|
Name |
Type |
Discontinued? |
|
1 |
RECORD_ID |
NUMERIC |
No |
|
|
|
The unique identifier for the claim record. |
|
|
2 |
LINE |
INTEGER |
No |
|
|
|
The line number for the information associated with this contact. Multiple pieces of information can be associated with this contact. |
|
|
3 |
LN_FROM_DT |
DATETIME |
No |
|
|
|
This item holds the earliest service date represented on the line. |
|
|
4 |
LN_TO_DT |
DATETIME |
No |
|
|
|
This item holds the latest service date represented on the line. It will not be populated if the line only represents a single date. |
|
|
5 |
LN_PROC_QUAL |
VARCHAR |
No |
|
|
|
This item holds a code identifying the type of procedure code reported on the line. |
|
|
6 |
LN_PROC_CD |
VARCHAR |
No |
|
|
|
This item holds the procedure code for the line. |
|
|
7 |
LN_PROC_DESC |
VARCHAR |
No |
|
|
|
This item holds a procedure specific description for the line. |
|
|
8 |
LN_PROC_MOD |
VARCHAR |
No |
|
|
|
This item holds a comma delimited list of modifiers for the procedure on the line. |
|
|
9 |
LN_QTY_QUAL |
VARCHAR |
No |
|
|
|
This item holds a code identifying the unit in which the quantity is reported. |
|
|
10 |
LN_QTY |
NUMERIC |
No |
|
|
|
This item holds the quantity for the service line. |
|
|
11 |
LN_AMT |
NUMERIC |
No |
|
|
|
This item holds the billed amount for the line. For Uniform Billing (UB) claims, this amount will include both covered and non-covered amounts. |
|
|
12 |
LN_REV_CD |
VARCHAR |
No |
|
|
|
This item holds the revenue code for the service line. |
|
|
13 |
LN_REV_CD_DESC |
VARCHAR |
No |
|
|
|
This item holds a revenue code specific description for the line. |
|
|
14 |
LN_RATE |
NUMERIC |
No |
|
|
|
This item holds the daily rate for accommodation revenue code lines. |
|
|
15 |
LN_NON_CVD_AMT |
NUMERIC |
No |
|
|
|
This item holds the non-covered amount for the line. |
|
|
16 |
LN_POS_CD |
VARCHAR |
No |
|
|
|
This item holds the place of service code identifying where the service on the line was performed. |
|
|
17 |
LN_DX_PTR |
VARCHAR |
No |
|
|
|
This item holds a comma delimited list of diagnosis pointers. Each piece of the string is a line number from the claim diagnosis table. |
|
|
18 |
LN_EMERG_IND |
VARCHAR |
No |
|
|
|
This item identifies the service on the line as an emergency service. |
|
|
19 |
LN_EPSDT_IND |
VARCHAR |
No |
|
|
|
This item identifies the service on the line as an Early & Periodic Screening, Diagnosis, and Treatment (EPSDT) service. |
|
|
20 |
LN_FAM_PLAN_IND |
VARCHAR |
No |
|
|
|
This item identifies the service on the line as a family planning service. |
|
|
21 |
LN_COPAY_STAT_CD |
VARCHAR |
No |
|
|
|
This item identifies when the patient was exempt from a copay for the service on the line. |
|
|
22 |
LN_AMB_PAT_CNT |
INTEGER |
No |
|
|
|
This item holds the number of patients transported in the ambulance when the line represents an ambulance service. |
|
|
23 |
LN_MAMM_CERT_NUM |
VARCHAR |
No |
|
|
|
This item holds the mammography certification number for the line. |
|
|
24 |
LN_CLIA_NUM |
VARCHAR |
No |
|
|
|
This item holds the Clinical Laboratory Improvement Amendment (CLIA) number for the line. |
|
|
25 |
LN_ORAL_CAV_CD |
VARCHAR |
No |
|
|
|
This item holds a comma delimited list of oral cavity codes for the line. |
|
|
26 |
LN_DENT_PROSTHESIS |
VARCHAR |
No |
|
|
|
This item holds a code to indicate the initial placement or replacement of a dental prosthesis, crown, or inlay. |
|
|
27 |
LN_DME_CMN_CD |
VARCHAR |
No |
|
|
|
This item holds a code describing how the certificate of medical necessity (CMN) for the line was transmitted to the DMERC. |
|
|
28 |
LN_DME_CERT_TYP |
VARCHAR |
No |
|
|
|
This item identifies the type of certification (initial, renewal, or revised) applies to the line. |
|
|
29 |
LN_DME_DURATION |
INTEGER |
No |
|
|
|
This item holds the number of months the durable medical equipment (DME) supplies will be needed. |
|
|
30 |
LN_DME_RECERT_DT |
DATETIME |
No |
|
|
|
This item holds the new durable medical equipment (DME) certification date when the certification type is renewed or revised. |
|
|
31 |
LN_CME_BEG_THRPY_DT |
DATETIME |
No |
|
|
|
This item holds the date that therapy requiring the durable medical equipment (DME) began. |
|
|
32 |
LN_DME_COND_IND |
VARCHAR |
No |
|
|
|
This item holds a comma delimited list of durable medical equipment (DME) condition codes for the service line. |
|
|
33 |
LN_CNTRCT_TYP |
VARCHAR |
No |
|
|
|
This item holds a code representing the type of contract between the provider and the payer used for the service line. |
|
|
34 |
LN_CNTRCT_AMT |
NUMERIC |
No |
|
|
|
This item holds the contract amount for the line. |
|
|
35 |
LN_CNTRCT_PCT |
NUMERIC |
No |
|
|
|
This item holds the contract percentage for the line. |
|
|
36 |
LN_CNTRCT_CD |
VARCHAR |
No |
|
|
|
This item holds a code representing the line. |
|
|
37 |
LN_CNTRCT_DISCNT_P |
NUMERIC |
No |
|
|
|
This item holds the discount percentage for the line. |
|
|
38 |
LN_CNTRCT_VERS_ID |
VARCHAR |
No |
|
|
|
This item identifies the version of the contract used for the line. |
|
|
39 |
LN_NDC |
VARCHAR |
No |
|
|
|
This item holds the National Drug Code (NDC) for the service line. |
|
|
40 |
LN_NDC_UNIT_QTY |
NUMERIC |
No |
|
|
|
This item holds the quantity associated with the National Drug Code (NDC), in terms of the units reported with the NDC. |
|
|
41 |
LN_NDC_UNIT |
VARCHAR |
No |
|
|
|
This item holds the units associated with the National Drug Code (NDC). |
|
|
42 |
LN_RX_NUM_QUAL |
VARCHAR |
No |
|
|
|
This item holds a code distinguishing prescription numbers from sequence numbers used to represent compound drugs. |
|
|
43 |
LN_RX_NUM |
VARCHAR |
No |
|
|
|
This item holds the prescription number for the line. |
|
|
44 |
LN_NOTE |
VARCHAR |
No |
|
|
|
This item holds a line level note. |
|
|
45 |
LN_REND_PROV_TYP |
VARCHAR |
No |
|
|
|
This item indicates whether the rendering provider on the line is a person or a non-person. |
|
|
46 |
LN_REND_NAM_LAST |
VARCHAR |
No |
|
|
|
This item holds the rendering provider's last name (if a person) or the organization name (if a non-person). |
|
|
47 |
LN_REND_NAM_FIRST |
VARCHAR |
No |
|
|
|
This item holds the rendering provider's first name. It is only populated when the provider is a person. |
|
|
48 |
LN_REND_NAM_MID |
VARCHAR |
No |
|
|
|
This item holds the rendering provider's middle name. It is only populated when the provider is a person. |
|
|
49 |
LN_REND_NAM_SUF |
VARCHAR |
No |
|
|
|
This item holds the suffix to the rendering provider's name (Jr, III, etc). It is only populated when the provider is a person. |
|
|
50 |
LN_REND_NPI |
VARCHAR |
No |
|
|
|
This item holds the rendering provider's National Provider Identifier (NPI). |
|
|
51 |
LN_REND_TAXONOMY |
VARCHAR |
No |
|
|
|
This item holds the rendering provider's taxonomy code. |
|
|
52 |
LN_SVC_FAC_NAM |
VARCHAR |
No |
|
|
|
This item holds the name of the external location where the services were performed. |
|
|
53 |
LN_SVC_FAC_NPI |
VARCHAR |
No |
|
|
|
This item holds the National Provider Identifier (NPI) of the external location where the services were performed. |
|
|
54 |
LN_SVC_FAC_ADDR_1 |
VARCHAR |
No |
|
|
|
This item holds the first line of the external location street address. |
|
|
55 |
LN_SVC_FAC_ADDR_2 |
VARCHAR |
No |
|
|
|
This item holds the second line of the external location street address. |
|
|
56 |
LN_SVC_FAC_CITY |
VARCHAR |
No |
|
|
|
This item holds the external location's city. |
|
|
57 |
LN_SVC_FAC_STATE |
VARCHAR |
No |
|
|
|
This item holds the external location's state. |
|
|
58 |
LN_SVC_FAC_ZIP |
VARCHAR |
No |
|
|
|
This item holds the external location's ZIP code. |
|
|
59 |
LN_SVC_FAC_CNTRY |
VARCHAR |
No |
|
|
|
This item holds the external location's country. It is only populated if the address is outside the United States. |
|
|
60 |
LN_SVC_FAC_CNTRY_SU |
VARCHAR |
No |
|
|
|
This item holds the external location's country subdivision (state, province, etc). It is only populated if the address is outside the United States. |
|
|
61 |
LN_SUP_NAM_LAST |
VARCHAR |
No |
|
|
|
This item holds the supervising provider's last name. |
|
|
62 |
LN_SUP_NAM_FIRST |
VARCHAR |
No |
|
|
|
This item holds the supervising provider's first name. |
|
|
63 |
LN_SUP_NAM_MID |
VARCHAR |
No |
|
|
|
This item holds the supervising provider's middle name. |
|
|
64 |
LN_SUP_NAM_SUF |
VARCHAR |
No |
|
|
|
This item holds the suffix to the supervising provider's name (Jr, III, etc). |
|
|
65 |
LN_SUP_NPI |
VARCHAR |
No |
|
|
|
This item holds the supervising provider's National Provider Identifier (NPI). |
|
|
66 |
LN_ORD_NAM_LAST |
VARCHAR |
No |
|
|
|
This item holds the ordering provider's last name. |
|
|
67 |
LN_ORD_NAM_FIRST |
VARCHAR |
No |
|
|
|
This item holds the ordering provider's first name. |
|
|
68 |
LN_ORD_NAM_MID |
VARCHAR |
No |
|
|
|
This item holds the ordering provider's middle name. |
|
|
69 |
LN_ORD_NAM_SUF |
VARCHAR |
No |
|
|
|
This item holds the suffix to the ordering provider's name (Jr, III, etc). |
|
|
70 |
LN_ORD_NPI |
VARCHAR |
No |
|
|
|
This item holds the ordering provider's National Provider Identifier (NPI). |
|
|
71 |
LN_ORD_ADDR_1 |
VARCHAR |
No |
|
|
|
This item holds the first line of the ordering provider's street address. |
|
|
72 |
LN_ORD_ADDR_2 |
VARCHAR |
No |
|
|
|
This item holds the second line of the ordering provider's street address. |
|
|
73 |
LN_ORD_CITY |
VARCHAR |
No |
|
|
|
This item holds the ordering provider's city. |
|
|
74 |
LN_ORD_STATE |
VARCHAR |
No |
|
|
|
This item holds the ordering provider's state. |
|
|
75 |
LN_ORD_ZIP |
VARCHAR |
No |
|
|
|
This item holds the ordering provider's ZIP code. |
|
|
76 |
LN_ORD_CNTRY |
VARCHAR |
No |
|
|
|
This item holds the ordering provider's country. It is only populated if the address is outside the United States. |
|
|
77 |
LN_ORD_CNTRY_SUB |
VARCHAR |
No |
|
|
|
This item holds the ordering provider's country subdivision (state, province, etc). It is only populated if the address is outside the United States. |
|
|
78 |
LN_PURCH_PROV_TYP |
VARCHAR |
No |
|
|
|
This item indicates whether the purchased service provider on the line is a person or a non-person. |
|
|
79 |
LN_PURCH_NPI |
VARCHAR |
No |
|
|
|
This item holds the purchased service provider's National Provider Identifier (NPI). |
|
|
80 |
LN_ASST_TYP |
VARCHAR |
No |
|
|
|
This item indicates whether the assistant dental surgeon on the line is a person or a non-person. |
|
|
81 |
LN_ASST_NAM_LAST |
VARCHAR |
No |
|
|
|
This item holds the assistant dental surgeon's last name (if a person) or the organization name (if a non-person). |
|
|
82 |
LN_ASST_NAM_FIRST |
VARCHAR |
No |
|
|
|
This item holds the assistant dental surgeon's first name. It is only populated when the provider is a person. |
|
|
83 |
LN_ASST_NAM_MID |
VARCHAR |
No |
|
|
|
This item holds the assistant dental surgeon's middle name. It is only populated when the provider is a person. |
|
|
84 |
LN_ASST_NAM_SUF |
VARCHAR |
No |
|
|
|
This item holds the suffix to the assistant dental surgeon's name (Jr, III, etc). It is only populated when the provider is a person. |
|
|
85 |
LN_ASST_NPI |
VARCHAR |
No |
|
|
|
This item holds the assistant dental surgeon's National Provider Identifier (NPI). |
|
|
86 |
LN_ASST_TAXONOMY |
VARCHAR |
No |
|
|
|
This item holds the assistant dental surgeon's taxonomy code. |
|
|
87 |
LN_DOC_TYP |
VARCHAR |
No |
|
|
|
This item holds a code indicating the type of supporting document included with the service line. |
|
|
88 |
LN_DOC_FORM_ID |
VARCHAR |
No |
|
|
|
This item identifies the specific document. For example, this can identify the version number of a questionnaire so that the payer can correctly interpret the responses. |
|
|