA |
2 | 2 | DATA PEND | PENDING / IN PROGRESS - LETTER DATA |
3 | 3 | DATA PASS | PASS - LETTER DATA |
4 | 4 | DATA FAIL | FAIL - LETTER DATA |
5 | 5 | IMAGE NEW | NEW - LETTER IMAGE |
6 | 6 | IMAGE PEND | PENDING / IN PROGRESS - LETTER IMAGE |
7 | 7 | IMAGE PASS | PASS - LETTER IMAGE |
8 | 8 | IMAGE FAIL | FAIL - LETTER IMAGE |
Last Update: 11/20/2023 8:50:11 AM
PA Letter QA Sample Indicator
NCMMIS Number: A17P
Description: The PA Letter QA Sample Indicator will identify if the record is included in the reporting for SLA 40.7.3.51.
Data Type: CHARACTER
Size: X(01)
Functional Area Owner: Prior Authorization
Valid Values:
From Value | Thru Value | Short Description | Long Description |
|---|---|---|---|
N | N | NO | NOT INCLUDED IN SLA REPORTING; DEFAULT VALUE |
Y | Y | YES | INCLUDED IN SLA REPORTING |
Last Update: 11/20/2023 8:50:12 AM
PA Letter QA Category Code
NCMMIS Number: A17Q
Description: The PA Letter QA Category Code defines the review category.
Data Type: CHARACTER
Size: X(02)
Functional Area Owner: Prior Authorization
Valid Values:
From Value | Thru Value | Short Description | Long Description |
|---|---|---|---|
01 | 01 | 1ST PAGE | LETTER FIRST PAGE |
02 | 02 | REC SRVCS | YOU WERE RECEIVING SERVICES |
03 | 03 | REQ SRVCS | YOU ASKED FOR SERVICES |
04 | 04 | APP SRVCS | APPROVED SERVICES |
05 | 05 | DEN SRVCS | DENIED SERVICES |
06 | 06 | RDCD CMNTS | REDUCED SERVICE COMMENTS |
07 | 07 | VOID CMNTS | VOIDED SERVICE COMMENTS |
08 | 08 | SPELL CHCK | SPELL CHECK |
09 | 09 | DD1 RSN | DD1 REASON |
10 | 10 | DD2 RSN | DD2 REASON |
11 | 11 | DD3 RSN | DD3 REASON |
12 | 12 | DD4 RSN | DD4 REASON |
13 | 13 | EPSDT 1 | EPSDT OPTION 1 |
14 | 14 | EPSDT 2 | EPSDT OPTION 2 |
15 | 15 | EPSDT 3 | EPSDT OPTION 3 |
16 | 16 | LTR IMAGE | LETTER IMAGE |
Last Update: 11/20/2023 8:50:12 AM
PA Letter QA Text
NCMMIS Number: A17R
Description: PA Letter QA Text is the review comments associated with the PA Letter QA Category Code.
Data Type: CHARACTER
Size: X(500)
Functional Area Owner: Prior Authorization
Valid Values:
Last Update: 11/4/2019 10:55:54 AM
PA Letter QA Category Status
NCMMIS Number: A17S
Description: The PA Letter QA Category Status is the review status for the individual review category.
Data Type: CHARACTER
Size: X(01)
Functional Area Owner: Prior Authorization
Valid Values:
From Value | Thru Value | Short Description | Long Description |
|---|---|---|---|
F | F | FAIL | FAIL |
N | N | N/A | NOT APPLICABLE |
P | P | PASS | PASS |
Last Update: 11/20/2023 8:50:14 AM
PA Letter Version
NCMMIS Number: A17T
Description: The PA Letter Version defines who the letter is issued for – recipient, provider or the recipient’s authorized representative.
Data Type: CHARACTER
Size: X(01)
Functional Area Owner: Prior Authorization
Valid Values:
From Value | Thru Value | Short Description | Long Description |
|---|---|---|---|
A | A | AUTH REP | RECIPIENT AUTHORIZED REPRESENTATIVE |
P | P | PROVIDER | PROVIDER |
R | R | RECIPIENT | RECIPIENT |
Last Update: 11/20/2023 8:50:15 AM
PA Letter Extract Header Label
NCMMIS Number: A17U
Description: The PA Letter Extract Header Label describes the type of letter extract data.
Data Type: CHARACTER
Size: X(25)
Functional Area Owner: Prior Authorization
Valid Values:
Last Update: 11/4/2019 11:01:46 AM
PA Letter Extract Data
NCMMIS Number: A17V
Description: The PA Letter Extract Data includes the letter data text associated with the PA Letter Extract Header Label.
Data Type: CHARACTER
Size: X(11500)
Functional Area Owner: Prior Authorization
Valid Values:
Last Update: 11/4/2019 11:03:10 AM
PA Letter QA Identifier
NCMMIS Number: A17W
Description: The PA Letter QA Identifier indicates if the letter record needs to go through the QA process.
Data Type: CHARACTER
Size: X(01)
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 8:50:16 AM
PA Letter QA Type
NCMMIS Number: A17X
Description: The PA Letter QA Type identifies the component of the letter QA process.
Data Type: CHARACTER
Size: X(01)
Functional Area Owner: Prior Authorization
Valid Values:
From Value | Thru Value | Short Description | Long Description |
|---|---|---|---|
1 | 1 | LTR DATA | LETTER DATA |
2 | 2 | LTR IMAGE | LETTER IMAGE |
Last Update: 11/20/2023 8:50:16 AM
PA Letter Override ID
NCMMIS Number: A17Y
Description: The PA Letter Override ID indicates the PA number or PA criteria sequence number the override word was added for.
Data Type: CHARACTER
Size: X(14)
Functional Area Owner: Prior Authorization
Valid Values:
Last Update: 11/4/2019 11:16:37 AM
PA Override Sequence Number
NCMMIS Number: A17Z
Description: The PA Override Sequence Number is a system generated sequential identifier for the record.
Data Type: NUMERIC
Size: 9(02)
Functional Area Owner: Prior Authorization
Valid Values:
Last Update: 11/4/2019 11:25:02 AM
PA Override Status Date
NCMMIS Number: A180
Description: The PA Override Status Date identifies the date the override status was set for the record.
Data Type: DATE
Size: X(10)
Functional Area Owner: Prior Authorization
Valid Values:
Last Update: 11/4/2019 11:41:16 AM
PA Letter Extract Data Sequence Number
NCMMIS Number: A181
Description: The PA Letter Extract Data Sequence Number is a system generated sequential identifier for the record.
Data Type: NUMERIC
Size: 9(03)
Functional Area Owner: Prior Authorization
Valid Values:
Last Update: 11/4/2019 11:43:27 AM
PA Letter QA Eligible Indicator
NCMMIS Number: A182
Description: The PA Letter QA Eligible Indicator identifies if the letter record will be reviewed through the letter QA process.
Data Type: CHARACTER
Size: X(01)
Functional Area Owner: Prior Authorization
Valid Values:
From Value | Thru Value | Short Description | Long Description |
|---|---|---|---|
N | N | NO | NO |
X | X | NO REVIEW | ELIGIBLE BUT NOT REVIEW PERFORMED |
Y | Y | YES | YES |
Last Update: 11/20/2023 8:50:17 AM
PA QA Letter Status Date
NCMMIS Number: A183
Description: The PA QA Letter Status Date identifies the date the QA override status was set for the record.
Data Type: DATE
Size: X(10)
Functional Area Owner: Prior Authorization
Valid Values:
Last Update: 11/5/2019 9:49:06 AM
PA Letter Data QA Attestation User ID
NCMMIS Number: A184
Description: The PA Letter Data QA Attestation ID identifies the user who selected the letter data attestation checkbox.
Data Type: CHARACTER
Size: X(32)
Functional Area Owner: Prior Authorization
Valid Values:
Last Update: 11/5/2019 9:59:39 AM
PA Letter Image QA Attestation User ID
NCMMIS Number: A185
Description: The PA Letter Image QA Attestation ID identifies the user who selected the letter image attestation checkbox.
Data Type: CHARACTER
Size: X(32)
Functional Area Owner: Prior Authorization
Valid Values:
Last Update: 11/5/2019 10:00:36 AM
PA Letter Data QA Attestation Date
NCMMIS Number: A186
Description: The PA Letter Data QA Attestation Date identifies when the letter data attestation checkbox was selected.
Data Type: DATE
Size: X(10)
Functional Area Owner: Prior Authorization
Valid Values:
Last Update: 11/5/2019 10:01:20 AM
PA Letter Image QA Attestation Date
NCMMIS Number: A187
Description: The PA Letter Image QA Attestation Date identifies when the letter image attestation checkbox was selected.
Data Type: DATE
Size: X(10)
Functional Area Owner: Prior Authorization
Valid Values:
Last Update: 11/5/2019 10:02:13 AM
Provider Supplemental Information Type Code
NCMMIS Number: A188
Description: Type of supplemental information entered by the enrolling provider
Data Type: CHARACTER
Size: X(1)
Functional Area Owner: Provider
Valid Values:
From Value | Thru Value | Short Description | Long Description |
|---|---|---|---|
1 | 1 | WORKHIST | WORK HISTORY |
2 | 2 | EDUCATION | EDUCATION |
3 | 3 | MALFEDTORT | FEDERAL TORT MALPRACTICE |
4 | 4 | MAL-INDIV | INDIVIDUAL MALPRACTICE COVERAGE |
5 | 5 | MAL-GROUP | MALPRACTICE COVERAGE UNDER A GROUP |
Last Update: 3/8/2021 4:25:39 PM
Provider Supplemental Information Begin Date
NCMMIS Number: A189
Description: Job start date, Malpractice Effective Date, or School Start Date
Data Type: DATE
Size: X(10)
Functional Area Owner: Provider
Valid Values:
Last Update: 11/26/2019 3:02:00 PM
Provider Supplemental Information End Date
NCMMIS Number: A18A
Description: Job end date, Malpractice Expiration Date, or School Graduation Date
Data Type: DATE
Size: X(10)
Functional Area Owner: Provider
Valid Values:
Last Update: 11/26/2019 3:04:12 PM
Provider Supplemental Information Type Name
NCMMIS Number: A18B
Description: Free text field to capture the Job Company Name, Malpractice Insurance Agency, or School Name
Data Type: CHARACTER
Size: X(80)
Functional Area Owner: Provider
Valid Values:
Last Update: 11/26/2019 3:06:36 PM
Provider Supplemental Information Type Text
NCMMIS Number: A18C
Description: Free text field to capture the Job title, Malpractice Amount, or Degree
Data Type: CHARACTER
Size: X(80)
Functional Area Owner: Provider
Valid Values:
Last Update: 11/26/2019 3:07:57 PM
Drug Termination Begin Date
NCMMIS Number: A18D
Description: The first date of the drug termination date segment
Data Type: DATE
Size: X(10)
Functional Area Owner: Reference
Valid Values:
Last Update: 12/18/2019 2:26:10 PM
Drug Termination End Date
NCMMIS Number: A18E
Description: The last date of the drug termination date segment.
Data Type: DATE
Size: X(10)
Functional Area Owner: Reference
Valid Values:
Last Update: 12/18/2019 2:32:41 PM
FDB Attribute Type Code
NCMMIS Number: A18F
Description: NDC Attribute Type Code. This is the FDB code that tells us which type of data is on the FDB Attribute Record.
Data Type: CHARACTER
Size: X(4)
Functional Area Owner: Reference
Valid Values:
From Value | Thru Value | Short Description | Long Description |
|---|---|---|---|
58 | 58 | ATTRTYCD | ATTRIBUTE TYPE CODE |
59 | 59 | ATTREFFDT | ATTRIBUTE EFFECTIVE DATE |
60 | 60 | REACTVDT | REACTIVATION DATE |
Last Update: 3/12/2021 2:18:20 PM
PA Letter FileNet Index Status
NCMMIS Number: A18G
Description: The PA Letter FileNet Index Status identifies if the data in the FileNet index fields should be removed from the letter record when initially processed by R2W. Index field data is removed from the record when the letter needs to go through the QA process and image shouldn’t be available in FileNet until passing the QA process. Spaces for historical PA records will be treated as Y (index field data remains).
Data Type: CHARACTER
Size: X(1)
Functional Area Owner: Prior Authorization
Valid Values:
From Value | Thru Value | Short Description | Long Description |
|---|---|---|---|
N | N | NO | INDEX FIELD DATA REMOVED |
Y | Y | YES | INDEX FIELD DATA REMAINS |
Last Update: 11/20/2023 8:50:18 AM
Attribute Value
NCMMIS Number: A18H
Description: This is the FDB code that tells us the value on the FDB Attribute Record.
Data Type: CHARACTER
Size: X(50)
Functional Area Owner: Reference
Valid Values:
Last Update: 1/30/2020 9:03:38 AM
Attribute Sequence Number
NCMMIS Number: A18I
Description: This is the FDB code that tells us which type of data is on the FDB Attribute Record.
Data Type: NUMERIC
Size: X(4)
Functional Area Owner: Reference
Valid Values:
Last Update: 1/30/2020 9:13:48 AM
First Databank Product Identifier
NCMMIS Number: A18J
Description: This is the FDB Product Identifer that tells us which type of data is on the External Product Code Record.
Data Type: NUMERIC
Size: X(11)
Functional Area Owner: Reference
Valid Values:
Last Update: 1/30/2020 9:16:44 AM
External Product Code Type Identifier
NCMMIS Number: A18K
Description: This is the External Product Code Type Identifier code that tells us which type of data is on the External Product Code Record.
Data Type: NUMERIC
Size: X(8)
Functional Area Owner: Reference
Valid Values:
Last Update: 1/30/2020 9:19:51 AM
External Product Code Start Date
NCMMIS Number: A18L
Description: This is the start date on the External Product Code Record.
Data Type: DATE
Size: X(10)
Functional Area Owner: Reference
Valid Values:
Last Update: 1/30/2020 9:24:35 AM
External Product Code End Date
NCMMIS Number: A18M
Description: This is the end date on the External Product Code Record.
Data Type: DATE
Size: X(10)
Functional Area Owner: Reference
Valid Values:
Last Update: 1/30/2020 9:27:16 AM
External Product Code
NCMMIS Number: A18N
Description: This is the External Product Code that tells us which type of data is on the External Product Code Record.
Data Type: CHARACTER
Size: X(100)
Functional Area Owner: Reference
Valid Values:
Last Update: 1/30/2020 9:30:44 AM
Price Type Identifier
NCMMIS Number: A18O
Description: This is the Price Type Identifier code that tells us which type of data is on the Product Price Record.
Data Type: NUMERIC
Size: X(3)
Functional Area Owner: Reference
Valid Values:
Last Update: 1/30/2020 9:41:11 AM
Price Effective Date
NCMMIS Number: A18P
Description: This is the Price Effective Date data on the Product Price Record.
Data Type: DATE
Size: X(10)
Functional Area Owner: Reference
Valid Values:
Last Update: 3/12/2021 2:18:24 PM
Price
NCMMIS Number: A18Q
Description: This is the Price data on the Product Price Record.
Data Type: CURRENCY
Size: 9(11)V9(07)
Functional Area Owner: Reference
Valid Values:
Last Update: 1/30/2020 10:12:12 AM
Price Quantity
NCMMIS Number: A18R
Description: This is the Price Quantity code data on the Product Price Record.
Data Type: CURRENCY
Size: 9(11)V9(07)
Functional Area Owner: Reference
Valid Values:
Last Update: 1/30/2020 10:13:44 AM
Price Unit of Measure Identifier
NCMMIS Number: A18S
Description: This is the Price Unit of Measure Identifier data on the Product Price Record.
Data Type: NUMERIC
Size: X(8)
Functional Area Owner: Reference
Valid Values:
Last Update: 1/30/2020 9:59:34 AM
Currency Code
NCMMIS Number: A18T
Description: This is the Currency Code data on the Product Price Record
Data Type: CHARACTER
Size: X(3)
Functional Area Owner: Reference
Valid Values:
Last Update: 1/30/2020 10:00:59 AM
Letter Vendor Sequence Number
NCMMIS Number: A18U
Description: The Letter Vendor Sequence Number is the unique sequence number in the letter outputs that identifies all pages of an individual letter record.
Data Type: NUMERIC
Size: X(6)
Functional Area Owner: Prior Authorization
Valid Values:
Last Update: 2/3/2020 10:08:52 AM
Drug Term Status Indicator
NCMMIS Number: A18V
Description: The Drug Term Status Indicator on the Drug Termination Date Table identifies each segment as 'active' or 'inactive'.
Data Type: CHARACTER
Size: X (1)
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 2:18:21 PM
Reprocessing From Date
NCMMIS Number: A18W
Description: Indicates the start date the reprocessing is requested for
Data Type: DATE
Size: X(10)
Functional Area Owner: Managed Care-Use_Recipient
Valid Values:
Last Update: 6/8/2020 1:25:44 PM
Reprocessing To Date
NCMMIS Number: A18X
Description: Indicate the end date the reprocessing is requested for
Data Type: DATE
Size: X(10)
Functional Area Owner: Managed Care-Use_Recipient
Valid Values:
Last Update: 6/8/2020 1:28:05 PM
Reprocess or Void Indicator
NCMMIS Number: A18Y
Description: Indicates if it is reprocessing request or void only request
Data Type: CHARACTER
Size: X(1)
Functional Area Owner: Managed Care-Use_Recipient
Valid Values:
From Value | Thru Value | Short Description | Long Description |
|---|---|---|---|
R | R | REPROC | REPROCESS |
V | V | VOID | VOID |
Last Update: 5/7/2020 11:26:58 AM
Reprocessing Adjustment Reason Codes
NCMMIS Number: A18Z
Description: Indicates the reason for reprocessing, predefined characters.
Data Type: CHARACTER
Size: X(3)
Functional Area Owner: Managed Care-Use_Recipient
Valid Values:
From Value | Thru Value | Short Description | Long Description |
|---|---|---|---|
ADM | ADM | ADMENTCH | ADMIN ENTITY CHANGES |
COE | COE | CATELI | CATEGORY OF ELIGIBILTY CHANGES |
CTY | CTY | CTYCH | COUNTY CHANGES |
DOD | DOD | DTEDEATH | DATE OF DEATH ENTRY ISSUES |
MPT | MPT | MSNGPYMT | MISSING PAYMENT |
PLN | PLN | BFTPLCH | BENEFIT PLAN CHANGES |
RCH | RCH | RETRCHGS | RETRO ELIGIBILITY CHANGES |
REC | REC | RECNTPAID | RECOUPED AND NOT PAID |
RTE | RTE | RTECH | RATE CHANGES |
Last Update: 5/19/2020 2:57:50 PM
Defect SILK ID
NCMMIS Number: A190
Description: Silk Defect ID
Data Type: CHARACTER
Size: X(10)
Functional Area Owner: Managed Care-Use_Recipient
Valid Values:
Last Update: 2/12/2020 4:19:38 PM
FMR Number
NCMMIS Number: A191
Description: FMR Number
Data Type: CHARACTER
Size: X(10)
Functional Area Owner: Managed Care-Use_Recipient
Valid Values:
Last Update: 2/12/2020 4:20:35 PM
Comment - reason for reprocessing
NCMMIS Number: A192
Description: Indicates the reason for reprocessing
Data Type: CHARACTER
Size: X500)
Functional Area Owner: Managed Care-Use_Recipient
Valid Values:
Last Update: 2/12/2020 4:21:36 PM
Reprocessing Completion Status
NCMMIS Number: A193
Description: Indicates the status of reprocessing
Data Type: CHARACTER
Size: X(20)
Functional Area Owner: Managed Care-Use_Recipient
Valid Values:
From Value | Thru Value | Short Description | Long Description |
|---|---|---|---|
ERR | ERR | ERROR | ERROR |
INACTV | INACTV | INACTV | INACTIVE |
NOT PRCSED | NOT PRCSED | NOT PRCSED | NOT PROCESSED |
PRCSED | PRCSED | PRCSED | PROCESSED |
Last Update: 5/27/2020 2:56:31 PM
Reprocessing Mainframe file name
NCMMIS Number: A194
Description: Mainframe File Name
Data Type: CHARACTER
Size: X(50)
Functional Area Owner: Managed Care-Use_Recipient
Valid Values:
Last Update: 2/12/2020 4:23:32 PM
Input File Name
NCMMIS Number: A195
Description: Filename, as submitted to MOVEit
Data Type: CHARACTER
Size: X(200)
Functional Area Owner:
Valid Values:
Last Update: 2/18/2020 10:40:57 AM
Output File Name
NCMMIS Number: A196
Description: Filename that MOVEit uses when placing on NAS
Data Type: CHARACTER
Size: X(400)
Functional Area Owner:
Valid Values:
Last Update: 2/18/2020 10:41:19 AM
Folder
NCMMIS Number: A197
Description: MOVEit Folder
Data Type: CHARACTER
Size: X(400)
Functional Area Owner:
Valid Values:
Last Update: 2/18/2020 10:26:35 AM
MOVEit ID
NCMMIS Number: A198
Description: MOVEit ID
Data Type: CHARACTER
Size: X(128)
Functional Area Owner:
Valid Values:
Last Update: 2/18/2020 10:27:41 AM
Claim Submit Date
NCMMIS Number: A199
Description: The date the claim was submitted
Data Type: DATE
Size: X(10)
Functional Area Owner:
Valid Values:
Last Update: 2/18/2020 10:38:31 AM
Export to Excel
NCMMIS Number: A19A
Description: Button on the Ops Portal to export data to an Excel spreadsheet
Data Type: CHARACTER
Size: X(1)
Functional Area Owner:
Valid Values:
Last Update: 2/18/2020 10:40:10 AM
Provider Malpractice Judgment Settlement Date
NCMMIS Number: A19B
Description: Date the malpractice case was finalized
Data Type: DATE
Size: X(10)
Functional Area Owner: Provider
Valid Values:
Last Update: 3/4/2020 5:01:38 PM
Provider Malpractice Entity Type Code
NCMMIS Number: A19C
Description: Type of malpractice entity
Data Type: CHARACTER
Size: X(1)
Functional Area Owner: Provider
Valid Values:
From Value | Thru Value | Short Description | Long Description |
|---|---|---|---|
E | E | EXCESSINS | INSURANCE COMPANY - EXCESS INSURER |
G | G | GUARNTY | INSURANCE GUARANTY FUND |
M | M | STATEPRIM | STATE MEDICAL MALPRACTICE PAYMENT FUND AS THE PRIMARY PAYER FOR THIS PRACTITIONER |
O | O | STATESEC | STATE MEDICAL MALPRACTICE PAYMENT FUND AS A SECONDARY PAYER FOR THIS PRACTITIONER |
P | P | PRIMINS | INSURANCE COMPANY - PRIMARY INSURER |
S | S | SELFINS | SELF-INSURED ORGANIZATION |
Last Update: 3/8/2021 4:25:39 PM
Provider Malpractice Payment Result Type
NCMMIS Number: A19D
Description: Type of payment
Data Type: CHARACTER
Size: X(1)
Functional Area Owner: Provider
Valid Values:
From Value | Thru Value | Short Description | Long Description |
|---|---|---|---|
B | B | PAYPRIOR | PAYMENT PRIOR TO SETTLEMENT |
J | J | JUDGEMT | JUDGEMENT |
S | S | SETTLEMT | SETTLEMENT |
Last Update: 3/8/2021 4:25:40 PM
Provider Malpractice Outcome Type Code
NCMMIS Number: A19E
Description: Outcome of the malpractice case
Data Type: CHARACTER
Size: X(2)
Functional Area Owner: Provider
Valid Values:
From Value | Thru Value | Short Description | Long Description |
|---|---|---|---|
01 | 01 | EMINJURY | EMOTIONAL INJURY ONLY |
02 | 02 | INSINJRY | INSIGNIFICANT INJURY |
03 | 03 | MINTEMP | MINOR TEMPORARY INJURY |
04 | 04 | MINPERM | MINOR PERMANENT INJURY |
05 | 05 | MAJTEMP | MAJOR TEMPORARY INJURY |
06 | 06 | SIGPERM | SIGNIFICANT PERMANENT INJURY |
07 | 07 | MAJPERM | MAJOR PERMANENT INJURY |
08 | 08 | GRAVE | GRAVE PERMANENT INJURY, SUCH AS QUADRIPLEGIC OR BRAIN DAMAGE, REQUIRING LIFELONG DEPENDENT CARE |
09 | 09 | DEATH | DEATH |
10 | 10 | UNKNOWN | CANNOT BE DETERMINED FROM AVAILABLE RECORDS |
Last Update: 3/8/2021 4:25:41 PM
Provider Malpractice Insurance Agency
NCMMIS Number: A19F
Description: Provider Malpractice Insurance Agency
Data Type: CHARACTER
Size: x(80)
Functional Area Owner: Provider
Valid Values:
Last Update: 3/4/2020 5:08:27 PM
Provider Malpractice Status Code
NCMMIS Number: A19G
Description: Status of the malpractice case
Data Type: CHARACTER
Size: X(1)
Functional Area Owner: Provider
Valid Values:
From Value | Thru Value | Short Description | Long Description |
|---|---|---|---|
I | I | INVALID | THE MALPRACTICE CASE HAS BEEN DEEMED INVALID |
V | V | VALID | THE MALPRACTICE CASE HAS BEEN VERIFIED |
Last Update: 3/8/2021 4:25:43 PM
Tribal Options Indicator
NCMMIS Number: A19H
Description: The Tribal Option is an option the beneficiary can choose if they want the Tribe to manage their care.
Tribal Options Indicator
Length: Char(01)
Table: B_ELIG_SPN_TB
Possible Valid values: Y-Yes, N-No
Data Type: CHARACTER
Size: 01
Functional Area Owner: Recipient
Valid Values:
From Value | Thru Value | Short Description | Long Description |
|---|---|---|---|
N | N | NO | NOT TRIBAL OPTIONS |
Y | Y | YES | TRIBAL OPTIONS |
Last Update: 8/18/2022 9:02:15 AM
Provider Tribal Identification Number
NCMMIS Number: A19I
Description: Internal base provider id number of the Tribal network that the provider is associated to
Data Type: CHARACTER
Size: X(04)
Functional Area Owner: Provider
Valid Values:
Last Update: 4/3/2020 3:59:06 PM
Provider Tribal Begin Date
NCMMIS Number: A19J
Description: Start date of the Tribal affiliation between the provider and the Tribal network
Data Type: DATE
Size: X(10)
Functional Area Owner: Provider
Valid Values:
Last Update: 4/3/2020 3:59:32 PM
Provider Tribal End Date
NCMMIS Number: A19K
Description: Last date of the Tribal affiliation between the provider and the Tribal network
Data Type: DATE
Size: X(10)
Functional Area Owner: Provider
Valid Values:
Last Update: 4/3/2020 3:59:56 PM
Provider Tribal Termination Code
NCMMIS Number: A19L
Description: A code representing the termination reason for Tribal participation
Data Type: CHARACTER
Size: X(02)
Functional Area Owner: Provider
Valid Values:
From Value | Thru Value | Short Description | Long Description |
|---|---|---|---|
02 | 02 | TRIBEREQ | REQUEST FROM TRIBE TO TERMINATE REMOVAL OF PROVIDER FROM THE TRIBAL OPTION NETWORK |
03 | 03 | PROVREQU | REQUEST FROM PROVIDER TO LEAVE THE TRIBAL OPTION VOLUNTARILY |
04 | 04 | PROVDEATH | NOTIFICATION RECEIVED OF PROVIDER'S DEATH |
05 | 05 | OWNSHPCHN | PROVIDER PRACTICE CHANGES OWNERSHIP |
06 | 06 | LOCNCLOS | PROVIDER LOCATION CLOSED |
07 | 07 | STATE | TRIBAL AFFILIATION TERMINATED AT THE REQUEST OF THE STATE |
08 | 08 | TRMVOLMC | VOLUNTARY TERMINATION FROM MEDICAID |
09 | 09 | TRMIVLMC | INVOLUNTARY TERMINATION FROM MEDICAID |
15 | 15 | TRMLICEN | PROVIDER'S MEDICAL LICENSE IS TERMINATED, SUSPENDED OR EXPIRES |
16 | 16 | CA | CAROLINA ACCESS TERMINATED |
99 | 99 | ERROR | ERROR/VOID ROW IF ADDED AND NEEDS TO BE REMOVED |
Last Update: 3/8/2021 4:25:43 PM
Provider current Tribal Enrollee Number
NCMMIS Number: A19M
Description: Total number of enrollees at a Tribal provider's service location.
Data Type: CHARACTER
Size: X(02)
Functional Area Owner: Provider
Valid Values:
Last Update: 4/3/2020 4:14:00 PM
Provider Tribal Enrollee Number
NCMMIS Number: A19N
Description: Total number of enrollees at a Tribal provider's service location.
Data Type: CHARACTER
Size: X(02)
Functional Area Owner: Provider
Valid Values:
Last Update: 4/3/2020 4:15:49 PM
MoveIt Central File ID
NCMMIS Number: A19O
Description: Comes from moveit column moveitdmz.FileID (unzipped file)
Data Type: INTEGER
Size:
Functional Area Owner:
Valid Values:
Last Update: 4/13/2020 12:10:40 PM
Submitter User ID
NCMMIS Number: A19P
Description: Comes from MoveIt column users.LoginName; could be an NCID or a MoveIt ID
Data Type: CHARACTER
Size: X(128)
Functional Area Owner:
Valid Values:
Last Update: 4/13/2020 12:14:38 PM
NCPDP OTHER AMOUNT PAID COUNT
NCMMIS Number: A19Q
Description: NCPDP field 565-J2. This field is used to specify the number of Other Amount Paid values are included on the Paid segment of the response transaction. NCTracks pays no more than one Other Amount Paid per claim.
Data Type: CHARACTER
Size: 9(1)
Functional Area Owner: Claims
Valid Values:
Last Update: 4/21/2020 4:43:25 PM
NCPDP OTHER AMOUNT PAID QUALIFIER
NCMMIS Number: A19R
Description: NCPDP field 565-J3. This field is used to specify the type of additional fee that was paid on a pharmacy claim. NCTracks returns a value of 01 (delivery) on response transactions for some claims.
Data Type: CHARACTER
Size: X(2)
Functional Area Owner: Claims
Valid Values:
From Value | Thru Value | Short Description | Long Description |
|---|---|---|---|
00 | 00 | NOT SPECIF | NOT SPECIFIED |
01 | 01 | DELIVERY | DELIVERY |
02 | 02 | SHIPPING | SHIPPING |
03 | 03 | POSTAGE | POSTAGE |
04 | 04 | ADMIN | ADMINISTRATIVE |
05 | 05 | INCENTIVE | INCENTIVE-AN INDICATOR WHICH SIGNIFIES THE DOLLAR AMOUNT PAID BY THE OTHER PAYER WHICH IS RELATED TO ADDITIONAL FEES OR COMPENSATIONS PAID AS AN INDUCEMENT FOR AN ACTION TAKEN BY THE PROVIDER (E.G. COLLECTION OF SURVEY DATA, COUNSELING PLAN ENROLLEES, VACCINE ADMINISTRATION). |
09 | 09 | COMP PREP | COMPOUND PREPARATION COST |
99 | 99 | OTHER | OTHER COST |
Last Update: 3/15/2022 11:52:24 AM
NCPDP OTHER AMOUNT PAID
NCMMIS Number: A19S
Description: NCPDP field 565-J4. This field is used to specify an additional fee that was paid on a pharmacy claim.
Data Type: DECIMAL
Size: S9(06)V99
Functional Area Owner: Claims
Valid Values:
Last Update: 4/21/2020 4:51:30 PM
Reprocessing Sequence Number
NCMMIS Number: A19T
Description: Indicates the sequence number for reprocessing request
Data Type: UNSPECIFIED
Size:
Functional Area Owner: Managed Care-Use_Recipient
Valid Values:
Last Update: 5/1/2020 11:57:29 AM
Reprocessing Benefit Plan Number
NCMMIS Number: A19U
Description: Reprocessing Benefit Plan Number - Indicates the benefit plans for reprocessing
Data Type: DECIMAL
Size: INT(4)
Functional Area Owner: Managed Care-Use_Recipient
Valid Values:
From Value | Thru Value | Short Description | Long Description |
|---|---|---|---|
11 | 11 | PACE | PACE |
12 | 12 | PHPB | PHPB |
13 | 13 | PHPC | PHPC |
14 | 14 | TBI | TRAUMATIC BRAIN INJURY |
15 | 15 | MCAID | MEDICAID |
100 | 100 | MCSTD | MC-MEDICAID STANDARD PLAN |
102 | 102 | HCSTD | MC-NCHC STANDARD PLAN |
106 | 106 | TPMC | TAILORED PLAN MEDICAID |
107 | 107 | TPHC | TAILORED PLAN HEALTH CHOICE |
108 | 108 | TPINV | TAILORED PLAN INNOVATIONS |
109 | 109 | TPTBI | TAILORED PLAN TRAUMATIC BRAIN INJURY |
111 | 111 | PHHC | BEHAVIORAL HEALTH SERVICES FOR NORTH CAROLINA HEALTH CHOICE |
Last Update: 7/15/2022 9:27:34 AM
Managed Care Tribal Options Indicator
NCMMIS Number: A19V
Description: Managed Care Tribal Options Indicator
Length: Char(01)
B_TRIB_OPTNS_IND
Possible Valid values: Y-Yes, N-No
Data Type: CHARACTER
Size: 1
Functional Area Owner: Managed Care-Use_Recipient
Valid Values:
From Value | Thru Value | Short Description | Long Description |
|---|---|---|---|
N | N | NO | NOT MC-TRIBAL OPTONS |
Y | Y | YES | MC-TRIBAL OPTIONS |
Last Update: 5/20/2020 4:27:05 PM
Provider PHP Contract Status code
NCMMIS Number: A19W
Description: Provider PHP Contract Status code
Data Type: CHARACTER
Size: X(02)
Functional Area Owner: Provider
Valid Values:
From Value | Thru Value | Short Description | Long Description |
|---|---|---|---|
03 | 03 | VOID | VOID |
Last Update: 3/8/2021 4:25:44 PM
Batch File Status Code
NCMMIS Number: A19X
Description: Batch File Status Code
Data Type: CHARACTER
Size: VARCHAR(32)
Functional Area Owner: E-Commerce
Valid Values:
Last Update: 3/4/2021 1:50:55 PM
Claim File Status Code
NCMMIS Number: A19Y
Description: Claim File Status Code
Data Type: TIMESTAMP
Size: X(26)
Functional Area Owner: E-Commerce
Valid Values:
Last Update: 3/4/2021 1:58:53 PM
SharePoint Defined Element
NCMMIS Number: A19Z
Description: SharePoint Defined Element is an internal value used only in SharePoint forms.
Data Type: UNSPECIFIED
Size:
Functional Area Owner: Reference
Valid Values:
Last Update: 6/19/2020 8:53:36 AM
Line Quantity Prescribed
NCMMIS Number: A1A0
Description: Quantity Prescribed represents the quantity, in metric units, that was prescribed to the patient. Multiple claims may be necessary to bill the entire Quantity Prescribed. This value is submitted in NCPDP D.0 field 460-ET.
Data Type: DECIMAL
Size: 9(7)v999
Functional Area Owner: Claims
Valid Values:
Last Update: 6/30/2020 9:17:40 AM
Reprocessing Pricing Code
NCMMIS Number: A1A1
Description: Code indicating special pricing action taken during claim reprocessing.
Data Type: CHARACTER
Size: X(1)
Functional Area Owner: Claims
Valid Values:
From Value | Thru Value | Short Description | Long Description |
|---|---|---|---|
1 | 1 | BYPASS-LOL | BYPASS LESSOR OF LOGIC |
Last Update: 3/15/2022 11:52:25 AM
Claim Transaction ID
NCMMIS Number: A1A2
Description: Claim Transaction ID
Data Type: INTEGER
Size: S9(9)
Functional Area Owner: Provider
Valid Values:
Last Update: 9/4/2020 3:54:53 PM
Claim Service Date
NCMMIS Number: A1A3
Description: Claim Service Date
Data Type: DATE
Size: X(10)
Functional Area Owner: Provider
Valid Values:
Last Update: 9/4/2020 3:49:48 PM
Claim Transaction Status
NCMMIS Number: A1A4
Description: Claim Transaction Status
Data Type: CHARACTER
Size: X(01)
Functional Area Owner: Provider
Valid Values:
From Value | Thru Value | Short Description | Long Description |
|---|---|---|---|
A | A | APPROVED | APPROVED |
D | D | DENIED | DENIED |
P | P | PENDING | PENDING |
Last Update: 3/8/2021 4:25:44 PM
Electronic Visit Verification (EVV) Start time
NCMMIS Number: A1A5
Description: Electronic Visit Verification (EVV) Start time - HHMM
Data Type: CHARACTER
Size: X(4)
Functional Area Owner:
Valid Values:
Last Update: 11/2/2020 12:30:56 PM
Electronic Visit Verification (EVV) End time
NCMMIS Number: A1A6
Description: Electronic Visit Verification (EVV) End time - HHMM
Data Type: CHARACTER
Size: X(4)
Functional Area Owner:
Valid Values:
Last Update: 11/2/2020 12:31:47 PM
Electronic Visit Verification (EVV) Last Name
NCMMIS Number: A1A7
Description: Electronic Visit Verification (EVV) Last Name
Data Type: CHARACTER
Size: X(15)
Functional Area Owner:
Valid Values:
Last Update: 11/2/2020 12:32:23 PM
Electronic Visit Verification (EVV) First Name
NCMMIS Number: A1A8
Description: Electronic Visit Verification (EVV) First Name
Data Type: CHARACTER
Size: X(10)
Functional Area Owner:
Valid Values:
Last Update: 11/2/2020 12:33:09 PM
Electronic Visit Verification (EVV) Identifier
NCMMIS Number: A1AB
Description: Electronic Visit Verification (EVV) Identifier
Data Type: CHARACTER
Size: X(12)
Functional Area Owner: Recipient
Valid Values:
Last Update: 11/2/2020 4:36:47 PM
Electronic Visit Verification (EVV) Units
NCMMIS Number: A1AC
Description: Electronic Visit Verification (EVV) Units
Data Type: INTEGER
Size: S9(11,3)
Functional Area Owner: Recipient
Valid Values:
Last Update: 11/2/2020 4:36:34 PM
Electronic Visit Verification (EVV) Date of Visit
NCMMIS Number: A1AE
Description: Electronic Visit Verification (EVV) Date of Visit
Data Type: DATE
Size: X(10)
Functional Area Owner: Recipient
Valid Values:
Last Update: 11/2/2020 4:37:56 PM
Electronic Visit Verification (EVV) Vendor Visit Identifier (Visit Key)
NCMMIS Number: A1AF
Description: Electronic Visit Verification (EVV) Vendor Visit Identifier (Visit Key)
Data Type: CHARACTER
Size: X(16)
Functional Area Owner: Recipient
Valid Values:
Last Update: 11/24/2020 11:05:31 AM
Electronic Visit Verification (EVV) Visit Duration in Minutes
NCMMIS Number: A1AI
Description: Electronic Visit Verification (EVV) Visit Duration in Minutes
Data Type: INTEGER
Size: S9(11,3)
Functional Area Owner: Recipient
Valid Values:
Last Update: 11/2/2020 4:41:09 PM
Electronic Visit Verification (EVV) Visit Void Indicator
NCMMIS Number: A1AK
Description: Electronic Visit Verification (EVV) Visit Void Indicator
Data Type: CHARACTER
Size: X(1)
Functional Area Owner: Recipient
Valid Values:
From Value | Thru Value | Short Description | Long Description |
|---|---|---|---|
N | N | NO | NO |
Y | Y | YES | YES |
Last Update: 8/18/2022 9:02:16 AM
Electronic Visit Verification (EVV) Indicator
NCMMIS Number: A1AL
Description: Electronic Visit Verification (EVV) Indicator
Data Type: CHARACTER
Size: X(01)
Functional Area Owner: Recipient
Valid Values:
From Value | Thru Value | Short Description | Long Description |
|---|---|---|---|
N | N | NO | NO |
SPACE | SPACE | BLANK | BLANK |
Y | Y | YES | YES |
Last Update: 8/18/2022 9:02:16 AM
Electronic Visit Verification (EVV) Encounter Visit Key
NCMMIS Number: A1AM
Description: Electronic Visit Verification (EVV) Vendor Visit Identifier (Visit Key) for Encounters
Data Type: CHARACTER
Size: X(10)
Functional Area Owner: Recipient
Valid Values:
Last Update: 12/2/2020 12:52:01 PM
Index
NCMMIS Number: A1AO
Description: Index number of uploaded document
Data Type: INTEGER
Size: 9(03)
Functional Area Owner: Recipient
Valid Values:
Last Update: 12/18/2020 10:13:35 AM
Uploaded Document Type
NCMMIS Number: A1AP
Description: Uploaded Doc Type Code - document type of file uplaoded
Data Type: CHARACTER
Size: X(06)
Functional Area Owner: Recipient
Valid Values:
From Value | Thru Value | Short Description | Long Description |
|---|---|---|---|
CAPC | CAPC | CAPC FORM | CAP C FORM |
CAPDA | CAPDA | CAPDA FORM | CAP DA FORM |
Last Update: 8/18/2022 9:02:17 AM
Uploaded Document Status
NCMMIS Number: A1AQ
Description: Status of document that was uploaded
Data Type: CHARACTER
Size: X(01)
Functional Area Owner: Recipient
Valid Values:
From Value | Thru Value | Short Description | Long Description |
|---|---|---|---|
A | A | APPROVED | APPROVED |
D | D | DENIED | DENIED |
P | P | PENDING | PENDING |
Last Update: 8/18/2022 9:02:17 AM
PHP PA Reject Reason Code
NCMMIS Number: A1AR
Description: The PHP Reject Reason Codes are assigned to invalid PAs that were submitted to NCTracks from a PHP. The reason code is returned to the PHP as the explanation for the PA rejection. A single PA may be assigned 0 to 5 PHP Reject Reason Codes.
Data Type: CHARACTER
Size: X(02)
Functional Area Owner: Prior Authorization
Valid Values:
From Value | Thru Value | Short Description | Long Description |
|---|---|---|---|
A1 | A1 | INV TR NUM | INVALID PHP TRACKING NUMBER |
A2 | A2 | DUPE TRCK# | PHP TRACKING NUMBER ALREADY EXISTS |
A3 | A3 | INV RECIP | INVALID RECIPIENT ID |
A4 | A4 | INV DR CDT | INVALID DRUG CODE TYPE |
A5 | A5 | INV NDC | INVALID DRUG CODE |
A6 | A6 | INV EFF DT | INVALID PA EFFECTIVE DATE |
A7 | A7 | INV EXP DT | INVALID PA EXPIRATION DATE |
A8 | A8 | INV A UNTS | INVALID APPROVED UNITS |
A9 | A9 | INV R UNTS | INVALID REMAINING UNITS |
B1 | B1 | INV PR NPI | INVALID PROVIDER NPI |
B2 | B2 | NO HDR REC | FILE REJECTED - NO PA HEADER RECORDS |
B3 | B3 | INV HDR ID | INVALID PA HEADER IDENTIFIER - NO RECORD CREATED |
B4 | B4 | PHP ID | PHP ID MISMATCH - NO RECORD CREATED |
B5 | B5 | NEW RCRD | PHP TRACKING NUMBER NOT UNIQUE FOR NEW PA - NO RECORD CREATED |
B6 | B6 | INV HDR ST | INVALID HEADER STATUS |
B7 | B7 | INV CH IND | INVALID CHANGE INDICATOR - NO RECORD CREATED |
B8 | B8 | INV PA TYP | INVALID PA TYPE - NO RECORD CREATED |
B9 | B9 | INV HP | INVALID HEALTH PLAN - NO RECORD CREATED |
C1 | C1 | INV B NPI | INVALID BILLLING NPI |
C2 | C2 | INV B ATYP | INVALID BILLING ATYPICAL ID |
C3 | C3 | INV B TAX | NO ACTIVE TAXONOMY FOR THE BILLING PROVIDER ID AND LOCATION |
C4 | C4 | INV B LOC | INVALID BILLING LOCATOR CODE |
C5 | C5 | INV RQ NPI | INVALID REQUESTING NPI |
C6 | C6 | INV RQ ATY | INVALID REQUESTING ATYPICAL ID |
C7 | C7 | INV RQ TAX | NO ACTIVE TAXONOMY FOR THE REQUESTING PROVIDER ID AND LOCATION |
C8 | C8 | INV RQ LOC | INVALID REQUESTING LOCATOR CODE |
C9 | C9 | INV DX | INVALID DIAGNOSIS CODE |
D1 | D1 | NO A10 DX | NO DIAGNOSIS CODE FOR A10 PA RECORD |
D2 | D2 | INV LN NUM | INVALID LINE NUMBER - NO RECORD CREATED |
D3 | D3 | LINE NUM | HEADER AND DETAIL LINE NUMBER MISMATCH - NO RECORD CREATED |
D4 | D4 | INV EPSDT | INVALID EPSDT INDICATOR |
D5 | D5 | NO DTL REC | FILE REJECTED - NO PA DETAIL RECORDS |
D6 | D6 | INV DTL ID | INVALID PA DETAIL IDENTIFIER - NO RECORD CREATED |
D7 | D7 | LN NUM SEQ | LINE NUMBERS NOT SEQUENTIAL - NO RECORD CREATED |
D8 | D8 | A00 DTL LN | PA TYPE CAN ONLY HAVE 1 DETAIL LINE - NO RECORD CREATED |
D9 | D9 | INV LN ST | INVALID LINE STATUS |
E1 | E1 | INV SV TYP | INVALID SERVICE TYPE FOR PA TYPE AND PROC CODE |
E2 | E2 | INV RN NPI | INVALID RENDERING NPI |
E3 | E3 | INV RN ATY | INVALID RENDERING ATYPICAL ID |
E4 | E4 | INV RN TAX | NO ACTIVE TAXONOMY FOR THE RENDERING PROVIDER ID AND LOCATION |
E5 | E5 | INV RN LOC | INVALID RENDERING LOCATOR CODE |
E6 | E6 | INV BEG DT | INVALID LINE BEGIN DATE |
E7 | E7 | INV END DT | INVALID LINE END DATE |
E8 | E8 | INV PRC CD | INVALID PROC CODE FOR PA TYPE |
E9 | E9 | INV MOD | INVALID MODIFIER |
F1 | F1 | INV 04 MOD | INVALID MODIFIER FOR A04 PA |
F2 | F2 | INV APPR | INVALID APPROVED UNITS/AMOUNT |
F3 | F3 | INV REMAIN | INVALID REMAINING UNITS/AMOUNT |
F4 | F4 | INV R UNIT | INVALID REMAINING UNITS |
F5 | F5 | INV R AMT | INVALID REMAINING AMOUNT |
F6 | F6 | UPDAT RCRD | PHP TRACKING NUMBER DOES NOT EXIST FOR UPDATED PA - NO RECORD CREATED |
F7 | F7 | UPDATE LN | LINE COUNT MISMATCH BETWEEN UPDATE PA AND ORIGINAL PA - NO RECORD CREATED |
F8 | F8 | TERMINATED | PA STATUS HAS BEEN SET TO TERMINATED BY FA - NO RECORD UPDATE |
F9 | F9 | A00 PA | NO PHP UPDATE TO A00 PA - NO RECORD UPDATE |
G1 | G1 | NCOV PROC | THIS CODE IS NOT COVERED BY MEDICAID DIRECT. IF CODE WAS INTENTIONAL, PLEASE NOTIFY PROVIDER THAT THIS PA WILL NOT TRANSFER TO NCTRACKS. |
G2 | G2 | CAP PROC | THIS CODE IS ASSOCIATED WITH A CAP BSG AND CANNOT BE TRANSFERRED TO MEDICAID DIRECT. CAP AUTHORIZATIONS ARE ISSUED BY THE ASSIGNED STATE UM VENDOR. |
G3 | G3 | PA NOT REQ | THIS CODE DOES NOT REQUIRE PRIOR APPROVAL BY MEDICAID DIRECT. IF CODE WAS INTENTIONAL, PLEASE NOTIFY PROVIDER THAT THIS PA WILL NOT TRANSFER TO NCTRACKS. |
G4 | G4 | DENTAL CD | THIS CODE IS ASSOCIATED WITH A DENTAL SERVICE AND CANNOT BE TRANSFERRED TO MEDICAID DIRECT. IF CODE WAS INTENTIONAL, PLEASE NOTIFY PROVIDER THAT THIS PA WILL NOT TRANSFER TO NCTRACKS. |
G5 | G5 | NO ELIG | THERE IS NO CURRENT MEDICAID DIRECT ELIGIBILITY ON FILE FOR THE BENEFICIARY LISTED IN THIS PRIOR AUTHORIZATION; PLEASE NOTIFY PROVIDER THAT THIS PA WILL NOT TRANSFER TO NCTRACKS. |
G6 | G6 | SPEC THRPY | THE CODE IS ASSOCIATED WITH A SPECIALIZED THERAPY SERVICE AND CANNOT BE TRANSFERRED TO MEDICAID DIRECT. PROVIDERS SHOULD BE ADVISED TO SUBMIT A NEW PA THROUGH THE ASSIGNED STATE UM VENDOR. |
G7 | G7 | MOD REQ | THIS PRIOR AUTHORIZATION TYPE REQUIRES A MODIFIER TO BE SUBMITTER WITH THE PROCEDURE CODE. |
G8 | G8 | PIHP SRVC | THE BENEFICIARY IS ENROLLED WITH A PIHP FOR THE SERVICE AND DATES ASSOCIATED WITH THE PA TYPE. PLEASE SUBMIT THE PA TO THE APPROPRIATE PIHP. |
G9 | G9 | DME NEW PA | THE CODE IS ASSOCIATED WITH A MANUALLY PRICED DME ITEM AND CANNOT BE TRANSFERRED TO MEDICAID DIRECT. PROVIDERS SHOULD BE ADVISED TO SUBMIT A NEW PA THROUGH NCTRACKS. |
H1 | H1 | INV HDR RT | FILE REJECTED - INVALID FILE HEADER RECORD TYPE |
H2 | H2 | INV CLIENT | FILE REJECTED - CLIENT ID IS INVALID OR DOESNT MATCH |
H3 | H3 | INV HDR DT | FILE REJECTED - CREATION DATE IS INVALID OR DOESNT MATCH |
H4 | H4 | INV FIL TY | FILE REJECTED - INVALID FILE TYPE |
H5 | H5 | INV PHP ID | FILE REJECTED - INVALID PHP ID |
H6 | H6 | INV DATA | FILE REJECTED - INVALID OR JUNK DATA |
H7 | H7 | NO FILE | NO FILE RECEIVED |
J1 | J1 | NEMT PROC | UNDER MEDICAID DIRECT ALL TRANSPORTATION SERVICES ARE COVERED THROUGH THE NEMT PROGRAM AND ARE MANAGED BY THE COUNTY DSS OFFICES. |
J2 | J2 | HH HOSPICE | THIS CODE IS ASSOCIATED WITH A HOME HEALTH OR HOSPICE SERVICE AND CANNOT BE TRANSFERRED TO MEDICAID DIRECT. PROVIDERS SHOULD REACH OUT TO THE STATE ASSIGNED UM VENDOR TO REQUEST A NEW PA IF NEEDED. |
T0 | T0 | FILE ACPT | NO REJECTIONS. ALL PAS ACCEPTED |
T1 | T1 | INV TLR ID | FILE REJECTED - INVALID FILE TRAILER RECORD TYPE |
T2 | T2 | INV REC CT | FILE REJECTED - RECORD COUNT MISMATCH |
Last Update: 5/6/2024 11:46:26 AM
Uploaded Document Index Number
NCMMIS Number: A1AS
Description: Upload Document Index Number
Data Type: CHARACTER
Size: X(10)
Functional Area Owner: Recipient
Valid Values:
Last Update: 1/11/2021 2:37:27 PM
Uploaded Document Control Number
NCMMIS Number: A1AT
Description: Document Control Number
Data Type: CHARACTER
Size: X(12)
Functional Area Owner: Recipient
Valid Values:
Last Update: 1/11/2021 2:37:46 PM
External PA ID
NCMMIS Number: A1AU
Description: The External PA ID is the number received from vendors in PA files. It represents the PA number for the record in the vendor's system.
Data Type: CHARACTER
Size: X(30)
Functional Area Owner: Prior Authorization
Valid Values:
Last Update: 2/9/2021 3:59:08 PM
External PA ID Type
NCMMIS Number: A1AV
Description: The External PA ID Type represents the type of vendor the External PA ID is from.
Data Type: CHARACTER
Size: X(01)
Functional Area Owner: Prior Authorization
Valid Values:
From Value | Thru Value | Short Description | Long Description |
|---|---|---|---|
H | H | PHP ID | PHP ID |
V | V | VENDOR ID | VENDOR ID |
Last Update: 11/20/2023 8:50:24 AM
Provider Entity Message Print Indicator
NCMMIS Number: A1AW
Description: Provider entity message print indicator
Data Type: CHARACTER
Size: X(1)
Functional Area Owner: Provider
Valid Values:
Last Update: 3/17/2021 9:19:13 AM
PA Incomplete Address Indicator
NCMMIS Number: A1AX
Description: The PA Incomplete Address Indicator will identify PA letter records in which the letter was not generated and mailed because the recipient address was invalid.
Data Type: CHARACTER
Size: X(01)
Functional Area Owner: Prior Authorization
Valid Values:
From Value | Thru Value | Short Description | Long Description |
|---|---|---|---|
N | N | N | INDICATOR CHANGED FROM Y TO N |
Y | Y | Y | INCOMPLETE ADDRESS FOR RECIPIENT |
Last Update: 11/20/2023 8:50:25 AM
Entity Message Print Indicator
NCMMIS Number: A1AY
Description: Entity Message Print Indicator
Data Type: CHARACTER
Size: X(1)
Functional Area Owner: Provider
Valid Values:
Last Update: 4/8/2021 2:40:51 PM
Claim Line Base Rate Segment Begin Date
NCMMIS Number: A1AZ
Description: The beginning date of the portion of the claim line date span the base rate was applicable
Data Type: DATE
Size: X(10)
Functional Area Owner: Claims
Valid Values:
Last Update: 6/30/2021 11:38:50 AM
Claim Line Base Rate Segment End Date
NCMMIS Number: A1B0
Description: The ending date of the portion of the claim line date span the base rate was applicable
Data Type: DATE
Size: X(10)
Functional Area Owner: Claims
Valid Values:
Last Update: 6/30/2021 11:39:34 AM
Provider Derived Location Code
NCMMIS Number: A1B1
Description: Provider Derived Location Code
Data Type: CHARACTER
Size: X(03)
Functional Area Owner: Provider
Valid Values:
Last Update: 8/12/2021 8:34:41 AM
Batch ID
NCMMIS Number: A1B2
Description: Batch Identifier is a system generated identifier assigned to each batch transaction file submission. It provides a cross-reference to all transactions contained within a batch and is used to track processing.
Data Type: INTEGER
Size: S9(8)
Functional Area Owner: Reference
Valid Values:
Last Update: 8/17/2021 10:54:28 AM
Batch Profile Type Number
NCMMIS Number: A1B3
Description: Batch profile type defines the single profile or a group of profiles that is being processed as a part of a batch.
Data Type: INTEGER
Size: S9(8)
Functional Area Owner: Reference
Valid Values:
From Value | Thru Value | Short Description | Long Description |
|---|---|---|---|
1000 | 1000 | ALLPROF | ALL DAVINCI PDEX AND CARIN BB PROFILES |
1001 | 1001 | ALLPDEX | ALL DAVINCI PDEX PROFILES |
1002 | 1002 | PDEXENDPT | PDEX PLANNET ENDPOINT |
1003 | 1003 | PDEXHEALTH | PDEX PLANNET HEALTHCARE SERVICE |
1004 | 1004 | PDEXINSUR | PDEX PLANNET INSURANCE PLAN |
1005 | 1005 | PDEXLOC | PDEX PLANNET LOCATION |
1006 | 1006 | PDEXNETW | PDEX PLANNET NETWORK |
1007 | 1007 | PDEXORG | PDEX PLANNET ORGANIZATION |
1008 | 1008 | PDEXORGAFF | PDEX PLANNET ORGANIZATION AFFILIATION |
1009 | 1009 | PDEXPRAC | PDEX PLANNET PRACTITIONER |
1010 | 1010 | PDEXPRARL | PDEX PLANNET PRACTITIONER ROLE |
1101 | 1101 | CARINBBALL | CARIN BB PROVIDER PROFILES |
1102 | 1102 | CARINBBORG | CARIN BB - C4BB ORGANIZATION |
1103 | 1103 | CARINBBPRA | CARIN BB - C4BB PRACTITIONER |
2000 | 2000 | CARINCLALL | CARIN BB - ALL CLAIMS PROFILES |
2001 | 2001 | CARINBBCL | CARIN BB - CLAIM PROFILES |
2002 | 2002 | CBBINPINST | CARIN BB - C4BB EXPLANATION OF BENEFITS - INPATIENT INSTITUTIONAL |
2003 | 2003 | CBBOUTINST | CARIN BB - C4BB EXPLANATION OF BENEFITS - OUTPATIENT INSTITUTIONAL |
2004 | 2004 | CBBPHARM | CARIN BB - C4BB EXPLANATION OF BENEFITS - PHARMACY |
2005 | 2005 | CBBPROFN | CARIN BB - C4BB EXPLANATION OF BENEFITS - PROFESSIONAL NONCLINICIAN |
Last Update: 8/17/2021 11:13:19 AM
Batch Load Type Number
NCMMIS Number: A1B4
Description: Batch load type defines the type of load being run by the batch process.
Data Type: INTEGER
Size: S9(8)
Functional Area Owner: Reference
Valid Values:
From Value | Thru Value | Short Description | Long Description |
|---|---|---|---|
XX | XX | REPRCFAIL | REPROCESS FAILED FROM SPECIFIC BATCH |
1 | 1 | FULLLD | FULL LOAD |
2 | 2 | INCRLD | INCREMENTAL LOAD |
Last Update: 8/17/2021 11:20:28 AM
Batch Record ID
NCMMIS Number: A1B5
Description: Batch record ID defines the type of record being run by the batch process. This will either be recipient ID, provider ID, or a TCN.
Data Type: CHARACTER
Size: CHAR (16)
Functional Area Owner: Reference
Valid Values:
Last Update: 8/17/2021 11:23:22 AM
FHIR Valid Values
NCMMIS Number: A1B6
Description: Equivalent FHIR valid value to the corresponding NCTracks valid value.
Data Type: CHARACTER
Size: CHAR (20)
Functional Area Owner: Reference
Valid Values:
Last Update: 8/17/2021 11:36:19 AM
Batch Error Description
NCMMIS Number: A1B7
Description: Batch Error description is a free form text description describing the error corresponding to the type of record being processed.
Data Type: CHARACTER
Size: VARCHAR (50)
Functional Area Owner: Reference
Valid Values:
Last Update: 8/17/2021 11:42:03 AM
Recipient Social Security Number
NCMMIS Number: A1B8
Description: Recipient social security number (SSN)
Data Type: CHARACTER
Size: X(09)
Functional Area Owner: Recipient
Valid Values:
Last Update: 8/19/2021 10:47:13 AM
Choose File Button
NCMMIS Number: A1B9
Description: Button to choose a file located on the PC
Data Type: UNSPECIFIED
Size:
Functional Area Owner:
Valid Values:
Last Update: 8/19/2021 11:19:17 AM
Resource Type Code
NCMMIS Number: A1BA
Description: Resource Type Code - FHIR Resource - Patient Access Profiles
Data Type: CHARACTER
Size: 01
Functional Area Owner: Reference
Valid Values:
From Value | Thru Value | Short Description | Long Description |
|---|---|---|---|
1 | 1 | INPAT | INPATIENT |
2 | 2 | OUT PAT | OUT PATIENT |
3 | 3 | PROF | PROFESSIONAL |
4 | 4 | PHARM | PHARMACY |
Last Update: 9/14/2021 1:27:54 PM
MC Plan type
NCMMIS Number: A1BB
Description: Managed Care plan type
Data Type: CHARACTER
Size: X(06)
Functional Area Owner: Recipient
Valid Values:
From Value | Thru Value | Short Description | Long Description |
|---|---|---|---|
MCP001 | MCP001 | MCSTDTYPE | MANAGED CARE STANDARD PLAN TYPE |
MCP002 | MCP002 | MCTPTYPE | MANAGED CARE TAILORED PLAN TYPE |
Last Update: 8/18/2022 9:02:18 AM
Care Manager NPI
NCMMIS Number: A1BC
Description: Care Manager NPI
Data Type: CHARACTER
Size: X(10)
Functional Area Owner: Recipient
Valid Values:
Last Update: 9/15/2021 11:08:04 AM
Care Manager Loc cd
NCMMIS Number: A1BD
Description: Care Manager Locator code
Data Type: CHARACTER
Size: X(03)
Functional Area Owner: Recipient
Valid Values:
Last Update: 9/15/2021 11:10:01 AM
Batch Record Status Code
NCMMIS Number: A1BE
Description: Batch Record Status Code
Data Type: CHARACTER
Size: (01)
Functional Area Owner: Reference
Valid Values:
From Value | Thru Value | Short Description | Long Description |
|---|---|---|---|
0 | 0 | NOTSTA | NOT STARTED |
1 | 1 | SUCC | SUCCESS |
2 | 2 | FAIL | FAILED |
Last Update: 9/28/2021 9:26:03 AM
Reference Valid Value Category Code
NCMMIS Number: A1BF
Description: Valid Value Qualifier for data mapping.
Data Type: CHARACTER
Size: (16)
Functional Area Owner: Reference
Valid Values:
Last Update: 9/30/2021 9:51:23 AM
Provider AAR Indicator
NCMMIS Number: A1BG
Description: Provider Adverse Actions Report (AAR) Indicator
Data Type: DECIMAL
Size: X(01)
Functional Area Owner: Provider
Valid Values:
Last Update: 10/14/2021 1:07:40 PM
Provider PPT Indicator
NCMMIS Number: A1BH
Description: Provider Provider Penalty Tracking (PPT) Indicator
Data Type: CHARACTER
Size: X(01)
Functional Area Owner: Provider
Valid Values:
Last Update: 10/14/2021 1:07:17 PM
Provider Sub Sequence Number
NCMMIS Number: A1BI
Description: Provider Substitute Sequence Number - System generated number to provider for a unique record
Data Type: INTEGER
Size: 9(04)
Functional Area Owner: Provider
Valid Values:
Last Update: 10/27/2021 10:43:08 AM
Provider Appeal Expiration
NCMMIS Number: A1BJ
Description: Provider Appeal Expiration - Is it past the date to be able to appeal
Data Type: CHARACTER
Size: X(03)
Functional Area Owner: Provider
Valid Values:
Last Update: 10/27/2021 10:33:03 AM
Provider Appeal Effective Date
NCMMIS Number: A1BK
Description: Provider Appeal Effective Date
Data Type: DATE
Size: X(10)
Functional Area Owner: Provider
Valid Values:
Last Update: 10/27/2021 12:39:51 PM
Provider Adverse Action Reason
NCMMIS Number: A1BL
Description: Provider Adverse Action Reason
Data Type: CHARACTER
Size: X(250)
Functional Area Owner: Provider
Valid Values:
Last Update: 10/27/2021 10:34:50 AM
Provider Active Enrollment Bar Code
NCMMIS Number: A1BM
Description: Provider Active Enrollment Bar Code - YES/NO
Data Type: CHARACTER
Size: X(01)
Functional Area Owner: Provider
Valid Values:
Last Update: 10/27/2021 10:36:17 AM
Provider Enrollment Bar Expiration Date
NCMMIS Number: A1BN
Description: Provider Enrollment Bar Expiration Date
Data Type: DATE
Size: X(10)
Functional Area Owner: Provider
Valid Values:
Last Update: 10/27/2021 12:40:11 PM
Provider Status
NCMMIS Number: A1BO
Description: Provider Status - Status of AAR Record
Data Type: CHARACTER
Size: X(25)
Functional Area Owner: Provider
Valid Values:
Last Update: 10/27/2021 10:39:50 AM
Provider Termination Agency Name
NCMMIS Number: A1BP
Description: Provider Termination Agency Name
Data Type: CHARACTER
Size: X(35)
Functional Area Owner: Provider
Valid Values:
Last Update: 10/27/2021 10:40:45 AM
Provider CMS Published Date
NCMMIS Number: A1BQ
Description: Provider CMS Published Date
Data Type: DATE
Size: X(10)
Functional Area Owner: Provider
Valid Values:
Last Update: 10/27/2021 12:40:25 PM
Provider Penalty Creation Date
NCMMIS Number: A1BR
Description: Provider Penalty Creation Date
Data Type: DATE
Size: X(10)
Functional Area Owner: Provider
Valid Values:
Last Update: 10/27/2021 12:40:41 PM
Provider Facility Name
NCMMIS Number: A1BS
Description: Provider Facility Name
Data Type: CHARACTER
Size: X(35)
Functional Area Owner: Provider
Valid Values:
Last Update: 10/27/2021 10:52:48 AM
Provider Facility ID
NCMMIS Number: A1BT
Description: Provider Facility ID
Data Type: CHARACTER
Size: X(12)
Functional Area Owner: Provider
Valid Values:
Last Update: 10/27/2021 10:53:46 AM
Provider Facility Address line 1
NCMMIS Number: A1BU
Description: Provider Facility Address line 1
Data Type: CHARACTER
Size: X(40)
Functional Area Owner: Provider
Valid Values:
Last Update: 10/27/2021 10:54:50 AM
Provider Facility Address line 2
NCMMIS Number: A1BV
Description: Provider Facility Address line 2
Data Type: CHARACTER
Size: X(40)
Functional Area Owner: Provider
Valid Values:
Last Update: 10/27/2021 10:55:43 AM
Provider Facility Address City
NCMMIS Number: A1BW
Description: Provider Facility Address City
Data Type: CHARACTER
Size: X(25)
Functional Area Owner: Provider
Valid Values:
Last Update: 10/27/2021 10:56:38 AM
Provider Facility Address State code
NCMMIS Number: A1BX
Description: Provider Facility Address State code
Data Type: CHARACTER
Size: X(02)
Functional Area Owner: Provider
Valid Values:
Last Update: 10/27/2021 11:06:56 AM
Provider Facility Address Postal code
NCMMIS Number: A1BY
Description: Provider Facility Address Postal code
Data Type: CHARACTER
Size: X(15)
Functional Area Owner: Provider
Valid Values:
Last Update: 10/27/2021 11:07:59 AM
Division Name
NCMMIS Number: A1BZ
Description: Division Name
Data Type: CHARACTER
Size: x(35)
Functional Area Owner: Provider
Valid Values:
Last Update: 10/27/2021 11:09:56 AM
Owner Last Name
NCMMIS Number: A1C0
Description: Owner Last Name
Data Type: CHARACTER
Size: X(35)
Functional Area Owner: Provider
Valid Values:
Last Update: 10/27/2021 11:12:33 AM
Owner First Name
NCMMIS Number: A1C1
Description: Owner First Name
Data Type: CHARACTER
Size: X(20)
Functional Area Owner: Provider
Valid Values:
Last Update: 10/27/2021 11:13:20 AM
Corporation Name
NCMMIS Number: A1C2
Description: Corporation Name
Data Type: CHARACTER
Size: X(35)
Functional Area Owner: Provider
Valid Values:
Last Update: 10/27/2021 11:49:12 AM
Owner EIN
NCMMIS Number: A1C3
Description: Owner EIN
Data Type: CHARACTER
Size: X(09)
Functional Area Owner: Provider
Valid Values:
Last Update: 10/27/2021 11:50:04 AM
Owner SSN
NCMMIS Number: A1C4
Description: Owner SSN
Data Type: CHARACTER
Size: X(09)
Functional Area Owner: Provider
Valid Values:
Last Update: 10/27/2021 11:52:06 AM
Owner Percent Interest
NCMMIS Number: A1C5
Description: Owner Percent Interest
Data Type: DECIMAL
Size: 9(3,2)
Functional Area Owner: Provider
Valid Values:
Last Update: 10/27/2021 11:53:48 AM
Mental Health License Number
NCMMIS Number: A1C6
Description: Mental Health License Number
Data Type: CHARACTER
Size: X(15)
Functional Area Owner: Provider
Valid Values:
Last Update: 10/27/2021 11:54:52 AM
Prohibition Start Date
NCMMIS Number: A1C7
Description: Prohibition Start Date
Data Type: DATE
Size: X(10)
Functional Area Owner: Provider
Valid Values:
Last Update: 10/27/2021 12:41:03 PM
Prohibition End Date
NCMMIS Number: A1C8
Description: Prohibition End Date
Data Type: DATE
Size: X(10)
Functional Area Owner: Provider
Valid Values:
Last Update: 10/27/2021 12:41:13 PM
Action Summary
NCMMIS Number: A1C9
Description: Action Summary
Data Type: CHARACTER
Size: X(35)
Functional Area Owner: Provider
Valid Values:
Last Update: 10/27/2021 12:03:54 PM
Action Start Date
NCMMIS Number: A1CA
Description: Action Start Date
Data Type: DATE
Size: X(10)
Functional Area Owner: Provider
Valid Values:
Last Update: 10/27/2021 12:41:24 PM
Action End Date
NCMMIS Number: A1CB
Description: Action End Date
Data Type: DATE
Size: X(10)
Functional Area Owner: Provider
Valid Values:
Last Update: 10/27/2021 12:41:37 PM
Action Issued
NCMMIS Number: A1CC
Description: Action Issued
Data Type: CHARACTER
Size: X(35)
Functional Area Owner: Provider
Valid Values:
Last Update: 10/27/2021 12:08:42 PM
Action Post Appeal
NCMMIS Number: A1CD
Description: Action Post Appeal
Data Type: CHARACTER
Size: X(35)
Functional Area Owner: Provider
Valid Values:
Last Update: 10/28/2021 10:54:09 AM
Maternity Event Rate Identifier
NCMMIS Number: A1CF
Description: Maternity Event Rate Identifier
Data Type: INTEGER
Size: 4
Functional Area Owner: Reference
Valid Values:
Last Update: 11/2/2021 3:40:43 PM
File Type Code
NCMMIS Number: A1CG
Description: Indicates the type of record (i.e. Claims, Pharmacy, Encounter) being sent
Data Type: CHARACTER
Size: X(01)
Functional Area Owner: Claims
Valid Values:
From Value | Thru Value | Short Description | Long Description |
|---|---|---|---|
C | C | MEDICAL | MEDICAL |
E | E | ENCOUNTER | ENCOUNTER |
P | P | PHARMACY | PHARMACY |
Last Update: 3/15/2022 11:52:25 AM
Created Date
NCMMIS Number: A1CH
Description: Date the file was created
Data Type: DATE
Size: X(10)
Functional Area Owner: Claims
Valid Values:
Last Update: 11/22/2021 1:13:51 PM
MC PA TOC Record Indicator
NCMMIS Number: A1CI
Description: MC PA TOC Record Indicator identifies why the PA record was included in the transition of care file.
Data Type: CHARACTER
Size: X(1)
Functional Area Owner: Reference
Valid Values:
From Value | Thru Value | Short Description | Long Description |
|---|---|---|---|
1 | 1 | ENROLL | RECIPIENT ENROLLMENT IN MANAGED CARE PROGRAM |
2 | 2 | UPDATE | UPDATE TO PREVIOUSLY SENT PA TOC RECORD |
Last Update: 11/22/2021 1:40:54 PM
Acuity Tier Population Class
NCMMIS Number: A1CJ
Description: Acuity Tier Population Class
Data Type: CHARACTER
Size: X(03)
Functional Area Owner: Recipient
Valid Values:
From Value | Thru Value | Short Description | Long Description |
|---|---|---|---|
BH | BH | BH | ACUITY TIER - BEHAVIOURAL HEALTH (BH) |
IDD | IDD | IDD | ACUITY TIER - INTELLECTUAL AND DEVELOPMENTAL DISABILITY (I/DD) |
UN | UN | UN | ACUITY TIER - UNDEFINED (UN) |
Last Update: 8/18/2022 9:02:19 AM
Acuity Tier Source
NCMMIS Number: A1CK
Description: Acuity Tier Source
Data Type: CHARACTER
Size: X(04)
Functional Area Owner: Recipient
Valid Values:
From Value | Thru Value | Short Description | Long Description |
|---|---|---|---|
NCA | NCA | NCA | NCANALYTICS |
NCT | NCT | NCT | NCTRACKS |
Last Update: 8/18/2022 9:02:20 AM
Acuity Tier Code
NCMMIS Number: A1CL
Description: Acuity Tier Code
Data Type: CHARACTER
Size: X(05)
Functional Area Owner: Recipient
Valid Values:
From Value | Thru Value | Short Description | Long Description |
|---|---|---|---|
BH01 | BH01 | BH LOW | ACUITY TIER BEHAVIORAL HEALTH LOW |
BH02 | BH02 | BH MEDIUM | ACUITY TIER BEHAVIORAL HEALTH MEDIUM |
BH03 | BH03 | BH HIGH | ACUITY TIER BEHAVIORAL HEALTH HIGH |
IDD01 | IDD01 | IDD LOW | ACUITY TIER INTELLECTUAL AND DEVELOPMENTAL DISABILITY LOW |
IDD02 | IDD02 | IDD MEDIUM | ACUITY TIER INTELLECTUAL AND DEVELOPMENTAL DISABILITY MEDIUM |
IDD03 | IDD03 | IDD HIGH | ACUITY TIER INTELLECTUAL AND DEVELOPMENTAL DISABILITY HIGH |
UN01 | UN01 | UNDEFINED | ACUITY TIER UNDEFINED |
Last Update: 8/18/2022 9:02:20 AM
Acuity Tier Assign Date
NCMMIS Number: A1CM
Description: Acuity Tier Assign Date
Data Type: DATE
Size: X(10)
Functional Area Owner: Recipient
Valid Values:
Last Update: 12/13/2021 9:30:07 AM
Acuity Tier Begin Date
NCMMIS Number: A1CN
Description: Acuity Tier Begin Date
Data Type: DATE
Size: X(10)
Functional Area Owner: Recipient
Valid Values:
Last Update: 12/13/2021 9:30:49 AM
Acuity Tier End Date
NCMMIS Number: A1CO
Description: Acuity Tier End Date
Data Type: DATE
Size: X(10)
Functional Area Owner: Recipient
Valid Values:
Last Update: 12/13/2021 9:31:24 AM
Acuity Tier Score
NCMMIS Number: A1CP
Description: Acuity Tier Score
Data Type: INTEGER
Size: 9(04)
Functional Area Owner: Recipient
Valid Values:
Last Update: 12/13/2021 9:32:19 AM
Provider Enrollment Tracking PECOS Indicator
NCMMIS Number: A1CQ
Description: Provider Association PECOS indicator specifies owner/managing employee has the negative finding
Data Type: CHARACTER
Size: X(01)
Functional Area Owner: Provider
Valid Values:
From Value | Thru Value | Short Description | Long Description |
|---|---|---|---|
N | N | NO | NO |
Y | Y | YES | YES |
Last Update: 12/17/2021 9:52:03 AM
PHP Affiliatin Indicator Type Code
NCMMIS Number: A1CR
Description: Additional indicator under the PHP contract
Data Type: CHARACTER
Size: X(01)
Functional Area Owner: Provider
Valid Values:
From Value | Thru Value | Short Description | Long Description |
|---|---|---|---|
C | C | CM | CMA CERTIFIED |
H | H | HOP | HEALTH OPPORTUNITIES AMH3 PROVIDER |
P | P | AMHPLUS | AMH PLUS CERTIFIED |
Last Update: 12/22/2021 12:40:21 PM
PHP Affiliation Indicator Begin Date
NCMMIS Number: A1CS
Description: PHP Affiliation Indicator Begin Date
Data Type: DATE
Size: X(10)
Functional Area Owner: Provider
Valid Values:
Last Update: 12/22/2021 12:52:36 PM
PHP Affiliation Indicator End Date
NCMMIS Number: A1CT
Description: PHP Affiliation Indicator End Date
Data Type: DATE
Size: X(10)
Functional Area Owner: Provider
Valid Values:
Last Update: 12/22/2021 12:52:59 PM
PHP Affiliation Indicator Status Code
NCMMIS Number: A1CU
Description: PHP Affiliation Indicator Status Code
Data Type: CHARACTER
Size: X(04)
Functional Area Owner: Provider
Valid Values:
Last Update: 12/22/2021 12:54:31 PM
Tier Level Type Code
NCMMIS Number: A1CV
Description: Provider DHS Approved Code
Data Type: CHARACTER
Size: X(01)
Functional Area Owner: Provider
Valid Values:
From Value | Thru Value | Short Description | Long Description |
|---|---|---|---|
A | A | AMHPLUS | NCTRACKS HAS RECEIVED INFORMATION FROM THE TAILORED CARE MANAGEMENT VENDOR THAT THIS LOCATION IS AMH PLUS CERTIFIED. |
B | B | AMHP-UNDER | NCTRACKS HAS RECEIVED INFORMATION FROM THE TAILORED CARE MANAGEMENT VENDOR THAT THIS LOCATION IS CURRENTLY UNDERGOING AMH PLUS CERTIFICATION. |
C | C | AMHP-FAIL | NCTRACKS HAS RECEIVED INFORMATION FROM THE TAILORED CARE MANAGEMENT VENDOR THAT THIS LOCATION HAS NOT PASSED AMH PLUS CERTIFICATION. |
D | D | CMA | NCTRACKS HAS RECEIVED INFORMATION FROM THE TAILORED CARE MANAGEMENT VENDOR THAT THIS LOCATION IS CMA CERTIFIED. |
E | E | CMA-UNDER | NCTRACKS HAS RECEIVED INFORMATION FROM THE TAILORED CARE MANAGEMENT VENDOR THAT THIS LOCATION IS CURRENTLY UNDERGOING CMA CERTIFICATION. |
F | F | CMA-FAIL | NCTRACKS HAS RECEIVED INFORMATION FROM THE TAILORED CARE MANAGEMENT VENDOR THAT HAS NOT PASSED CMA CERTIFICATION. |
1 | 1 | AMHTIER1 | THIS LOCATION IS A CERTIFIED TIER 1 ADVANCED MEDICAL HOME (AMH) PROVIDER. |
2 | 2 | AMHTIER2 | THIS LOCATION IS A CERTIFIED TIER 2 ADVANCED MEDICAL HOME (AMH) PROVIDER. |
3 | 3 | AMHTIER3 | THIS LOCATION IS A CERTIFIED TIER 3 ADVANCED MEDICAL HOME (AMH) PROVIDER. |
Last Update: 2/3/2022 9:31:42 AM
Acuity Tier Effective Date
NCMMIS Number: A1CX
Description: Acuity Tier Effective Date
Data Type: DATE
Size: X(10)
Functional Area Owner: Recipient
Valid Values:
Last Update: 1/27/2022 2:56:43 PM
Acuity Tier Ingestion Code
NCMMIS Number: A1CY
Description: Acuity Tier Ingestion Code
Data Type: CHARACTER
Size: X(22)
Functional Area Owner: Recipient
Valid Values:
From Value | Thru Value | Short Description | Long Description |
|---|---|---|---|
E001 | E001 | E001 | CNDSNOTFNDINNCT |
E002 | E002 | E002 | INVALIDPOPCLASS |
E003 | E003 | E003 | INVALIDATSCORE |
E004 | E004 | E004 | INVALIDASSIGNDT |
E005 | E005 | E005 | MRGDXXXXXXXXXX |
E006 | E006 | E006 | SAMESCR/POPNOUPD |
E007 | E007 | E007 | CNDSAGAININFILE |
INCREMENTAL | INCREMENTAL | INCREMENTL | THE RECORD IS PART OF THE WEEKLY INCREMENTAL FILE |
RECONCILE | RECONCILE | RECONCILE | THE RECORD IS PART OF THE QUARTERLY RECONCILIATION FILE |
SUCCESS | SUCCESS | SUCCESS | THE ACUITY TIER RECORD WAS PROCESSED SUCCESSFULLY |
Last Update: 8/14/2023 10:48:22 AM
Acuity Tier Description
NCMMIS Number: A1CZ
Description: Acuity Tier Description
Data Type: CHARACTER
Size: X(10)
Functional Area Owner: Recipient
Valid Values:
Last Update: 1/27/2022 2:50:04 PM
End Dated TOC PA Indicator
NCMMIS Number: A1D0
Description: The End Dated TOC PA Indicator identifies PA records sent to a PHP when recipient transitions from FFS to MC and the PA end date is modified to align with the recipient's last day of FFS eligibility.
Data Type: CHARACTER
Size: X(1)
Functional Area Owner: Prior Authorization
Valid Values:
From Value | Thru Value | Short Description | Long Description |
|---|---|---|---|
Y | Y | YES | YES |
Last Update: 11/20/2023 8:50:26 AM
Primary Source Verification Indicator
NCMMIS Number: A1D1
Description: Primary Source Verification Indicator - PSV
Data Type: CHARACTER
Size: X(01)
Functional Area Owner: Provider
Valid Values:
From Value | Thru Value | Short Description | Long Description |
|---|---|---|---|
N | N | NO | NO |
Y | Y | YES | YES |
Last Update: 3/25/2022 4:05:07 PM
Primary Source Verification Indicator for second certification
NCMMIS Number: A1D2
Description: Primary Source Verification Indicator for second certification - PSV
Data Type: CHARACTER
Size: X(01)
Functional Area Owner: Provider
Valid Values:
From Value | Thru Value | Short Description | Long Description |
|---|---|---|---|
N | N | NO | NO |
Y | Y | YES | YES |
Last Update: 3/25/2022 4:05:23 PM
Provider Transcript Confirmed
NCMMIS Number: A1D3
Description: Indicates whether or not the Provider Transcript has been primary source verified/confirmed using an automated feed.
Data Type: CHARACTER
Size: X(01)
Functional Area Owner: Provider
Valid Values:
From Value | Thru Value | Short Description | Long Description |
|---|---|---|---|
N | N | NO | NO |
Y | Y | YES | YES |
Last Update: 4/28/2022 4:11:58 PM
Acuity Tier Rate
NCMMIS Number: A1D4
Description: Rate assigned to the beneficiaries' Acuity Tier
Data Type: DECIMAL
Size: 9(2)V99
Functional Area Owner: Reference
Valid Values:
Last Update: 4/19/2022 4:22:56 PM
Acuity Tier Rate Addon
NCMMIS Number: A1D5
Description: Additional Rate added to TCM claims reimbursement.
Data Type: DECIMAL
Size: 9(2)V99
Functional Area Owner: Reference
Valid Values:
Last Update: 4/19/2022 4:22:30 PM
Acuity Tier Rate Identifier
NCMMIS Number: A1D6
Description: Acuity Tier Rate Identifier
Data Type: INTEGER
Size: 9(4)
Functional Area Owner: Reference
Valid Values:
Last Update: 4/19/2022 4:24:24 PM
Electronic Visit Verification (EVV) Pay Time
NCMMIS Number: A1D7
Description: Minutes that are going to be billed. Field captured from EVV aggregator.
Data Type: SMALLINT
Size: 2
Functional Area Owner: Reference
Valid Values:
Last Update: 5/4/2022 1:21:56 PM
Electronic Visit Verification (EVV) Bill Time
NCMMIS Number: A1D8
Description: Minutes that are going to be paid. Field captured from EVV aggregator.
Data Type: SMALLINT
Size: 2
Functional Area Owner: Reference
Valid Values:
Last Update: 5/4/2022 1:23:35 PM
Electronic Visit Verification (EVV) Actual Duration
NCMMIS Number: A1D9
Description: Adjusted, calculated duration (Adj Call Out -Adj Call In). Field captured from EVV aggregator.
Data Type: SMALLINT
Size: 2
Functional Area Owner: Reference
Valid Values:
Last Update: 5/4/2022 1:25:15 PM
Electronic Visit Verification (EVV) Adjusted Duration
NCMMIS Number: A1DA
Description: Actual, calculated duration (Call Out – Call In) in Minutes. Field captured from EVV aggregator.
Data Type: SMALLINT
Size: 2
Functional Area Owner: Reference
Valid Values:
Last Update: 5/4/2022 1:26:04 PM
340B-HRSA Provider Indicator
NCMMIS Number: A1DB
Description: This indicator identifies the billing proivder on a pharmacy claim as a 340B provider from the HRSA Provider File or not a 340B provider from the HRSA Provider File.
Data Type: CHARACTER
Size: X(01)
Functional Area Owner: Claims
Valid Values:
From Value | Thru Value | Short Description | Long Description |
|---|---|---|---|
N | N | NO | NOT A 340B-HRSA PROVIDER |
Y | Y | YES | THIS IS A 340B-HRSA PROVIDER |
Last Update: 5/17/2022 10:04:01 AM
340B Claim Code
NCMMIS Number: A1DC
Description: The 340B Claim Code is used to specify the pharmacy claim's 340B status.
Data Type: CHARACTER
Size: X(01)
Functional Area Owner: Claims
Valid Values:
From Value | Thru Value | Short Description | Long Description |
|---|---|---|---|
B | B | 340B CLM | 340B CLAIM FOR A NON-HEMOPHILIA DRUG |
H | H | 340B HEMO | 340B CLAIM FOR A HEMOPHILIA DRUG |
N | N | NOT 340B | NOT A 340B CLAIM |
Last Update: 5/17/2022 10:06:49 AM
Pilot Region
NCMMIS Number: A1DD
Description: Pilot Regions:
1. Access East - Beaufort, Bertie, Chowan, Edgecombe, Halifax, Hertford, Martin, Northampton, Pitt
2. Community Care of the Lower Cape Fear (Comm Care Lower Cape Fear) - Bladen, Brunswick., Columbus, New Hanover, Onslow, Pender
3. Impact Health - Avery, Buncombe, Burke, Cherokee, Clay, Graham, Haywood, Henderson, Jackson, Macon, Madison, McDowell, Mitchell, Polk, Rutherford, Swain, Transylvania, Yancey
Data Type: CHARACTER
Size: X(25)
Functional Area Owner: Recipient
Valid Values:
Last Update: 6/6/2022 10:57:02 AM
Attribute Type Code
NCMMIS Number: A1DE
Description: Attribute type code
Data Type:
Size:
Functional Area Owner:
Valid Values:
From Value | Thru Value | Short Description | Long Description |
|---|---|---|---|
01 | 01 | RACETHMIN | RACIAL/ETHNIC MINORITY |
02 | 02 | WOMAN | WOMAN |
03 | 03 | P-W-DISAB | PEOPLE WITH DISABILITY |
04 | 04 | LGBTQ+ | LGBTQ+ |
05 | 05 | DISADVANTG | SOCIALLY/ECONOMICALLY DISADVANTAGED |
06 | 06 | AFR-AMER | AFRICAN AMERICAN/BLACK |
07 | 07 | NAT-AMER | AMERICAN INDIAN/NATIVE AMERICAN/ALASKA NATIVE |
08 | 08 | ASIAN | ASIAN |
09 | 09 | PACIF-ISLE | PACIFIC ISLANDER |
10 | 10 | MULT-RAC | MULTIRACIAL |
11 | 11 | OTHER-RAC | OTHER RACIAL MINORITY NOT LISTED |
12 | 12 | HISPANIC | HISPANIC |
13 | 13 | OTHER-ETH | OTHER ETHNIC MINORITY NOT LISTED |
14 | 14 | VETERAN | VETERAN |
Last Update: 11/2/2022 1:47:45 PM
Plan - Eligibility Response Codes
NCMMIS Number: A1DF
Description: Create DE using data extracted from DB2 tables for use in Portals. Need to be updated everytime there is a new benefit plan.
Data Type: UNSPECIFIED
Size: X(01)
Functional Area Owner: Reference
Valid Values:
From Value | Thru Value | Short Description | Long Description |
|---|---|---|---|
DMHDD-ADAO | DMHDD-ADAO | ADAO | ADULT DEVELOPMENTAL DISABILITY ASSESSMENT ONLY |
DMHDD-ADCEP | DMHDD-ADCEP | ADCEP | ADULT DEVELOPMENTAL DISABILITY COMMUNITY ENHANCEMENT PROGRAM |
DMHDD-ADCS | DMHDD-ADCS | ADCS | ADULT DEVELOPMENTAL DISABILITY CRISIS SERVICES |
DMHDD-ADMRI | DMHDD-ADMRI | ADMRI | ADULT DEVELOPMENTAL DISABILITY MR/MI |
DMHDD-ADSN | DMHDD-ADSN | ADSN | ADULT WITH DEVELOPMENTAL DISABILITY |
DMHDD-ADTNC | DMHDD-ADTNC | ADTNC | ADULT DEVELOPMENTAL DISABILITY COUNTY FUNDS |
DMHDD-CDAO | DMHDD-CDAO | CDAO | CHILD DEVELOPMENTAL DISABILITY ASSESSMENT ONLY |
DMHDD-CDCEP | DMHDD-CDCEP | CDCEP | CHILD DEVELOPMENTAL DISABILITY COMMUNITY ENHANCEMENT PROGRAM |
DMHDD-CDCS | DMHDD-CDCS | CDCS | CHILD DEVELOPMENTAL DISABILITY CRISIS SERVICES |
DMHDD-CDECI | DMHDD-CDECI | CDECI | CHILD DEVELOPMENTAL DISABILITY ECI |
DMHDD-CDSN | DMHDD-CDSN | CDSN | CHILD DEVELOPMENTAL DISABILITY |
DMHDD-CDTNC | DMHDD-CDTNC | CDTNC | CHILD DEVELOPMENTAL DISABILITY COUNTY FUNDS |
DMHDD-DMHAD | DMHDD-DMHAD | DMHAD | DIVISION OF MENTAL HELTH ADMINISTRATIVE BENEFIT PLAN |
DMHMH-ADIDD | DMHMH-ADIDD | ADIDD | ADULT DISABILITY INTELLECTUAL DEVELOPMENTAL DISABILITY |
DMHMH-AMAO | DMHMH-AMAO | AMAO | ADULT MENTAL HEALTH ASSESSMENT ONLY |
DMHMH-AMCEP | DMHMH-AMCEP | AMCEP | ADULT MENTAL HEALTH COMMUNITY ENHANCEMENT PROGRAM |
DMHMH-AMCS | DMHMH-AMCS | AMCS | ADULT MENTAL HEALTH CRISIS SERVICES |
DMHMH-AMDEF | DMHMH-AMDEF | AMDEF | ADULT MENTAL HEALTH DEAF OR HARD OF HEARING |
DMHMH-AMI | DMHMH-AMI | AMI | ADULT WITH MENTAL ILLNESS |
DMHMH-AMPAT | DMHMH-AMPAT | AMPAT | ADULT MENTAL HEALTH HOMELESS (PATH) |
DMHMH-AMSMI | DMHMH-AMSMI | AMSMI | ADULT MENTAL HEALTH ADULT WITH SERIOUS MENTAL ILLNESS |
DMHMH-AMSPM | DMHMH-AMSPM | AMSPM | ADULT MENTAL HEALTH ADULT WITH SEVERE AND PERSISTENT MENTAL ILLNESS |
DMHMH-AMSRE | DMHMH-AMSRE | AMSRE | ADULT MENTAL HEALTH STABLE RECOVERY POPULATION |
DMHMH-AMTCL | DMHMH-AMTCL | AMTCL | TRANSITION TO COMMUNITY LIVING |
DMHMH-AMTNC | DMHMH-AMTNC | AMTNC | ADULT MENTAL HEALTH COUNTY FUNDS |
DMHMH-AMVET | DMHMH-AMVET | AMVET | ADULT MENTAL HEALTH VETERAN AND FAMILY |
DMHMH-CDF | DMHMH-CDF | CDF | CROSS DISABILITY FUNDED |
DMHMH-CMAO | DMHMH-CMAO | CMAO | CHILD MENTAL HEALTH ASSESSMENT ONLY |
DMHMH-CMCEP | DMHMH-CMCEP | CMCEP | CHILD MENTAL HEALTH COMMUNITY ENHANCE PROGRAM |
DMHMH-CMCS | DMHMH-CMCS | CMCS | CHILD MENTAL HEALTH CRISIS SERVICES |
DMHMH-CMDEF | DMHMH-CMDEF | CMDEF | CHILD MENTAL HEALTH DEAF OR HARD OF HEARING |
DMHMH-CMECD | DMHMH-CMECD | CMECD | CHILD MENTAL HEALTH EARLY CHILDHOOD DISORDER |
DMHMH-CMMED | DMHMH-CMMED | CMMED | CHILD MENTAL HEALTH SERIOUSLY EMOTIONALLY DISTURBED |
DMHMH-CMPAT | DMHMH-CMPAT | CMPAT | CHILD MENTAL HEALTHHOMELESS (PATH) |
DMHMH-CMSED | DMHMH-CMSED | CMSED | CHILD MENTAL HEALTH SERIOUSLY EMOTIONALLY DISTURBED WITH OUT-OF-HOME PLACEMENT |
DMHMH-CMTNC | DMHMH-CMTNC | CMTNC | CHILD MENTAL HEALTH COUNTY FUNDS |
DMHMH-CMVET | DMHMH-CMVET | CMVET | CHILD MENTAL HEALTH VETERAN AND FAMILY |
DMHMH-DMHAD | DMHMH-DMHAD | DMHAD | DIVISION OF MENTAL HEALTH ADMINISTRATIVE BENEFIT PLAN |
DMHMH-GAP | DMHMH-GAP | GAP | GENERIC ASSESSMENT PAYMENT |
DMHSA-ASAO | DMHSA-ASAO | ASAO | ADULTSUBSTANCE ABUSE ASSESSMENT ONLY |
DMHSA-ASCDR | DMHSA-ASCDR | ASCDR | ADULT SUBSTANCE ABUSE INJECTING DRUG USER |
DMHSA-ASCEP | DMHSA-ASCEP | ASCEP | ADULT SUBSTANCE ABUSE COMMUNITY ENHANCEMENT PROGRAM |
DMHSA-ASCJO | DMHSA-ASCJO | ASCJO | ADULT SUBSTANCE ABUSE CRIMINAL JUSTICE OFFENDER |
DMHSA-ASCOV | DMHSA-ASCOV | ASCOV | ADULT SA COVID OPIOID USE DISORDER |
DMHSA-ASCS | DMHSA-ASCS | ASCS | ADULT SUBSTANCE ABUSE CRISIS SERVICES |
DMHSA-ASCSP | DMHSA-ASCSP | ASCSP | ADULT SUBSTANCE USE COMMUNITY SUPERVISION POPULATION |
DMHSA-ASDHH | DMHSA-ASDHH | ASDHH | ADULT SUBSTANCE ABUSE DEAF AND HARD OF HEARING |
DMHSA-ASDSS | DMHSA-ASDSS | ASDSS | ADULT SUBSTANCE ABUSE DEPARTMENT OF SOCIAL SERVICE INVOLVED |
DMHSA-ASDWI | DMHSA-ASDWI | ASDWI | ADULT SUBSTANCE ABUSE DRIVING WHILE INTOXICATED TREATMENT |
DMHSA-ASHMT | DMHSA-ASHMT | ASHMT | ADULT SUBSTANCE ABUSE HIGH MANAGEMENT |
DMHSA-ASHOM | DMHSA-ASHOM | ASHOM | ADULT SUBSTANCE ABUSE HOMELESS |
DMHSA-ASOUD | DMHSA-ASOUD | ASOUD | ADULT SUBSTANCE ABUSE OPIOID USE DISORDER |
DMHSA-ASTER | DMHSA-ASTER | ASTER | ADULT SUBSTANCE ABUSE TREATMENT ENGAGEMENT AND RECOVERY |
DMHSA-ASTIM | DMHSA-ASTIM | ASTIM | ADULT SA STIMULANT USE DISORDER |
DMHSA-ASTNC | DMHSA-ASTNC | ASTNC | ADULT SUBSTANCE ABUSE COUNTY FUNDS |
DMHSA-ASWOM | DMHSA-ASWOM | ASWOM | ADULT SUBSTANCE ABUSE WOMEN |
DMHSA-CSAO | DMHSA-CSAO | CSAO | CHILD SUBSTANCE ABUSE ASSESSMENT ONLY |
DMHSA-CSCEP | DMHSA-CSCEP | CSCEP | CHILD SUBSTANCE ABUSE ENHANCEMENT PROGRAM |
DMHSA-CSCJO | DMHSA-CSCJO | CSCJO | CHILD SUBSTANCE ABUSE CRIMINAL JUSTICE OFFENDER |
DMHSA-CSCS | DMHSA-CSCS | CSCS | CHILD SUBSTANCE ABUSE CRISIS SERVICES |
DMHSA-CSDWI | DMHSA-CSDWI | CSDWI | CHILD SUBSTANCE ABUSE DRIVING WHILE IMPAIRED TREATMENT |
DMHSA-CSIP | DMHSA-CSIP | CSIP | CHILD SUBSTANCE ABUSE INDICATED PREVENTION |
DMHSA-CSMAJ | DMHSA-CSMAJ | CSMAJ | CHILD SUBSTANCE ABUSE CHILD IN THE MAJORS PROGRAM |
DMHSA-CSSAD | DMHSA-CSSAD | CSSAD | CHILD SUBSTANCE ABUSE CHILD WITH SUBSTANCE ABUSE DISORDER |
DMHSA-CSSP | DMHSA-CSSP | CSSP | CHILD SUBSTANCE ABUSE SELECTIVE PREVENTION |
DMHSA-CSTNC | DMHSA-CSTNC | CSTNC | CHILD SUBSTANCE ABUSE COUNTY FUNDS |
DMHSA-CSWOM | DMHSA-CSWOM | CSWOM | ADULT SUBSTANCE ABUSE WOMEN |
DMHSA-DMHAD | DMHSA-DMHAD | DMHAB | DIVISION OF MENTAL HEALTH ADMINISTRATIVE BENEFIT PLAN |
DPH-ADAP | DPH-ADAP | ADAP | AIDS DRUG ASSISTANCE PROGRAM |
DPH-AT | DPH-AT | AT | ASSISTIVE TECHNOLOGY |
DPH-CANCE | DPH-CANCE | CANCE | NO LONGER ACTIVE |
DPH-CF | DPH-CF | CF | NO LONGER ACTIVE |
DPH-CSHS | DPH-CSHS | CSHS | NO LONGER ACTIVE |
DPH-DPHAD | DPH-DPHAD | DPHAD | DIVISION OF PUBLIC HEALTH CLOSED PROGRAMS |
DPH-EHDI | DPH-EHDI | EHDI | EARLY HEARING DETECTION AND INTERVENTION PROGRAM |
DPH-ITP | DPH-ITP | ITP | INFANT TODDLER |
DPH-KIDNY | DPH-KIDNY | KIDNY | NO LONGER ACTIVE |
DPH-SC | DPH-SC | SC | SICKLE CELL |
DPH-VACIN | DPH-VACIN | VACIN | VACCINE INJURY |
NCXIX-CAPAI | NCXIX-CAPAI | CAPAI | CAP-AIDS |
NCXIX-CAPCD | NCXIX-CAPCD | CAPCD | CAP CONSUMER DIRECTION SERVICES |
NCXIX-CAPCH | NCXIX-CAPCH | CAPCH | CAP-CHILDREN |
NCXIX-CAPDA | NCXIX-CAPDA | CAPDA | CAP-DISABLED ADULTS |
NCXIX-CAPMR | NCXIX-CAPMR | CAPMR | CAP-MENTALLY RETARDED-DEVELOPMENTALLY DISABLED |
NCXIX-DHBAD | NCXIX-DHBAD | DHBAD | DHB ADMINISTRATIVE BENEFIT PLAN |
NCXIX-HMOM | NCXIX-HMOM | HMOM | HEALTH MAINTENANCE ORGANIZATION |
NCXIX-MAFDN | NCXIX-MAFDN | MAFDN | MEDICAID FAMILY PLANNING |
NCXIX-MCAID | NCXIX-MCAID | MCAID | MEDICAID |
NCXIX-MCCRV | NCXIX-MCCRV | MCCRV | MC-MEDICAID CARVE-OUT PLAN |
NCXIX-MCSTD | NCXIX-MCSTD | MCSTD | MC-MEDICAID STANDARD PLAN |
NCXIX-MFP | NCXIX-MFP | MFP | MONEY FOLLOWS THE PERSON |
NCXIX-MQBB | NCXIX-MQBB | MQBB | QUALIFIED MEDICARE BENEFICIARY-PART B PREMIUM ONLY |
NCXIX-MQBE | NCXIX-MQBE | MQBE | QUALIFIED MEDICARE BENEFICIARY-PART B PREMIUM ONLY |
NCXIX-MQBQ | NCXIX-MQBQ | MQBQ | QUALIFIED MEDICARE BENEFICIARY |
NCXIX-PACE | NCXIX-PACE | PACE | PLAN OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) |
NCXIX-PHPB | NCXIX-PHPB | PHPB | MANAGED CARE FOR BEHAVIORAL HEALTH SERVICES |
NCXIX-PHPC | NCXIX-PHPC | PHPC | INNOVATIONS WAIVER - CAP SERVICES |
NCXIX-TBI | NCXIX-TBI | TBI | TRAUMATIC BRAIN INJURY WAIVER |
NCXIX-TPINV | NCXIX-TPINV | TPINV | TPINV - TAILORED PLAN INNOVATIONS WAIVER MANAGED CARE |
NCXIX-TPMC | NCXIX-TPMC | TPMC | TPMC - TAILORED PLAN MEDICAID MANAGED CARE |
NCXIX-TPTBI | NCXIX-TPTBI | TPTBI | TPTBI - TAILORED PLAN TRAUMATIC BRAIN INJURY MANAGED CARE |
NCXXI-DHBAD | NCXXI-DHBAD | DHBAB | DHB ADMINISTRATIVE BENEFIT PLAN |
NCXXI-HCCRV | NCXXI-HCCRV | HCCRV | MC-NCHC CARVE-OUT PLAN |
NCXXI-HCSTD | NCXXI-HCSTD | HCSTD | MC-NCHC STANDARD PLAN |
NCXXI-NCHC | NCXXI-NCHC | NCHC | NORTH CAROLINA HEALTH CHOICE |
NCXXI-PHHC | NCXXI-PHHC | PHHC | BEHAVIORAL HEALTH SERVICES FOR NORTH CAROLINA HEALTH CHOICE |
NCXXI-TPHC | NCXXI-TPHC | TPHC | TPHC-TAILORED PLAN HEALTH CHOICE MANAGED CARE |
ORHCC-CCNC | ORHCC-CCNC | CCNC | COMMUNITY CARE OF NORTH CAROLINA - UNINSURED PARENTS |
ORHCC-HLTNT | ORHCC-HLTNT | HLTNT | HEALTHNET |
ORHCC-MIGRH | ORHCC-MIGRH | MIGRH | MIGRANT HEALTH |
ORHCC-ORHAD | ORHCC-ORHAD | ORHAD | OFFICE OF RURAL HEALTH AND COMMUNITY CARE ADMINISTRATIVE BENEFIT PLAN |
Last Update: 7/11/2022 4:25:33 PM
Claim Health Home Quarter Utilization Count
NCMMIS Number: A1DG
Description: Claim Health Home Quarter Utilization Count
Data Type: INTEGER
Size: 9(9)
Functional Area Owner: Financial
Valid Values:
Last Update: 7/14/2022 2:42:39 PM
Claim Health Home Quarter ID
NCMMIS Number: A1DH
Description: Claim Health Home Quarter ID
Data Type: CHARACTER
Size: X(6)
Functional Area Owner: Financial
Valid Values:
Last Update: 7/14/2022 2:42:01 PM
Claim Health Home Claim Count
NCMMIS Number: A1DI
Description: Claim Health Home Claim Count
Data Type: INTEGER
Size: 9(9)
Functional Area Owner: Financial
Valid Values:
Last Update: 7/14/2022 2:41:10 PM
Estate Recovery Managed Care Amount
NCMMIS Number: A1DJ
Description: Amount of estate recoverable services submitted on managed care encounters. Amount provided by NC Analytics.
Data Type: DECIMAL
Size: 9(09)V99
Functional Area Owner: Third Party Liability
Valid Values:
Last Update: 7/27/2022 11:20:25 AM
Estate Recovery Managed Care Processed Date
NCMMIS Number: A1DK
Description: Date NC Analytics determined the amount of estate recoverable services submitted on managed care encounters.
Data Type: DATE
Size: X(10)
Functional Area Owner: Third Party Liability
Valid Values:
Last Update: 7/27/2022 11:17:43 AM
Group Price Other Amount
NCMMIS Number: A1DM
Description: This fields stores the amount to be added to a pharmacy claim reimbursement amount. The Group Price Admin Fee Code is used to describe the purpose of the amount stored in this field.
Data Type: DECIMAL
Size: S9(05)V99
Functional Area Owner: Reference
Valid Values:
Last Update: 9/7/2022 4:46:29 PM
Taxonomy Risk Indicator
NCMMIS Number: A1DN
Description: Risk Level Indicator used to identify the risk level of each taxonomy on the Provider Permission Matrix (PPM)
Data Type: CHARACTER
Size: X(2)
Functional Area Owner: Provider
Valid Values:
From Value | Thru Value | Short Description | Long Description |
|---|---|---|---|
R1 | R1 | LIMITED | LIMITED RISK |
R2 | R2 | MOD | MODERATE RISK |
R3 | R3 | HIGH | HIGH RISK |
Last Update: 9/26/2022 1:40:07 PM
Claim Count for HH
NCMMIS Number: A1DO
Description: Claim Health Home Claim Count for C_HLTH_HOME_DTL_TB
Data Type: INTEGER
Size: 9
Functional Area Owner: Financial
Valid Values:
Last Update: 9/28/2022 9:09:30 AM
Provider Current Tailored Care Management Enrollee Number
NCMMIS Number: A1E1
Description: Current count of Tailored Plan Enrollees assigned to the provider/location.
Data Type: INTEGER
Size: 9(9)
Functional Area Owner: Provider
Valid Values:
Last Update: 3/30/2023 9:22:45 AM
Provider Tailored Care Management Enrollee Number
NCMMIS Number: A1E2
Description: The monthly total of Tailored Plan Enrollees assigned to the provider/location.
Data Type: INTEGER
Size: 9(9)
Functional Area Owner: Provider
Valid Values:
Last Update: 3/30/2023 9:40:27 AM
PA Appeal 25th Day To Mediate
NCMMIS Number: A1E3
Description: PA Appeal 25th Day To Mediate is the date assigned by OAH by which the mediation should occur.
Data Type: DATE
Size: X(10)
Functional Area Owner: Prior Authorization
Valid Values:
Last Update: 12/1/2022 2:50:21 PM
PA Appeal Assigned Attorney General
NCMMIS Number: A1E4
Description: PA Appeal Assigned Attorney General is the name of the NC DOJ staff assigned to the OAH case.
Data Type: CHARACTER
Size: X(50)
Functional Area Owner: Prior Authorization
Valid Values:
Last Update: 12/1/2022 2:50:05 PM
PA Appeal Attorney To Attend
NCMMIS Number: A1E5
Description: PA Appeal Attorney To Attend identifies if an attorney will be attending/representing the beneficiary in the hearing.
Data Type: CHARACTER
Size: X(01)
Functional Area Owner: Prior Authorization
Valid Values:
From Value | Thru Value | Short Description | Long Description |
|---|---|---|---|
N | N | NO | RECIPIENT DOES NOT HAVE LEGAL REPRESENTATION |
Y | Y | YES | RECIPIENT HAS LEGAL REPRESENTATION |
Last Update: 11/20/2023 8:50:26 AM
PA Appeal Case Number
NCMMIS Number: A1E6
Description: PA Appeal Case Number is the identification number assigned by the State.
Data Type: CHARACTER
Size: X(20)
Functional Area Owner: Prior Authorization
Valid Values:
Last Update: 12/1/2022 3:13:20 PM
PA Appeal Contact Method
NCMMIS Number: A1E7
Description: PA Appeal Contact Method is how NCTracks staff will participate in the hearing.
Data Type: CHARACTER
Size: X(01)
Functional Area Owner: Prior Authorization
Valid Values:
From Value | Thru Value | Short Description | Long Description |
|---|---|---|---|
1 | 1 | MED CALL | MEDIATOR WILL CALL NCTRACKS TEAM |
2 | 2 | CONF LINE | NCTRACKS WILL CALL TO JOIN THE HEARING |
Last Update: 11/20/2023 8:50:27 AM
PA Appeal Conference Number
NCMMIS Number: A1E8
Description: PA Appeal Conference Number is the phone number for the hearing.
Data Type: CHARACTER
Size: X(50)
Functional Area Owner: Prior Authorization
Valid Values:
Last Update: 12/1/2022 3:22:34 PM
PA Appeal Contact Verified
NCMMIS Number: A1E9
Description: PA Appeal Contact Verified tracks that the hearing contact information has been confirmed.
Data Type: CHARACTER
Size: X(01)
Functional Area Owner: Prior Authorization
Valid Values:
From Value | Thru Value | Short Description | Long Description |
|---|---|---|---|
N | N | NO | APPEAL CONTACT INFORMATION NOT VERIFIED |
Y | Y | YES | APPEAL CONTACT INFORMATION VERIFIED |
Last Update: 11/20/2023 8:50:28 AM
PA Appeal Mediator Name
NCMMIS Number: A1EA
Description: PA Appeal Mediator Name is the mediator assigned to the case.
Data Type: CHARACTER
Size: X(50)
Functional Area Owner: Prior Authorization
Valid Values:
Last Update: 12/1/2022 3:25:37 PM
PA Appeal MOS Eligible
NCMMIS Number: A1EB
Description: PA Appeal MOS Eligible tracks if the PA is eligible for maintenance of services during the hearing period.
Data Type: CHARACTER
Size: X(01)
Functional Area Owner: Prior Authorization
Valid Values:
From Value | Thru Value | Short Description | Long Description |
|---|---|---|---|
N | N | NO | PA IS NOT ELIGIBLE FOR MOS |
Y | Y | YES | PA IS ELIGIBLE FOR MOS |
Last Update: 11/20/2023 8:50:28 AM
PA Appeal OAH Received Date
NCMMIS Number: A1EC
Description: PA Appeal OAH Received Date is the date the State received the appeal request.
Data Type: DATE
Size: X(10)
Functional Area Owner: Prior Authorization
Valid Values:
Last Update: 12/1/2022 3:28:47 PM
PA Appeal Outcome
NCMMIS Number: A1ED
Description: PA Appeal Outcome is the final hearing outcome.
Data Type: CHARACTER
Size: X(01)
Functional Area Owner: Prior Authorization
Valid Values:
From Value | Thru Value | Short Description | Long Description |
|---|---|---|---|
1 | 1 | OVERTURNED | DECISION OVERTURNED |
2 | 2 | UPHELD | DECISION UPHELD |
3 | 3 | IN PROG | APPEAL IN PROGRESS |
Last Update: 11/20/2023 8:50:29 AM
PA Appeal Physician To Attend
NCMMIS Number: A1EE
Description: PA Appeal Physician To Attend identifies if the beneficiary’s physician will be participating in the hearing.
Data Type: CHARACTER
Size: X(01)
Functional Area Owner: Prior Authorization
Valid Values:
From Value | Thru Value | Short Description | Long Description |
|---|---|---|---|
N | N | NO | PHYSICIAN IS NOT PARTICIPATING IN THE HEARING |
Y | Y | YES | PHYSICIAN IS PARTICIPATING IN THE HEARING |
Last Update: 11/20/2023 8:50:30 AM
PA Appeal Received Date
NCMMIS Number: A1EF
Description: PA Appeal Received Date is the date NCTracks received the appeal information.
Data Type: DATE
Size: X(10)
Functional Area Owner: Prior Authorization
Valid Values:
Last Update: 12/1/2022 4:35:11 PM
PA Appeal Uploaded
NCMMIS Number: A1EG
Description: PA Appeal Uploaded tracks that the appeal request form has been uploaded to the corresponding PA record.
Data Type: CHARACTER
Size: X(01)
Functional Area Owner: Prior Authorization
Valid Values:
From Value | Thru Value | Short Description | Long Description |
|---|---|---|---|
N | N | NO | APPEAL REQUEST FORM NOT UPLOADED TO PA RECORD |
Y | Y | YES | APPEAL REQUEST FORM UPLOADED TO PA RECORD |
Last Update: 11/20/2023 8:50:30 AM
PA Appeal With Similar Service
NCMMIS Number: A1EH
Description: PA Appeal With Similar Service track if staff have identified a PA record with the same or similar service as the appealed service.
Data Type: CHARACTER
Size: X(01)
Functional Area Owner: Prior Authorization
Valid Values:
From Value | Thru Value | Short Description | Long Description |
|---|---|---|---|
N | N | NO | NO SAME OR SIMILAR SERVICE IDENTIFIED |
Y | Y | YES | SAME OR SIMILAR SERVICE IDENTIFIED |
Last Update: 11/20/2023 8:50:31 AM
PA Appeal Mediation Date
NCMMIS Number: A1EI
Description: PA Appeal Mediation Date is the date of the scheduled mediation hearing.
Data Type: DATE
Size: X(10)
Functional Area Owner:
Valid Values:
Last Update: 12/1/2022 4:39:26 PM
PA Hearing Time - Hour
NCMMIS Number: A1EJ
Description: PA Hearing Time - Hour captures the hour of the scheduled hearing start time.
Data Type: CHARACTER
Size: X(02)
Functional Area Owner: Prior Authorization
Valid Values:
From Value | Thru Value | Short Description | Long Description |
|---|---|---|---|
1 | 1 | 1 | 1 O'CLOCK HOUR |
2 | 2 | 2 | 2 O'CLOCK HOUR |
3 | 3 | 3 | 3 O'CLOCK HOUR |
4 | 4 | 4 | 4 O'CLOCK HOUR |
5 | 5 | 5 | 5 O'CLOCK HOUR |
6 | 6 | 6 | 6 O'CLOCK HOUR |
7 | 7 | 7 | 7 O'CLOCK HOUR |
8 | 8 | 8 | 8 O'CLOCK HOUR |
9 | 9 | 9 | 9 O'CLOCK HOUR |
10 | 10 | 10 | 10 O'CLOCK HOUR |
11 | 11 | 11 | 11 O'CLOCK HOUR |
12 | 12 | 12 | 12 O'CLOCK HOUR |
Last Update: 11/20/2023 8:50:32 AM
PA Appeal OAH Date
NCMMIS Number: A1EK
Description: PA Appeal OAH Date is the date of the scheduled OAH hearing.
Data Type: DATE
Size: X(10)
Functional Area Owner: Prior Authorization
Valid Values:
Last Update: 12/1/2022 4:56:49 PM
PA Hearing Time - Minute
NCMMIS Number: A1EL
Description: PA Hearing Time - Minute captures the minute of the scheduled hearing start time.
Data Type: CHARACTER
Size: X(02)
Functional Area Owner: Prior Authorization
Valid Values:
From Value | Thru Value | Short Description | Long Description |
|---|---|---|---|
00 | 00 | 00 | HEARING STARTS ON THE HOUR |
15 | 15 | 15 | HEARING STARTS AT 15 AFTER THE HOUR |
30 | 30 | 30 | HEARING STARTS ON THE HALF HOUR |
45 | 45 | 45 | HEARING STARTS AT 15 PRIOR TO THE HOUR |
Last Update: 11/20/2023 8:50:33 AM
Retroactive Void Status
NCMMIS Number: A1EM
Description: The Retroactive Void Status is used to trace the flow of a transaction from identification as a claim for a beneficiary who has retroactive eligibility in managed care through the process that voids the claim.
Data Type: CHARACTER
Size: X(01)
Functional Area Owner: Claims
Valid Values:
From Value | Thru Value | Short Description | Long Description |
|---|---|---|---|
1 | 1 | INITIAL | INITIAL |
2 | 2 | LETRGEN | LETTER GENERATED |
3 | 3 | LETRMAIL | LETTER MAILED |
4 | 4 | NOVOIDELG | DO NOT VOID PER ELIGIBLITY UPDATE |
5 | 5 | CLMVOIDP | CLAIM PREVIOUSLY VOIDED |
6 | 6 | CLMVOIDR | CLAIM VOIDED VIA RETROACTIVE ELIGIBILITY PROCESS |
7 | 7 | NOVOIDST | HOLD CLAIM VOID PER STATE REQUEST |
8 | 8 | RELEASE | RELEASE STATE HOLD |
9 | 9 | CONTINUE | CONTINUATION OF PREVIOUS CLAIMS |
Last Update: 2/14/2023 9:51:11 AM
Claim Extract Date
NCMMIS Number: A1EN
Description: The date the claim was identified as impacted by the beneficiary's retroactive enrollment and consequently added to the Pharmacy Retroactive Reprocess TCN table.
Data Type: DATE
Size: X(10)
Functional Area Owner: Claims
Valid Values:
Last Update: 1/10/2023 2:52:04 PM
Sent to BSOC Date
NCMMIS Number: A1EO
Description: This field stores the date a letter was sent to BSOC.
Data Type: DATE
Size: X(10)
Functional Area Owner: Claims
Valid Values:
Last Update: 1/18/2023 10:30:05 AM
Letter Mail Date
NCMMIS Number: A1EP
Description: This field represents the date a letter was given to the USPS for delivery.
Data Type: DATE
Size: X(10)
Functional Area Owner: Claims
Valid Values:
Last Update: 1/18/2023 10:32:08 AM
Cohort Breakout Type Code
NCMMIS Number: A1EQ
Description: Indicates the type of the cohort rate breakout.
Data Type: CHARACTER
Size: X(02)
Functional Area Owner: Recipient
Valid Values:
From Value | Thru Value | Short Description | Long Description |
|---|---|---|---|
CT | CT | COVIDTEST | COVID TESTING |
FP | FP | FAMPLAN | FAMILY PLANNING |
VB | VB | VABRKOUT | VACCINE ADMINISTRATION BREAKOUT |
Last Update: 3/8/2023 7:48:01 AM
Cohort Rate Breakout Percentage
NCMMIS Number: A1ER
Description: Indicates the percentage of the cohort rate breakout
Data Type: DECIMAL
Size: 9(5,4)
Functional Area Owner: Recipient
Valid Values:
Last Update: 3/7/2023 2:55:56 PM
Managed Care Cohort Breakout Indicator
NCMMIS Number: A1ES
Description: This indicator will tell if there is a breakout percentage associated with the cohort rate.
Data Type: CHARACTER
Size: X(01)
Functional Area Owner: Recipient
Valid Values:
Last Update: 3/7/2023 4:36:02 PM
Processed Flag
NCMMIS Number: A1ET
Description: File processed Flag
Data Type: CHARACTER
Size: X(01)
Functional Area Owner: E-Commerce
Valid Values:
Last Update: 5/5/2023 1:42:21 PM
Managed Care Cohort COE Status Indicator
NCMMIS Number: A1EW
Description: The Managed Care Cohort COE Status Indicator is used to specify whether the status for a Cohort/COE combination is active or inactive.
Data Type: CHARACTER
Size: X(01)
Functional Area Owner: Reference
Valid Values:
From Value | Thru Value | Short Description | Long Description |
|---|---|---|---|
A | A | ACTIVE | MANAGED CARE COHORT COE STATUS IS ACTIVE |
I | I | INACTIVE | MANAGED CARE COHORT COE STATUS IS INACTIVE |
Last Update: 9/22/2023 4:23:28 PM
Interface File Name
NCMMIS Number: A1EX
Description: The Interface File Name refers to the name of the file to be transmitted to attestation partners. The Attestation relates to this file.
Data Type: CHARACTER
Size: X(30)
Functional Area Owner: Reference
Valid Values:
Last Update: 10/30/2023 11:02:12 AM
Interface Mainframe File Name
NCMMIS Number: A1EY
Description: The catalogued mainframe file name of the inbound interface file. The Attestation relates to this file.
Data Type: CHARACTER
Size: X(44)
Functional Area Owner: Reference
Valid Values:
Last Update: 10/30/2023 11:38:45 AM
Interface File Received Timestamp
NCMMIS Number: A1EZ
Description: Timestamp of the receipt of the inbound interface file.
Data Type: TIMESTAMP
Size: X(26)
Functional Area Owner: Reference
Valid Values:
Last Update: 10/30/2023 9:48:23 AM
Interface File Quarter Begin Date
NCMMIS Number: A1F0
Description: Effective date of the rate, or other time sensitive data, on the inbound interface file.
Data Type: DATE
Size: X(10)
Functional Area Owner: Reference
Valid Values:
Last Update: 10/30/2023 9:50:47 AM
Interface File Quarter End Date
NCMMIS Number: A1F1
Description: End date of the rate, or other time sensitive data, on the inbound interface file.
Data Type: DATE
Size: X(10)
Functional Area Owner: Reference
Valid Values:
Last Update: 10/30/2023 9:52:13 AM
Interface File Sequence Number
NCMMIS Number: A1F2
Description: The Interface file sequence number is incremented each time a file is sent to an attestation partner. The sequence number is used to uniquely identify each file that is sent to the attestation partner. An attestation partner will receive four quarterly files during an attestation year.
Data Type: INTEGER
Size: 9(08)
Functional Area Owner: Reference
Valid Values:
Last Update: 10/30/2023 11:43:08 AM
Interface MoveIT Destination Timestamp
NCMMIS Number: A1F3
Description: The timestamp of the receipt in the outbound file to the first moveIT folder
Data Type: TIMESTAMP
Size: X(26)
Functional Area Owner: Reference
Valid Values:
Last Update: 10/30/2023 10:37:26 AM
Interface MoveIT Outbound Timestamp
NCMMIS Number: A1F4
Description: The Interface MoveIT Outbound Timestamp stores the timestamp of the outbound file when it is received in the moveIT outbound folder. This folder is used by the vendors to receive the file. The timestamp is appended to the outbound file name by moveIT.
Data Type: TIMESTAMP
Size: X(26)
Functional Area Owner: Reference
Valid Values:
Last Update: 10/30/2023 10:56:25 AM
Interface Attestation Received Date
NCMMIS Number: A1F5
Description: Date the attestation was received by NCMMIS.
Data Type: DATE
Size: X(10)
Functional Area Owner: Reference
Valid Values:
Last Update: 10/2/2023 2:52:14 PM
Interface Attestation Quarter ID
NCMMIS Number: A1F6
Description: The Interface Attestation Quarter ID identifies which quarter is the first, of four quarters, to send to the attestation partner.
Data Type: CHARACTER
Size: X(01)
Functional Area Owner: Reference
Valid Values:
From Value | Thru Value | Short Description | Long Description |
|---|---|---|---|
1 | 1 | QUARTER1 | JANUARY 1 THROUGH MARCH 31 |
2 | 2 | QUARTER 2 | APRIL 1 THROUGH JUNE 30 |
3 | 3 | QUARTER 3 | JULY 1 THROUGH SEPTEMBER 30 |
4 | 4 | QUARTER 4 | OCTOBER 1 THROUGH DECEMBER 31 |
Last Update: 10/30/2023 11:47:58 AM
Interface Attestation User Id
NCMMIS Number: A1F7
Description: The Interface Attestation User ID refers to the user who requested an outbound file be sent to a plan based on the receipt of an attestation.
Data Type: CHARACTER
Size: X(32)
Functional Area Owner: Reference
Valid Values:
Last Update: 10/30/2023 10:23:29 AM
Interface Attestation Status Code
NCMMIS Number: A1F8
Description: The Interface Attestation Status Code is set to 'active' when the attestation is logged in NCTracks. The status can only be updated from 'active' to 'void'.
Data Type: CHARACTER
Size: X(01)
Functional Area Owner: Reference
Valid Values:
From Value | Thru Value | Short Description | Long Description |
|---|---|---|---|
A | A | ACTIVE | ACTIVE ATTESTATION |
V | V | VOID | VOIDED ATTESTATION |
Last Update: 10/30/2023 10:24:33 AM
Interface Attestation Begin Date
NCMMIS Number: A1F9
Description: The Interface Attestation Begin Date refers to the first day of the attestation. Attestations are valid for one year.
Data Type: DATE
Size: X(10)
Functional Area Owner: Reference
Valid Values:
Last Update: 10/30/2023 10:25:40 AM
Interface Attestation End Date
NCMMIS Number: A1FA
Description: The final day of the Attestation. Attestations are valid for 1 year.
Data Type: DATE
Size: X(10)
Functional Area Owner: Reference
Valid Values:
Last Update: 10/30/2023 10:25:57 AM
Capitation Withhold Begin Date
NCMMIS Number: A1FB
Description: Capitation Withhold Begin Date
Data Type: DATE
Size: X(10)
Functional Area Owner: Reference
Valid Values:
Last Update: 1/24/2024 5:17:18 PM
Capitation Withhold End Date
NCMMIS Number: A1FC
Description: Capitation Withhold End Date
Data Type: DATE
Size: X(10)
Functional Area Owner: Reference
Valid Values:
Last Update: 1/24/2024 5:17:34 PM
Capitation Withhold Percent
NCMMIS Number: A1FD
Description: Capitation Withhold Percent
Data Type: DECIMAL
Size: 9(5,4)
Functional Area Owner: Reference
Valid Values:
Last Update: 1/24/2024 5:17:47 PM
Capitation Withhold Status
NCMMIS Number: A1FE
Description: Capitation Withhold Status
Data Type: CHARACTER
Size: X(01)
Functional Area Owner: Reference
Valid Values:
Last Update: 1/24/2024 5:18:03 PM
Withhold Amount
NCMMIS Number: A1FF
Description: The calculated withhold amount for Capitation TCNs with a Line Base Change segment with a Base Reason Code of 'WH'. The calculation is by Health Plan (SP), County, COE and Dates of Service.
Data Type: DECIMAL
Size: S9(11)V99
Functional Area Owner: Financial
Valid Values:
Last Update: 2/12/2024 8:08:31 AM
Dates of Service Year and Month
NCMMIS Number: A1FG
Description: The Year and Month of the Dates of Service on a Capitation claim.
Data Type: CHARACTER
Size: 6
Functional Area Owner: Claims
Valid Values:
Last Update: 2/2/2024 1:14:38 PM
Requested Hours Per Day
NCMMIS Number: A1FH
Description: Requested Hours Per Day is a system calculated value of requested hours per week divided by 7 days per week. The requested hours per day value is used in the calculation of total requested units for a new PDN PA.
Data Type: DECIMAL
Size: S9(2)V9(2)
Functional Area Owner: Prior Authorization
Valid Values:
Last Update: 2/7/2024 11:54:12 AM
Approved Hours Per Day
NCMMIS Number: A1FI
Description: Approved Hours Per Day is a system calculated value of approved hours per week divided by 7 days per week. The approved hours per day value is used in the calculation of total approved units for a PDN PA.
Data Type: DECIMAL
Size: S9(2)V9(2)
Functional Area Owner: Prior Authorization
Valid Values:
Last Update: 2/7/2024 11:55:09 AM
Requested Hours Per Week
NCMMIS Number: A1FJ
Description: Requested Hours Per Week stores the provider requested hours per week in a new PDN PA. The value must be a whole number.
Data Type: DECIMAL
Size: S9(3)V9(2)
Functional Area Owner: Prior Authorization
Valid Values:
Last Update: 2/7/2024 12:04:08 PM
Approved Hours Per Week
NCMMIS Number: A1FK
Description: Approved Hours Per Week stores the reviewer approved hours per week in a PDN PA. The value must be a whole number.
Data Type: DECIMAL
Size: S9(3)V9(2)
Functional Area Owner: Prior Authorization
Valid Values:
Last Update: 2/7/2024 12:03:54 PM
PDN Full-Time Caregivers
NCMMIS Number: A1FL
Description: PDN Full-Time Caregivers defines the number of full-time caregivers available to render care.
Data Type: CHARACTER
Size: X(1)
Functional Area Owner: Prior Authorization
Valid Values:
From Value | Thru Value | Short Description | Long Description |
|---|---|---|---|
0 | 0 | 0 | NO FULL-TIME CAREGIVER |
1 | 1 | 1 | ONE FULL-TIME CAREGIVER |
2 | 2 | 2 | TWO FULL-TIME CAREGIVERS |
3 | 3 | 3 | THREE FULL-TIME CAREGIVERS |
4 | 4 | 4 | FOUR FULL-TIME CAREGIVERS |
Last Update: 2/7/2024 2:44:00 PM
PDN Part-Time Caregivers
NCMMIS Number: A1FM
Description: PDN Part-Time Caregivers defines the number of part-time caregivers available to render care.
Data Type: CHARACTER
Size: X (1)
Functional Area Owner: Prior Authorization
Valid Values:
From Value | Thru Value | Short Description | Long Description |
|---|---|---|---|
0 | 0 | 0 | NO PART-TIME CAREGIVER |
1 | 1 | 1 | ONE PART-TIME CAREGIVER |
2 | 2 | 2 | TWO PART-TIME CAREGIVERS |
3 | 3 | 3 | THREE PART-TIME CAREGIVERS |
4 | 4 | 4 | FOUR PART-TIME CAREGIVERS |
Last Update: 2/7/2024 2:46:23 PM
PA Attachment Reason
NCMMIS Number: A1FN
Description: PA Attachment Reason defines why an attachment is being added to a PA in a final status.
Data Type: CHARACTER
Size: X (4)
Functional Area Owner: Prior Authorization
Valid Values:
From Value | Thru Value | Short Description | Long Description |
|---|---|---|---|
01 | 01 | DISCHARGE | PATIENT DISCHARGE |
02 | 02 | EMERGENCY | EMERGENCY APPROVAL DOCUMENTS |
03 | 03 | 60 DAY | 60 DAY DOCUMENTATION |
04 | 04 | 120 DAY | 120 DAY DOCUMENTATION |
05 | 05 | OTHER | REASON NOT LISTED |
Last Update: 3/22/2024 3:19:07 PM
CAP SLA Date
NCMMIS Number: A1FO
Description: Milestone date in CAP SLA measurement
Data Type: CHARACTER
Size: X(8)
Functional Area Owner: Claims
Valid Values:
Last Update: 3/6/2024 2:50:48 PM
CAP Underpayment Amount
NCMMIS Number: A1FP
Description: The underpayment amount associated with a Corrective Action Plan.
Data Type: DECIMAL
Size: (X)11/2
Functional Area Owner: Claims
Valid Values:
Last Update: 3/6/2024 2:53:12 PM
CAP Erroneous Payment Type Code
NCMMIS Number: A1FQ
Description: Code indicating of the erroneous payment was overpayment, underpayment or both.
Data Type: CHARACTER
Size: X(1)
Functional Area Owner: Claims
Valid Values:
From Value | Thru Value | Short Description | Long Description |
|---|---|---|---|
B | B | OVER UNDER | ERROR RESULTED IN AN OVERPAYMENT TO SOME IMPACTED PROVIDERS AND AN UNDERPAYMENT TO SOME IMPACTED PROVIDERS. |
O | O | OVER PMT | ERROR RESULTED IN AN OVERPAYMENT TO ALL PROVIDERS IMPACTED. |
U | U | UNDER PMT | ERROR RESULTED IN AN UNDERPAYMENT TO ALL PROVIDERS IMPACTED. |
Last Update: 3/6/2024 3:28:29 PM
CAP Date Type Code
NCMMIS Number: A1FR
Description: Code indicating the type of date used in CAP SLA measurement
Data Type: CHARACTER
Size: 2
Functional Area Owner: Claims
Valid Values:
From Value | Thru Value | Short Description | Long Description |
|---|---|---|---|
01 | 01 | NCDHHS NTF | NCDHHS Notification Date |
02 | 02 | EST RES DT | Estimated Resolution Date |
03 | 03 | ESTRESENT | Date Estimated Resolution Date Entered |
04 | 04 | NCDHHS CLF | Defect assigned to NCDHHS for Clarification |
05 | 05 | DEF CLRIFD | Defect Returned with Clarification |
06 | 06 | DEF RESLVD | Defect Resolved |
07 | 07 | CAPDOCSUB | CAP Document to NCDHHS – Initial |
08 | 08 | CAPDOCRJT | CAP Document Rejected |
09 | 09 | CAPDOCRE | CAP Document to NCDHHS – Redo |
10 | 10 | CAPDOCAPP | CAP Document Approved |
11 | 11 | DRAFTCOMM | CAP Draft Provider Communication to NCDHHS |
98 | 98 | MULTIDEFT | Silk contains multiple defects with this CAP number assigned. |
99 | 99 | NOSilk | Silk Defect Cross-reference Not Created |
Last Update: 3/6/2024 3:14:48 PM
CAP Non-System Error Indicator
NCMMIS Number: A1FS
Description: Indicator indicating the CAP is a result of a non-system error
Data Type: CHARACTER
Size: X(01)
Functional Area Owner: Claims
Valid Values:
From Value | Thru Value | Short Description | Long Description |
|---|---|---|---|
N | N | NO | NO |
Y | Y | YES | YES |
Last Update: 4/12/2024 1:17:02 PM
A25 PDN Proc Codes
NCMMIS Number: A1FT
Description: A25 PDN Proc Codes defines the codes applicable to the A25 PA Type.
Data Type: CHARACTER
Size: X(05)
Functional Area Owner: Prior Authorization
Valid Values:
From Value | Thru Value | Short Description | Long Description |
|---|---|---|---|
S9123 | S9123 | S9123 | CONGREGATE NURSING SERVICES, RN |
S9124 | S9124 | S9124 | CONGREGATE NURSING SERVICES, LPN |
T1000 | T1000 | T1000 | PDN NURSING SERVICES |
Last Update: 4/15/2024 9:53:59 AM
Opill Prescription Code
NCMMIS Number: A1FU
Description: The Opill Prescription Code is used during pharmacy claim adjudication to identify claims for Opill that have a prescription, claims for Opill that do not have a prescription and also have an edit 7006 override, and claims for Opill that do not have a prescription and also do not have an edit 7006 override.
Data Type: CHARACTER
Size: X(01)
Functional Area Owner: Claims
Valid Values:
From Value | Thru Value | Short Description | Long Description |
|---|---|---|---|
E | E | NO RX / OV | OPILL CLAIM HAS NO PRESCRIPTION AND NO OVERRIDE CODE WAS SUBMITTED |
N | N | NO RX OV | OPILL CLAIM HAS NO PRESCRIPTION AND AN EDIT OVERRIDE WAS SUBMITTED |
P | P | RX CLAIM | OPILL CLAIM HAS A PRESCRIPTION |
Last Update: 5/15/2024 9:00:27 AM
Opill DUR Professional Indicator
NCMMIS Number: A1FV
Description: The Opill DUR Professional Indicator is used to identify claims for Opill that have a Professional Service Code equal to 'P0'.
Data Type: CHARACTER
Size: X(01)
Functional Area Owner: Claims
Valid Values:
From Value | Thru Value | Short Description | Long Description |
|---|---|---|---|
N | N | NO | OPILL CLAIM DOES NOT HAVE A PROFESSIONAL SERVICE CODE EQUAL TO ‘P0’ |
Y | Y | YES | OPILL CLAIM HAS A PROFESSIONAL SERVICE CODE EQUAL TO ‘P0’ |
Last Update: 5/15/2024 9:20:43 AM