Master Data Element Dictionary, version 20240608: NCMMIS 0001 - 0500
Document Control Number DCN
NCMMIS Number: 0001
Description: Document Control Number (DCN) is the number assigned to identify a document when it is imaged.
Data Type: CHARACTER
Size: X(12)
Functional Area Owner: Reference
Valid Values:
Last Update: 10/9/2018 6:24:16 PM
Interactive Submitter GUID
NCMMIS Number: 0002
Description: Interactive Submitter GUID
Data Type: CHARACTER
Size: X(32)
Functional Area Owner: E-Commerce
Valid Values:
Last Update: 3/4/2021 2:03:57 PM
Interactive Submitter NC Identifier
NCMMIS Number: 0003
Description: Interactive Submitter NC Identifier
Data Type: CHARACTER
Size: X(32)
Functional Area Owner: E-Commerce
Valid Values:
Last Update: 3/4/2021 1:51:08 PM
Payment Number
NCMMIS Number: 0004
Description: Payment Number is a number used to identify a payment. For system checks and EFT payments, the number is application generated by incrementing a system parameter (F5011). For manual checks, it is the number pre-printed on the check stock.
Data Type: CHARACTER
Size: X(15)
Functional Area Owner: Financial
Valid Values:
Last Update: 3/12/2021 1:57:31 PM
Payment Type Code
NCMMIS Number: 0005
Description: Payment Type Code specifies the method used to convey a payment to a provider. Payments may be made via check or Electronic Funds Transfer (EFT).
Data Type: CHARACTER
Size: X(1)
Functional Area Owner: Recipient
Valid Values:
From Value | Thru Value | Short Description | Long Description |
|---|---|---|---|
C | C | CHECK PYMT | PAYMENT MADE TO PROVIDER VIA CHECK |
E | E | EFT PYMT | PYMT MADE TO PROV VIA ELECTRONIC FUNDS TRANSFER |
Last Update: 8/18/2022 8:56:00 AM
Provider Upload Document Type Code
NCMMIS Number: 0006
Description: Type of document uploaded by the provider
Data Type: CHARACTER
Size: X(1)
Functional Area Owner: Provider
Valid Values:
From Value | Thru Value | Short Description | Long Description |
|---|---|---|---|
A | A | SIGNAGREE | AGREEMENT SIGNED BY THE INDIVIDUAL PROVIDER |
E | E | ENROLLADD | PROVIDER ENROLLMENT ADD |
F | F | FINGERPRNT | PROVIDER FINGER PRINT EVIDENCE |
L | L | PSVLAC | PRIMARY SOURCE VERIFICATION UPLOADED FOR LICENSE, ACCREDITATION, CERTIFICATION |
P | P | PRV_PE | DOCUMENTS UPLOADED BY THE PROVIDER ON THE UPLOAD DOCUMENTS PAGE |
R | R | BUMPUPFP | THE NOTIFICATION AND ELECTRONIC FINGERPRINT SUBMISSION RELEASE OF INFORMATION FORM (PM18802-R0002) LETTER HAS BEEN SENT TO A BUMPED UP PROVIDER. |
Last Update: 9/26/2022 1:34:42 PM
TPL - Buy-In Premium Amount
NCMMIS Number: 0007
Description: TPL Buy-In Premium Amount is a debit amount that the state of North Carolina owes the Federal government for an accrete or ongoing transaction or a credit or refund amount due to the state of North Carolina if the transaction is a delete record.
Data Type: CURRENCY
Size: S9(8)V99
Functional Area Owner: Third Party Liability
Valid Values:
Last Update: 3/12/2021 1:33:13 PM
TPL - Buy-In CMS Bill Date
NCMMIS Number: 0008
Description: TPL Buy-In CMS Bill Date represents the month, century, and year in which the Center for Medicare/Medicaid services (CMS) bills the State of North Carolina for all client's under the Buy-In program.
Data Type: DATE
Size: X(10)
Functional Area Owner: Third Party Liability
Valid Values:
Last Update: 3/12/2021 1:33:51 PM
TPL - Buy-In CMS Billing Begin Date
NCMMIS Number: 0009
Description: TPL Buy-In CMS Billing Begin Date is the beginning date used to calculate the refund or premium amount due for a transaction.
Data Type: DATE
Size: X(10)
Functional Area Owner: Third Party Liability
Valid Values:
Last Update: 3/12/2021 1:35:08 PM
Drug Rebate Adjustment Code
NCMMIS Number: 0010
Description: Drug Rebate Adjustment Code is an NCTracks defined adjustment code used to record the modifications made to a Drug Rebate accounts receivable item by either a state or fiscal agent or the drug manufacturer.
Data Type: CHARACTER
Size: X(1)
Functional Area Owner: Financial
Valid Values:
From Value | Thru Value | Short Description | Long Description |
|---|---|---|---|
B | B | CREDIT | CREDIT ISSUED |
D | D | SETTLE DSP | DISPUTE SETTLEMENT |
H | H | CMS CHG | CMS SUPPLIED URA CHANGE |
M | M | PYMT DIFF | PAYMENT DIFFERENCE DUE TO RATE CHANGE FROM LABELER |
P | P | CLAIM ADJ | CLAIMS BASED UNIT ADJUSTMENT |
R | R | RESTORE WO | RESTORE WRITTEN-OFF AMOUNT |
U | U | UNIT DISC | UNIT DISCREPANCY CORRECTION |
V | V | BNCD CHECK | REVERSE PAYMENT RECEIVED ON BOUNCED CHECK |
W | W | WRITE OFF | WRITTEN OFF AMOUNT |
Z | Z | RECEIVED | PAYMENT AMOUNT RECEIVED |
0 | 0 | ORIG INV | ORIGINAL INVOICED AMOUNT |
1 | 1 | NEWLY RBT | PREVIOUSLY NOT REBATABLE - NOW REBATABLE |
Last Update: 3/12/2021 1:55:45 PM
OA Application Returned Date
NCMMIS Number: 0011
Description: Date on which application was returned to OA for review
Data Type: DATE
Size: X(10)
Functional Area Owner: Provider
Valid Values:
Last Update: 5/11/2015 3:56:17 PM
Provider Designate Status Code
NCMMIS Number: 0012
Description: Provider Status Code
Data Type: CHARACTER
Size: (X)1
Functional Area Owner: Provider
Valid Values:
From Value | Thru Value | Short Description | Long Description |
|---|---|---|---|
A | A | ASSIGNED | ASSIGNED TO A DESIGNATED CLERK |
R | R | READYFOROA | READY FOR OFFICE ADMINISTRATOR TO SIGN AND SUBMIT APPLICATION |
Last Update: 3/8/2021 4:22:43 PM
Provider Organization Change Request Date
NCMMIS Number: 0013
Description: Provider Organization Change Request Date
Data Type: DATE
Size: X(10)
Functional Area Owner: Provider
Valid Values:
Last Update: 5/15/2015 12:09:27 AM
Provider Organization Change Type Code
NCMMIS Number: 0014
Description: Provider Organization Change Type Code
Data Type: CHARACTER
Size: (X)1
Functional Area Owner: Provider
Valid Values:
From Value | Thru Value | Short Description | Long Description |
|---|---|---|---|
A | A | ADDRESS | ADDRESS |
N | N | NAME | NAME |
Last Update: 3/8/2021 4:22:43 PM
Error Data Received
NCMMIS Number: 0015
Description: Error Data Received is the actual data content of an invalid data field as entered by a provider and received by the Medicaid Eligibility Verification System (MEVS).
Data Type: CHARACTER
Size: X(11)
Functional Area Owner: E-Commerce
Valid Values:
Last Update: 3/4/2021 1:59:47 PM
Provider Change Status Code
NCMMIS Number: 0016
Description: Provider Change Status Code
Data Type: CHARACTER
Size: (X)1
Functional Area Owner: Provider
Valid Values:
From Value | Thru Value | Short Description | Long Description |
|---|---|---|---|
1 | 1 | PENDING | PENDING (ALL PROVIDERS WITH THE SAME EIN HAVE NOT YET BEEN UPDATED) |
2 | 2 | COMPLETED | COMPLETED (ALL PROVIDERS WITH THE SAME EIN HAVE BEEN UPDATED) |
3 | 3 | VOID | VOID (ENTRY HAS BEEN VOIDED) |
Last Update: 3/8/2021 4:22:44 PM
Interactive Text Area Byte
NCMMIS Number: 0017
Description: Interactive Text Area Byte is a byte of the text of an input or output transaction.
Data Type: CHARACTER
Size: X(1)
Functional Area Owner: E-Commerce
Valid Values:
Last Update: 3/4/2021 2:05:34 PM
Prior Approval Business Location Code
NCMMIS Number: 0018
Description: Prior Approval Business Location Code identifies a location where Prior Approval requests are routed for manual review.
Data Type: CHARACTER
Size: X(2)
Functional Area Owner: Reference
Valid Values:
Last Update: 2/18/2010 7:39:27 AM
TPL Insurance Category Code
NCMMIS Number: 0019
Description: Type of insurance category whether its Health, Prescription drug etc. For ITP the information will for Third party coverage and hence the authorization number is added.
Data Type: CHARACTER
Size: X(1)
Functional Area Owner: Recipient
Valid Values:
From Value | Thru Value | Short Description | Long Description |
|---|---|---|---|
P | P | PRIMARY | PRIMARY COVERAGE |
S | S | SECONDARY | SECONDARY COVERAGE |
Last Update: 8/18/2022 8:53:32 AM
Reference Cancellation Reason Code
NCMMIS Number: 0020
Description: Reference Cancellation Reason Code specifies the reason why a drug, supply, or other medical item is not covered for payment.
Data Type: CHARACTER
Size: X(1)
Functional Area Owner: Reference
Valid Values:
From Value | Thru Value | Short Description | Long Description |
|---|---|---|---|
0 | 0 | NOT CANC | NOT CANCELLED |
1 | 1 | PRODDISCNT | PRODUCT DISCONTINUED BY MANUFACTURER |