1                       FI Inpatient SNF Claim Record - Limited Data Set Standard View -- 11/2005

                                                 POSITIONS
                  NAME              TYPE  LENGTH BEG  END                            CONTENTS
       ---------------------------  ----  ------ ---------  ------------------------------------------------------------

 ****  FI Inpatient/Skilled         REC     VAR             Fiscal intermediary Inpatient/SNF Limited Data
       Nursing Facility (SNF)                               Set Standard View for version I of the NCH.
       Claim Record - Limited
       Data Set Standard View                               The Limited Data Set Standard View supports the
                                                            users of CMS data and provides the data in "text"
                                                            ready format for easy conversion to ASCII
                                                            text files. This file is also specifically
                                                            processed to perform CMS standard encryption
                                                            processes for identifiable and personal
                                                            health information data fields.

 ****  FI Inpatient/SNF Claim       GROUP   461     1  461  Fixed portion of the fiscal intermediary
       Fixed Group -                                        claim record for the Limited Data Set Standard
       Limited Data Set                                     View of the Inpatient/Skilled Nursing Facility
       Standard View                                        version I NCH Nearline File.

    1. Record Length Count          NUM       5     1    5  The length of the record.

                                                            5 DIGITS UNSIGNED

                                                            STANDARD ALIAS:  DSY_VW_BYTE_CNT

    2. Record Number                NUM       9     6   14  A sequentially assigned number for the claims included
                                                            in the file. This number allows the user to link all of
                                                            the records associated with one claim.

                                                            9 DIGITS UNSIGNED

                                                            STANDARD ALIAS:  DSY_VW_REC_LNK_NUM

    3. Record Type                  NUM       2    15   16  Type of Record.

                                                            2 DIGITS UNSIGNED

                                                            STANDARD ALIAS:  DSY_VW_REC_TYPE

                                                            CODES:
                                                            00 = Fixed/Main Group
                                                            01 = Carrier Line Group
                                                            02 = Claim Demonstration ID Group
                                                            03 = Claim Diagnosis Group
                                                            04 = Claim Health PlanID Group
                                                            05 = Claim Occurrence Span Group
                                                            06 = Claim Procedure Group
                                                            07 = Claim Related Condition Group
                                                            08 = Claim Related Occurrence Group
                                                            09 = Claim Value Group
                                                            10 = MCO Period Group
                                                            11 = NCH Edit Group
                                                            12 = NCH Patch Group
                                                            13 = DMERC Line Group
                                                            14 = Revenue Center Group

1                       FI Inpatient SNF Claim Record - Limited Data Set Standard View -- 11/2005

                                                 POSITIONS
                  NAME              TYPE  LENGTH BEG  END                            CONTENTS
       ---------------------------  ----  ------ ---------  ------------------------------------------------------------

    4. Claim Sequence Number        NUM       3    17   19  A counter for records that consist of trailer
                                                            information, such as claim line and revenue center data,
                                                            which can occur multiple times for one claim.

                                                            3 DIGITS UNSIGNED

                                                            STANDARD ALIAS:  DSY_VW_REC_SEQ

    5. NCH Claim Type Code          CHAR      2    20   21  The code used to identify the type of claim record being
                                                            processed in NCH.

                                                            NOTE1:  During the Version H conversion this field was
                                                                    populated with data through-out history (back to
                                                                    service year 1991).

                                                            NOTE2:  During the Version I conversion this field was
                                                                    expanded to include inpatient 'full' encounter
                                                                    claims (for service dates after 6/30/97).
                                                                    Placeholders for Physician and Outpatient encounters
                                                                    (available in NMUD) have also been added.

                                                            DB2 ALIAS: NCH_CLM_TYPE_CD
                                                            SAS ALIAS: CLM_TYPE
                                                            STANDARD ALIAS: NCH_CLM_TYPE_CD
                                                            SYSTEM ALIAS: LTTYPE
                                                            TITLE ALIAS: CLAIM_TYPE

                                                            DERIVATION:
                                                            FFS CLAIM TYPE CODES DERIVED FROM:
                                                              NCH CLM_NEAR_LINE_RIC_CD
                                                              NCH PMT_EDIT_RIC_CD
                                                              NCH CLM_TRANS_CD
                                                              NCH PRVDR_NUM

                                                            INPATIENT 'FULL' ENCOUNTER TYPE CODE DERIVED FROM:
                                                              (Pre-HDC processing -- AVAILABLE IN NCH)
                                                              CLM_MCO_PD_SW
                                                              CLM_RLT_COND_CD
                                                              MCO_CNTRCT_NUM
                                                              MCO_OPTN_CD
                                                              MCO_PRD_EFCTV_DT
                                                              MCO_PRD_TRMNTN_DT

                                                            INPATIENT 'FULL' ENCOUNTER TYPE CODE DERIVED FROM:
                                                              (HDC processing -- AVAILABLE IN NMUD)
                                                              FI_NUM

                                                            INPATIENT 'ABBREVIATED' ENCOUNTER TYPE CODE DERIVED
                                                            FROM: (HDC processing -- AVAILABLE IN NMUD)
                                                              FI_NUM
                                                              CLM_FAC_TYPE_CD
                                                              CLM_SRVC_CLSFCTN_TYPE_CD
                                                              CLM_FREQ_CD
1                       FI Inpatient SNF Claim Record - Limited Data Set Standard View -- 11/2005

                                                 POSITIONS
                  NAME              TYPE  LENGTH BEG  END                            CONTENTS
       ---------------------------  ----  ------ ---------  ------------------------------------------------------------

                                                            NOTE:  From 7/1/97 to the start of HDC processing(?),
                                                            abbreviated inpatient encounter claims are not
                                                            available in NCH or NMUD.

                                                            PHYSICIAN 'FULL' ENCOUNTER TYPE CODE DERIVED FROM:
                                                              (AVAILABLE IN NMUD)
                                                              CARR_NUM
                                                              CLM_DEMO_ID_NUM

                                                              OUTPATIENT 'FULL' ENCOUNTER TYPE CODE DERIVED FROM:
                                                              (AVAILABLE IN NMUD)
                                                              FI_NUM

                                                            OUTPATIENT 'ABBREVIATED' ENCOUNTER TYPE CODE
                                                            DERIVED FROM:  (AVAILABLE IN NMUD)
                                                              FI_NUM
                                                              CLM_FAC_TYPE_CD
                                                              CLM_SRVC_CLSFCTN_TYPE_CD
                                                              CLM_FREQ_CD

                                                            DERIVATION RULES:

                                                              SET CLM_TYPE_CD TO 10 (HHA CLAIM) WHERE THE
                                                              FOLLOWING CONDITIONS ARE MET:
                                                              1.   CLM_NEAR_LINE_RIC_CD EQUAL 'V','W' OR 'U'
                                                              2.   PMT_EDIT_RIC_CD EQUAL 'F'
                                                              3.   CLM_TRANS_CD EQUAL '5'

                                                              SET CLM_TYPE_CD TO 20 (SNF NON-SWING BED CLAIM)
                                                              WHERE THE FOLLOWING CONDITIONS ARE MET:
                                                              1.   CLM_NEAR_LINE_RIC_CD EQUAL 'V'
                                                              2.   PMT_EDIT_RIC_CD EQUAL 'C' OR 'E'
                                                              3.   CLM_TRANS_CD EQUAL '0' OR '4'
                                                              4.   POSITION 3 OF PRVDR_NUM IS NOT 'U', 'W', 'Y'
                                                                   OR 'Z'

                                                              SET CLM_TYPE_CD TO 30 (SNF SWING BED CLAIM)
                                                              WHERE THE FOLLOWING CONDITIONS ARE MET:
                                                              1.   CLM_NEAR_LINE_RIC_CD EQUAL 'V'
                                                              2.   PMT_EDIT_RIC_CD EQUAL 'C' OR 'E'
                                                              3.   CLM_TRANS_CD EQUAL '0' OR '4'
                                                              4.   POSITION 3 OF PRVDR_NUM EQUAL 'U', 'W', 'Y'
                                                                   OR 'Z'

                                                              SET CLM_TYPE_CD TO 40 (OUTPATIENT CLAIM)
                                                              WHERE THE FOLLOWING CONDITIONS ARE MET:
                                                              1.   CLM_NEAR_LINE_RIC_CD EQUAL 'W'
                                                              2.   PMT_EDIT_RIC_CD EQUAL 'D'
                                                              3.   CLM_TRANS_CD EQUAL '6'

                                                              SET CLM_TYPE_CD TO 41 (OUTPATIENT 'FULL'
                                                              ENCOUNTER CLAIM -- AVAILABLE IN NMUD) WHERE
                                                              THE FOLLOWING CONDITIONS ARE MET:
                                                              1.   CLM_NEAR_LINE_RIC_CD EQUAL 'W'
                                                              2.   PMT_EDIT_RIC_CD EQUAL 'D'
1                       FI Inpatient SNF Claim Record - Limited Data Set Standard View -- 11/2005

                                                 POSITIONS
                  NAME              TYPE  LENGTH BEG  END                            CONTENTS
       ---------------------------  ----  ------ ---------  ------------------------------------------------------------

                                                              3.   CLM_TRANS_CD EQUAL '6'
                                                              4.   FI_NUM = 80881

                                                              SET CLM_TYPE_CD TO 42 (OUTPATIENT 'ABBREVIATED'
                                                              ENCOUNTER CLAIMS -- AVAILABLE IN NMUD)
                                                              1.   FI_NUM = 80881
                                                              2.   CLM_FAC_TYPE_CD = '1' OR '8'; CLM_SRVC_
                                                                   CLSFCTN_TYPE_CD = '2', '3' OR '4' &
                                                                   CLM_FREQ_CD = 'Z', 'Y' OR 'X'

                                                              SET CLM_TYPE_CD TO 50 (HOSPICE CLAIM)
                                                              WHERE THE FOLLOWING CONDITIONS ARE MET:
                                                              1.   CLM_NEAR_LINE_RIC_CD EQUAL 'V'
                                                              2.   PMT_EDIT_RIC_CD EQUAL 'I'
                                                              3.   CLM_TRANS_CD EQUAL 'H'

                                                              SET CLM_TYPE_CD TO 60 (INPATIENT CLAIM)
                                                              WHERE THE FOLLOWING CONDITIONS ARE MET:
                                                              1.   CLM_NEAR_LINE_RIC_CD EQUAL 'V'
                                                              2.   PMT_EDIT_RIC_CD EQUAL 'C' OR 'E'
                                                              3.   CLM_TRANS_CD EQUAL '1' '2' OR '3'

                                                              SET CLM_TYPE_CD TO 61 (INPATIENT 'FULL' ENCOUNTER
                                                              CLAIM - PRIOR TO HDC PROCESSING - AFTER 6/30/97 -
                                                              12/4/00) WHERE THE FOLLOWING CONDITIONS ARE MET:
                                                              1.   CLM_MCO_PD_SW = '1'
                                                              2.   CLM_RLT_COND_CD = '04'
                                                              3.   MCO_CNTRCT_NUM
                                                                   MCO_OPTN_CD = 'C'
                                                                   CLM_FROM_DT & CLM_THRU_DT ARE WITHIN THE
                                                                   MCO_PRD_EFCTV_DT & MCO_PRD_TRMNTN_DT
                                                                   ENROLLMENT PERIODS

                                                              SET_CLM_TYPE_CD TO 61 (INPATIENT 'FULL' ENCOUNTER
                                                              CLAIM -- EFFECTIVE WITH HDC PROCESSING) WHERE THE
                                                              FOLLOWING CONDITIONS ARE MET:
                                                              1.   CLM_NEAR_LINE_RIC_CD EQUAL 'V'
                                                              2.   PMT_EDIT_RIC_CD EQUAL 'C' OR 'E'
                                                              3.   CLM_TRANS_CD EQUAL '1' '2' OR '3'
                                                              4.   FI_NUM = 80881

                                                              SET CLM_TYPE_CD TO 62 (INPATIENT 'ABBREVIATED'
                                                              ENCOUNTER CLAIM -- AVAILABLE IN NMUD) WHERE
                                                              THE FOLLOWING CONDITIONS ARE MET:
                                                              1.   FI_NUM = 80881 AND
                                                              2.   CLM_FAC_TYPE_CD = '1'; CLM_SRVC_CLSFCTN_
                                                                   TYPE_CD = '1'; CLM_FREQ_CD = 'Z'

                                                              SET CLM_TYPE_CD TO 71 (RIC O non-DMEPOS CLAIM)
                                                              WHERE THE FOLLOWING CONDITIONS ARE MET:
                                                              1.   CLM_NEAR_LINE_RIC_CD EQUAL 'O'
                                                              2.   HCPCS_CD not on DMEPOS table

1                       FI Inpatient SNF Claim Record - Limited Data Set Standard View -- 11/2005

                                                 POSITIONS
                  NAME              TYPE  LENGTH BEG  END                            CONTENTS
       ---------------------------  ----  ------ ---------  ------------------------------------------------------------

                                                              SET CLM_TYPE_CD TO 72 (RIC O DMEPOS CLAIM)
                                                              WHERE THE FOLLOWING CONDITIONS ARE MET:
                                                              1.   CLM_NEAR_LINE_RIC_CD EQUAL 'O'
                                                              2.   HCPCS_CD on DMEPOS table (NOTE: if one or
                                                                    more line item(s) match the HCPCS on the
                                                                    DMEPOS table).

                                                              SET CLM_TYPE_CD TO 73 (PHYSICIAN ENCOUNTER CLAIM--
                                                              EFFECTIVE WITH HDC PROCESSING) WHERE THE FOLLOWING
                                                              CONDITIONS ARE MET:
                                                              1.   CARR_NUM = 80882 AND
                                                              2.   CLM_DEMO_ID_NUM = 38

                                                              SET CLM_TYPE_CD TO 81 (RIC M non-DMEPOS DMERC
                                                                 CLAIM)
                                                              WHERE THE FOLLOWING CONDITIONS ARE MET:

                                                              1.   CLM_NEAR_LINE_RIC_CD EQUAL 'M'
                                                              2.   HCPCS_CD not on DMEPOS table

                                                              SET CLM_TYPE_CD TO 82 (RIC M DMEPOS DMERC CLAIM)
                                                              WHERE THE FOLLOWING CONDITIONS ARE MET:
                                                              1.   CLM_NEAR_LINE_RIC_CD EQUAL 'M'
                                                              2.   HCPCS_CD on DMEPOS table (NOTE: if one or
                                                                    more line item(s) match the HCPCS on the
                                                                    DMEPOS table).

                                                            CODES:
                                                              REFER TO: NCH_CLM_TYPE_TB
                                                                        IN THE CODES APPENDIX

                                                            SOURCE:
                                                            NCH

    6. Beneficiary Birth Date       NUM       8    22   29  The beneficiary's date of birth.

                                                            For the Limited Data Set Standard View of
                                                            the Inpatient/SNF files, the beneficiary's
                                                            date of birth is coded as a range.

                                                            8 DIGITS UNSIGNED

                                                            DB2 ALIAS: BENE_BIRTH_DT
                                                            SAS ALIAS: BENE_DOB
                                                            STANDARD ALIAS: BENE_BIRTH_DT
                                                            TITLE ALIAS: BENE_BIRTH_DATE

                                                            EDIT-RULES FOR LIMITED DATA SET DATA:
                                                            0000000R
                                                            WHERE R HAS ONE OF THE FOLLOWING VALUES.
                                                            0 = Unknown
                                                            1 = <65
                                                            2 = 65 Thru 69
                                                            3 = 70 Thru 74
1                       FI Inpatient SNF Claim Record - Limited Data Set Standard View -- 11/2005

                                                 POSITIONS
                  NAME              TYPE  LENGTH BEG  END                            CONTENTS
       ---------------------------  ----  ------ ---------  ------------------------------------------------------------

                                                            4 = 75 Thru 79
                                                            5 = 80 Thru 84
                                                            6 = >84

                                                            SOURCE:
                                                            CWF

    7. Beneficiary Identification   CHAR      2    30   31  The code identifying the type of relationship between an
       Code                                                 individual and a primary Social Security Administration
                                                            (SSA) beneficiary or a primary Railroad Board (RRB)
                                                            beneficiary.

                                                            COMMON ALIAS: BIC
                                                            DA3 ALIAS: BENE_IDENT_CODE
                                                            DB2 ALIAS: BENE_IDENT_CD
                                                            SAS ALIAS: BIC
                                                            STANDARD ALIAS: BENE_IDENT_CD
                                                            TITLE ALIAS: BIC
                                                            EDIT-RULES:
                                                            EDB REQUIRED FIELD

                                                            CODES:
                                                              REFER TO: BENE_IDENT_TB
                                                                        IN THE CODES APPENDIX

                                                            SOURCE:
                                                            SSA/RRB

    8. Beneficiary LRD Used Count   NUM       4    32   35  The number of lifetime reserve days that the
                                                            beneficiary has elected to use during the period
                                                            covered by the institutional claim. Under Medicare,
                                                            each beneficiary has a one-time reserve of sixty
                                                            additional days of inpatient hospital coverage
                                                            that can be used after 90 days of inpatient care
                                                            have been provided in a single benefit period.
                                                            This count is used to subtract from the total
                                                            number of lifetime reserve days that a beneficiary
                                                            has available.

                                                            3 DIGITS SIGNED

                                                            DB2 ALIAS: BENE_LRD_USE_CNT
                                                            SAS ALIAS: LRD_USE
                                                            STANDARD ALIAS: BENE_LRD_USE_CNT
                                                            TITLE ALIAS: LRD_USED
1                       FI Inpatient SNF Claim Record - Limited Data Set Standard View -- 11/2005

                                                 POSITIONS
                  NAME              TYPE  LENGTH BEG  END                            CONTENTS
       ---------------------------  ----  ------ ---------  ------------------------------------------------------------

                                                            EDIT-RULES:
                                                            +999

                                                            SOURCE:
                                                            CWF

    9. Beneficiary Race Code        CHAR      1    36   36  The race of a beneficiary.

                                                            DA3 ALIAS: RACE_CODE
                                                            DB2 ALIAS: BENE_RACE_CD
                                                            SAS ALIAS: RACE
                                                            STANDARD ALIAS: BENE_RACE_CD
                                                            SYSTEM ALIAS: LTRACE
                                                            TITLE ALIAS: RACE_CD

                                                            CODES:
                                                            0 = Unknown
                                                            1 = White
                                                            2 = Black
                                                            3 = Other
                                                            4 = Asian
                                                            5 = Hispanic
                                                            6 = North American Native

                                                            SOURCE:
                                                            SSA

   10. Beneficiary Residence SSA    CHAR      3    37   39  The SSA standard county code of a beneficiary's residence.
       Standard County Code
                                                            DA3 ALIAS: SSA_STANDARD_COUNTY_CODE
                                                            DB2 ALIAS: BENE_SSA_CNTY_CD
                                                            SAS ALIAS: CNTY_CD
                                                            STANDARD ALIAS: BENE_RSDNC_SSA_STD_CNTY_CD
                                                            TITLE ALIAS: BENE_COUNTY_CD

                                                            EDIT-RULES:
                                                            OPTIONAL: MAY BE BLANK

                                                            SOURCE:
                                                            SSA/EDB

   11. Beneficiary Residence SSA    CHAR      2    40   41  The SSA standard state code of a beneficiary's residence.
       Standard State Code
                                                            DA3 ALIAS: SSA_STANDARD_STATE_CODE
                                                            DB2 ALIAS: BENE_SSA_STATE_CD
                                                            SAS ALIAS: STATE_CD
                                                            STANDARD ALIAS: BENE_RSDNC_SSA_STD_STATE_CD
                                                            TITLE ALIAS: BENE_STATE_CD

                                                            EDIT-RULES:
                                                            OPTIONAL: MAY BE BLANK

                                                            CODES:
                                                              REFER TO: GEO_SSA_STATE_TB
                                                                        IN THE CODES APPENDIX
1                       FI Inpatient SNF Claim Record - Limited Data Set Standard View -- 11/2005

                                                 POSITIONS
                  NAME              TYPE  LENGTH BEG  END                            CONTENTS
       ---------------------------  ----  ------ ---------  ------------------------------------------------------------

                                                            COMMENT:
                                                            1. Used in conjunction with a county code, as
                                                               selection criteria for the determination of
                                                               payment rates for HMO reimbursement.
                                                            2. Concerning individuals directly billable for
                                                               Part B and/or Part A premiums, this element
                                                               is used to determine if the beneficiary
                                                               will receive a bill in English or Spanish.
                                                            3. Also used for special studies.

                                                            SOURCE:
                                                            SSA/EDB

   12. Beneficiary Sex              CHAR      1    42   42  The sex of a beneficiary.
       Identification Code
                                                            COMMON ALIAS: SEX_CD
                                                            DA3 ALIAS: SEX_CODE
                                                            DB2 ALIAS: BENE_SEX_IDENT_CD
                                                            SAS ALIAS: SEX
                                                            STANDARD ALIAS: BENE_SEX_IDENT_CD
                                                            SYSTEM ALIAS: LTSEX
                                                            TITLE ALIAS: SEX_CD

                                                            EDIT-RULES:
                                                            REQUIRED FIELD

                                                            CODES:
                                                            1 = Male
                                                            2 = Female
                                                            0 = Unknown

                                                            SOURCE:
                                                            SSA,RRB,EDB

   13. Beneficiary Total            NUM       4    43   46  The count of the total number of coinsurance days
       Coinsurance Days Count                               involved with the beneficiary's stay in a facility.

                                                            3 DIGITS SIGNED

                                                            DB2 ALIAS: COINSRNC_DAY_CNT
                                                            SAS ALIAS: COIN_DAY
                                                            STANDARD ALIAS: BENE_TOT_COINSRNC_DAY_CNT
                                                            TITLE ALIAS: COINSRNC_DAYS

                                                            EDIT-RULES:
                                                            +999

                                                            SOURCE:
                                                            CWF

   14. Claim Admission Date         NUM       8    47   54  On an institutional claim, the date the beneficiary
                                                            was admitted to the hospital, skilled nursing
                                                            facility, or christian science sanitorium.

1                       FI Inpatient SNF Claim Record - Limited Data Set Standard View -- 11/2005

                                                 POSITIONS
                  NAME              TYPE  LENGTH BEG  END                            CONTENTS
       ---------------------------  ----  ------ ---------  ------------------------------------------------------------

                                                            For the Limited Data Set Standard View of
                                                            the Inpatient/SNF files, the admission date
                                                            for the claim is coded as the quarter of
                                                            the calendar year when the admission
                                                            occurred.

                                                            8 DIGITS UNSIGNED

                                                            DB2 ALIAS: CLM_ADMSN_DT
                                                            SAS ALIAS: ADMSN_DT
                                                            STANDARD ALIAS: CLM_ADMSN_DT
                                                            TITLE ALIAS: ADMISSION_DT

                                                            EDIT-RULES FOR LIMITED DATA SET DATA:
                                                            YYYYQ000 WHERE Q IS ONE OF THE
                                                            FOLLOWING VALUES.
                                                            1 = FIRST QUARTER OF THE CALENDAR YEAR
                                                            2 = SECOND QUARTER OF THE CALENDAR YEAR
                                                            3 = THIRD QUARTER OF THE CALENDAR YEAR
                                                            4 = FOURTH QUARTER OF THE CALENDAR YEAR

                                                            SOURCE:
                                                            CWF

   15. Claim Admitting Diagnosis    CHAR      5    55   59  An ICD-9-CM code on the institutional inpatient/
       Code                                                 SNF claim indicating the beneficiary's
                                                            initial diagnosis at admission.

                                                            DB2 ALIAS: CLM_ADMTG_DGNS_CD
                                                            SAS ALIAS: AD_DGNS
                                                            STANDARD ALIAS: CLM_ADMTG_DGNS_CD
                                                            TITLE ALIAS: ADMITTING_DIAGNOSIS

                                                            SOURCE:
                                                            CWF

   16. Claim Attending Physician    CHAR      6    60   65  On an institutional claim, the unique
       UPIN Number                                          physician identification number (UPIN) of the
                                                            physician who would normally be expected to
                                                            certify and recertify the medical necessity of
                                                            the services rendered and/or who has primary
                                                            responsibility for the beneficiary's medical
                                                            care and treatment (attending physician).

                                                            This field is ENCRYPTED for the Limited Data Set
                                                            Standard View of the Inpatient/SNF files.

                                                            COMMON ALIAS: ATTENDING_PHYSICIAN_UPIN
                                                            DB2 ALIAS: ATNDG_UPIN
                                                            SAS ALIAS: AT_UPIN
                                                            STANDARD ALIAS: CLM_ATNDG_PHYSN_UPIN_NUM
                                                            TITLE ALIAS: ATTENDING_PHYSICIAN

1                       FI Inpatient SNF Claim Record - Limited Data Set Standard View -- 11/2005

                                                 POSITIONS
                  NAME              TYPE  LENGTH BEG  END                            CONTENTS
       ---------------------------  ----  ------ ---------  ------------------------------------------------------------

                                                            COMMENT:
                                                            Prior to Version H this field was named:
                                                            CLM_PRMRY_CARE_PHYSN_IDENT_NUM and contained
                                                            10 positions (6-position UPIN and 4-position
                                                            physician surname).

                                                            SOURCE:
                                                            CWF

   17. Claim Diagnosis E Code       CHAR      5    66   70  Effective with Version H, the ICD-9-CM code
                                                            used to identify the external cause of injury,
                                                            poisoning, or other adverse affect.  Redundantly
                                                            this field is also stored as the last occurrence
                                                            of the diagnosis trailer.

                                                            NOTE: During the Version H conversion, the data
                                                            in the last occurrence of the diagnosis trailer
                                                            was used to populate history.

                                                            DB2 ALIAS: CLM_DGNS_E_CD
                                                            SAS ALIAS: DGNS_E
                                                            STANDARD ALIAS: CLM_DGNS_E_CD
                                                            TITLE ALIAS: DGNS_E_CD

                                                            SOURCE:
                                                            CWF

   18. Claim Diagnosis Related      CHAR      3    71   73  The diagnostic related group to which a hospital
       Group Code                                           claim belongs for prospective payment purposes.

                                                            COMMON ALIAS: DRG
                                                            DB2 ALIAS: CLM_DRG_CD
                                                            SAS ALIAS: DRG_CD
                                                            STANDARD ALIAS: CLM_DRG_CD
                                                            TITLE ALIAS: DRG

                                                            EDIT-RULES:
                                                            DRG DEFINITIONS MANUAL

                                                            COMMENT:
                                                            GROUPER is the software that determines the DRG
                                                            from data elements reported by the hospital.
                                                            Once determined, the DRG code is one of the
                                                            elements used to determine the price upon which
                                                            to base the reimbursement to the hospitals
                                                            under prospective payment.  Nonpayment claims
                                                            (zero reimbursement) may not have a DRG present.

                                                            SOURCE:
                                                            CWF

1                       FI Inpatient SNF Claim Record - Limited Data Set Standard View -- 11/2005

                                                 POSITIONS
                  NAME              TYPE  LENGTH BEG  END                            CONTENTS
       ---------------------------  ----  ------ ---------  ------------------------------------------------------------

   19. Claim Diagnosis Related      CHAR      1    74   74  On an institutional claim, the code that
       Group Outlier Stay Code                              indicates the beneficiary stay under the
                                                            prospective payment system which, although
                                                            classified into a specific diagnosis related
                                                            group, has an unusually long length (day
                                                            outlier) or exceptionally high cost
                                                            (cost outlier).

                                                            DB2 ALIAS:  DRG_OUTLIER_CD
                                                            SAS ALIAS:  OUTLR_CD
                                                            STANDARD ALIAS:  CLM_DRG_OUTLIER_STAY_CD
                                                            TITLE ALIAS:  DRG_OUTLIER_STAY_CODE

                                                            CODES:
                                                              REFER TO:  DRG_OUTLIER_STAY_TB

                                                            SOURCE:
                                                            CWF

   20. Claim Excepted/Nonexcepted   CHAR       1   75   75  Effective with Version I, the code used to identify
       Medical Treatment Code                               whether or not the medical care or treatment received
                                                            by a beneficiary, who has elected care from a
                                                            Religious Nonmedical Health Care Institution (RNHCI),
                                                            is excepted or nonexcepted.  Excepted is medical care
                                                            or treatment that is received involuntarily or is re-
                                                            quired under Federal, State or local law. Nonexcepted is
                                                            defined as medical care or treatment other than excepted.

                                                            DB2 ALIAS: EXCPTD_NEXCPTD_CD
                                                            SAS ALIAS: TRTMT_CD
                                                            STANDARD ALIAS: CLM_EXCPTD_NEXCPTD_TRTMT_CD
                                                            TITLE ALIAS: EXCPTD_NEXCPTD_CD

                                                            CODES:
                                                            0 = No Entry
                                                            1 = Excepted
                                                            2 = Nonexcepted

                                                            SOURCE:
                                                            CWF

   21. Claim Facility Type Code     CHAR      1    76   76  The first digit of the type of bill (TOB1) submitted on an
                                                            institutional claim used to identify the type of facility
                                                            that provided care to the beneficiary.

                                                            COMMON ALIAS: TOB1
                                                            DB2 ALIAS: CLM_FAC_TYPE_CD
                                                            SAS ALIAS: FAC_TYPE
                                                            STANDARD ALIAS: CLM_FAC_TYPE_CD
                                                            TITLE ALIAS: TOB1

                                                            CODES:
                                                              REFER TO: CLM_FAC_TYPE_TB
                                                                        IN THE CODES APPENDIX

1                       FI Inpatient SNF Claim Record - Limited Data Set Standard View -- 11/2005

                                                 POSITIONS
                  NAME              TYPE  LENGTH BEG  END                            CONTENTS
       ---------------------------  ----  ------ ---------  ------------------------------------------------------------

                                                            SOURCE:
                                                            CWF

   22. Claim Frequency Code         CHAR      1    77   77  The third digit of the type of bill (TOB3) submitted on an
                                                            institutional claim record to indicate the sequence of a
                                                            claim in the beneficiary's current episode of care.

                                                            COMMON ALIAS: TOB3
                                                            DB2 ALIAS: CLM_FREQ_CD
                                                            SAS ALIAS: FREQ_CD
                                                            STANDARD ALIAS: CLM_FREQ_CD
                                                            SYSTEM ALIAS: LTFREQ
                                                            TITLE ALIAS: FREQUENCY_CD

                                                            CODES:
                                                              REFER TO: CLM_FREQ_TB
                                                                        IN THE CODES APPENDIX

                                                            SOURCE:
                                                            CWF

   ***  Claim Locator Number Group  GROUP    11    78   88  This number uniquely identifies the beneficiary in the
                                                            NCH Nearline.

                                                            STANDARD ALIAS: CLM_LCTR_NUM_GRP

   23. Beneficiary Claim Account    CHAR      9    78   86  The number identifying the primary beneficiary
       Number                                               under the SSA or RRB programs submitted.

                                                            This field is ENCRYPTED for the Limited Data Set
                                                            Standard View of the Inpatient/SNF files.

                                                            STANDARD ALIAS: BENE_CLM_ACNT_NUM

                                                            SOURCE:
                                                            SSA, RRB

                                                            LIMITATIONS:
                                                            RRB-issued numbers contain an overpunch in
                                                            the first position that may appear as a plus
                                                            zero or A-G.   RRB-formatted numbers may
                                                            cause matching problems on non-IBM machines.

   24. NCH Category Equatable       CHAR      2    87   88  The code categorizing groups of BICs
       Beneficiary Identification                           representing similar relationships between
       Code                                                 the beneficiary and the primary wage
                                                            earner.
                                                            The equatable BIC module electronically
                                                            matches two records that contain different BICs
                                                            where it is apparent that both are records for
                                                            the same beneficiary. It validates the BIC and
                                                            returns a base BIC under which to house the
                                                            record in the National Claims History (NCH)
                                                            databases. (All records for a beneficiary are
                                                            stored under a single BIC.)
1                       FI Inpatient SNF Claim Record - Limited Data Set Standard View -- 11/2005

                                                 POSITIONS
                  NAME              TYPE  LENGTH BEG  END                            CONTENTS
       ---------------------------  ----  ------ ---------  ------------------------------------------------------------


                                                            For the Limited Data Set Standard View, this
                                                            field contains the Beneficiary Identification
                                                            Code. (See Field #7 of the FI Inpatient/SNF
                                                            Claim Fixed Group - Limited Data Set Standard View.)

   25. Claim Medicare Non Payment   CHAR      1    89   89  The reason that no Medicare payment is made for
       Reason Code                                          services on an institutional claim.

                                                            NOTE:  Effective with Version I, this field was
                                                                   put on all institutional claim types.
                                                                   Prior to Version I, this field was present
                                                                   only on inpatient/SNF claims.

                                                            DB2 ALIAS: MDCR_NPMT_RSN_CD
                                                            SAS ALIAS: NOPAY_CD
                                                            STANDARD ALIAS: CLM_MDCR_NPMT_RSN_CD
                                                            SYSTEM ALIAS: LTNPMT
                                                            TITLE ALIAS: NON_PAYMENT_REASON

                                                            EDIT-RULES:
                                                            OPTIONAL

                                                            CODES:
                                                              REFER TO: CLM_MDCR_NPMT_RSN_TB
                                                                        IN THE CODES APPENDIX

                                                            SOURCE:
                                                            CWF

   26. Claim MCO Paid Switch        CHAR      1    90   90  A switch indicating whether or not a Managed Care
                                                            Organization (MCO) has paid the provider for an
                                                            institutional claim.

                                                            COBOL ALIAS: MCO_PD_IND
                                                            DB2 ALIAS: CLM_MCO_PD_SW
                                                            SAS ALIAS: MCOPDSW
                                                            STANDARD ALIAS: CLM_MCO_PD_SW
                                                            TITLE ALIAS: MCO_PAID_SW

                                                            CODES:
                                                            1 = MCO has paid the provider for a claim
                                                            Blank or 0 = MCO has not paid the provider
                                                            COMMENT:
                                                            Prior to Version H this field was named:
                                                            CLM_GHO_PD_SW.

                                                            SOURCE:
                                                            CWF

   27. Claim Non Utilization Days   NUM       6    91   96  On an institutional claim, the number of days of
       Count                                                care that are not chargeable to Medicare facility
                                                            utilization.

1                       FI Inpatient SNF Claim Record - Limited Data Set Standard View -- 11/2005

                                                 POSITIONS
                  NAME              TYPE  LENGTH BEG  END                            CONTENTS
       ---------------------------  ----  ------ ---------  ------------------------------------------------------------

                                                            5 DIGITS SIGNED

                                                            DB2 ALIAS: NUTLZTN_DAY_CNT
                                                            SAS ALIAS: NUTILDAY
                                                            STANDARD ALIAS: CLM_NUTLZTN_DAY_CNT
                                                            TITLE ALIAS: NUTLZTN_DAYS

                                                            EDIT-RULES:
                                                            +9(5)

                                                            SOURCE:
                                                            CWF

   28. Claim Operating Physician    CHAR      6    97  102  On an institutional claim, the unique physician
       UPIN Number                                          identification number (UPIN) of the physician
                                                            who performed the principal procedure.  This
                                                            element is used by the provider to identify the
                                                            operating physician who performed the
                                                            surgical procedure.

                                                            This field is ENCRYPTED for the Limited Data
                                                            Set Standard View of the Inpatient/SNF files.

                                                            DB2 ALIAS: OPRTG_UPIN
                                                            SAS ALIAS: OP_UPIN
                                                            STANDARD ALIAS: CLM_OPRTG_PHYSN_UPIN_NUM
                                                            TITLE ALIAS: OPRTG_UPIN

                                                            COMMENT:
                                                            Prior to Version H this field was named:
                                                            CLM_PRNCPAL_PRCDR_PHYSN_NUM and contained
                                                            10 positions (6-position UPIN and 4-position
                                                            physician surname.

                                                            NOTE:  For HHA and Hospice formats beginning
                                                            with NCH weekly process date 10/3/97 this field
                                                            was populated with data.  HHA and Hospice claims
                                                            processed prior to 10/3/97 will contain spaces.

                                                            SOURCE:
                                                            CWF

   29. Claim Other Physician UPIN   CHAR      6   103  108  On an institutional claim, the unique physician
       Number                                               identification number (UPIN) of the other
                                                            physician associated with the institutional
                                                            claim.

                                                            This field is ENCRYPTED for the Limited Data Set
                                                            Standard View of the Inpatient/SNF files.

                                                            DB2 ALIAS: OTHR_UPIN
                                                            SAS ALIAS: OT_UPIN
                                                            STANDARD ALIAS: CLM_OTHR_PHYSN_UPIN_NUM
                                                            TITLE ALIAS: OTH_PHYSN_UPIN
1                       FI Inpatient SNF Claim Record - Limited Data Set Standard View -- 11/2005

                                                 POSITIONS
                  NAME              TYPE  LENGTH BEG  END                            CONTENTS
       ---------------------------  ----  ------ ---------  ------------------------------------------------------------


                                                            COMMENT:
                                                            Prior to Version H this field was named:
                                                            CLM_OTHR_PHYSN_IDENT_NUM and contained
                                                            10 positions (6-position UPIN and 4-position
                                                            other physician surname).

                                                            NOTE:  For HHA and Hospice formats beginning
                                                            with NCH weekly process date 10/3/97 this field
                                                            was populated with data.  HHA and Hospice claims
                                                            processed prior to 10/3/97 will contain spaces.

                                                            SOURCE:
                                                            CWF

   30. Claim Pass Thru Per Diem     NUM                                 f the established reimbursable costs
       Amount                                               for the current year divided by the estimated
                                                            Medicare days for the current year (all PPS
                                                            claims), as calculated by the FI and reim-
                                                            bursement staff.  Items reimbursed as a pass
                                                            through include capital-related costs; direct
                                                            medical education costs; kidney acquisition
                                                            costs for hospitals approved as RTCs; and
                                                            bad debts (per Provider Reimbursement Manual,
                                                            Part 1, Section 2405.2).  **Note: Pass throughs
                                                            are not included in the Claim Payment Amount.

                                                            9.2 DIGITS SIGNED

                                                            DB2 ALIAS: PASS_THRU_PER_DIEM
                                                            SAS ALIAS: PER_DIEM
                                                            STANDARD ALIAS: CLM_PASS_THRU_PER_DIEM_AMT
                                                            TITLE ALIAS: PER_DIEM

                                                            EDIT-RULES:
                                                            +9(9).99

                                                            COMMENT:
                                                            Prior to Version H the field size was:
                                                            S9(5)V99.

                                                            SOURCE:
                                                            CWF

   31. Claim Payment Amount         NUM      13   122  134  Amount of payment made from the Medicare trust fund for the
                                                            services covered by the claim record.  Generally, the amount
                                                            is calculated by the FI or carrier; and represents what was
                                                            paid to the institutional provider, physician, or supplier,
                                                            with the exceptions noted below.  **NOTE:  In some
                                                            situations, a negative claim payment amount may be pre-
                                                            sent; e.g., (1) when a beneficiary is charged the full
                                                            deductible during a short stay and the deductible exceeded
                                                            the amount Medicare pays; or (2) when a beneficiary is
                                                            charged a coinsurance amount during a long stay and the
                                                            coinsurance amount exceeds the amount Medicare pays (most
1                       FI Inpatient SNF Claim Record - Limited Data Set Standard View -- 11/2005

                                                 POSITIONS
                  NAME              TYPE  LENGTH BEG  END                            CONTENTS
       ---------------------------  ----  ------ ---------  ------------------------------------------------------------

                                                            prevalent situation involves psych hospitals who are paid a
                                                            daily per diem rate no matter what the charges are.)

                                                            Under IP PPS, inpatient hospital services are paid based on
                                                            a predetermined rate per discharge, using the DRG patient
                                                            classification system and the PRICER program.   On the IP
                                                            PPS claim, the payment amount includes the DRG outlier
                                                            approved payment amount, disproportionate share (since
                                                            5/1/86), indirect medical education (since 10/1/88), total
                                                            PPS capital (since 10/1/91).  It does NOT include the pass
                                                            thru amounts (i.e., capital-related costs, direct medical
                                                            education costs, kidney acquisition costs, bad debts); or
                                                            any beneficiary-paid amounts (i.e., deductibles and
                                                            coinsurance); or any other payer reimbursement.

                                                            Under SNF PPS, SNFs will classify beneficiaries using the
                                                            patient classification system known as RUGS III.  For the
                                                            SNF PPS claim, the SNF PRICER will calculate/return the rate
                                                            for each revenue center line item with revenue center code =
                                                            '0022'; multiply the rate times the units count; and then
                                                            sum the amount payable for all lines with revenue center
                                                            code '0022' to determine the total claim payment amount.

                                                            Under Outpatient PPS, the national ambulatory payment
                                                            classification (APC) rate that is calculated for each APC
                                                            group is the basis for determining the total payment.  The
                                                            Medicare payment amount takes into account the wage index
                                                            adjustment and the beneficiary deductible and coinsurance
                                                            amounts.  NOTE: There is no CWF edit check to validate that
                                                            the revenue center Medicare payment amount equals the claim
                                                            level Medicare payment amount.

                                                            Under Home Health PPS, beneficiaries will be classified into
                                                            an appropriate case mix category known as the Home Health
                                                            Resource Group.  A HIPPS code is then generated
                                                            corresponding to the case mix category (HHRG).

                                                            For the RAP, the PRICER will determine the payment amount
                                                            appropriate to the HIPPS code by computing 60% (for first
                                                            episode) or 50% (for subsequent episodes) of the case mix
                                                            episode payment.  The payment is then wage index adjusted.

                                                            For the final claim, PRICER calculates 100% of the amount
                                                            due, because the final claim is processed as an adjustment
                                                            to the RAP, reversing the RAP payment in full.  Although
                                                            final claim will show 100% payment amount, the provider will
                                                            actually receive the 40% or 50% payment.

                                                            Exceptions:  For claims involving demos and BBA encounter
                                                            data, the amount reported in this field may not just
                                                            represent the actual provider payment.

1                       FI Inpatient SNF Claim Record - Limited Data Set Standard View -- 11/2005

                                                 POSITIONS
                  NAME              TYPE  LENGTH BEG  END                            CONTENTS
       ---------------------------  ----  ------ ---------  ------------------------------------------------------------

                                                                 For demo Ids '01','02','03','04' -- claims contain
                                                                 amount paid to the provider, except that special
                                                                 'differentials' paid outside the normal payment system
                                                                 are not included.

                                                                 For demo Ids '05','15' -- encounter data 'claims'
                                                                 contain amount Medicare would have paid under FFS,
                                                                 instead of the actual payment to the MCO.

                                                                 For demo Ids '06','07','08' -- claims contain actual
                                                                 provider payment but represent a special negotiated
                                                                 bundled payment for both Part A and Part B services.
                                                                 To identify what the conventional provider Part A
                                                                 payment would have been, check value code = 'Y4'.   The
                                                                 related noninstitutional (physician/supplier) claims
                                                                 contain what would have been paid had there been no
                                                                 demo.

                                                                 For BBA encounter data (non-demo) -- 'claims' contain
                                                                 amount Medicare would have paid under FFS, instead of
                                                                 the actual payment to the BBA plan.

                                                            9.2 DIGITS SIGNED

                                                            COMMON ALIAS: REIMBURSEMENT
                                                            DB2 ALIAS: CLM_PMT_AMT
                                                            SAS ALIAS: PMT_AMT
                                                            STANDARD ALIAS: CLM_PMT_AMT
                                                            TITLE ALIAS: REIMBURSEMENT

                                                            EDIT-RULES:
                                                            +9(9).99

                                                            COMMENT:
                                                            Prior to Version H the size of this field was S9(7)V99.
                                                            Also the noninstitutional claim records carried this field
                                                            as a line item.  Effective with Version H, this element is a
                                                            claim level field across all claim types (and the line item
                                                            field has been renamed.)

                                                            SOURCE:
                                                            CWF

                                                            LIMITATIONS:
                                                            Prior to 4/6/93, on inpatient, outpatient, and
                                                            physician/supplier claims containing a
                                                            CLM_DISP_CD of '02', the amount shown as the Medicare
                                                            reimbursement does not take into consideration
                                                            any CWF automatic adjustments (involving erroneous
                                                            deductibles in most cases).  In as many as 30% of
                                                            the claims (30% IP, 15% OP, 5% PART B), the
                                                            reimbursement reported on the claims may be over
                                                            or under the actual Medicare payment amount.

1                       FI Inpatient SNF Claim Record - Limited Data Set Standard View -- 11/2005

                                                 POSITIONS
                  NAME              TYPE  LENGTH BEG  END                            CONTENTS
       ---------------------------  ----  ------ ---------  ------------------------------------------------------------

   32. Claim Principal Diagnosis    CHAR      5   135  139  The ICD-9-CM diagnosis code identifying the diagnosis,
       Code                                                 condition, problem or other reason for the
                                                            admission/encounter/visit shown in the medical record to be
                                                            chiefly responsible for the services provided.

                                                            NOTE:  Effective with Version H, this data is also
                                                            redundantly stored as the first occurrence of the diagnosis
                                                            trailer.

                                                            DB2 ALIAS: PRNCPAL_DGNS_CD
                                                            SAS ALIAS: PDGNS_CD
                                                            STANDARD ALIAS: CLM_PRNCPAL_DGNS_CD
                                                            TITLE ALIAS: PRINCIPAL_DIAGNOSIS

                                                            EDIT-RULES:
                                                            ICD-9-CM

                                                            SOURCE:
                                                            CWF

   33. Claim PPS Capital Discharge  NUM       7   140  146  Effective 3/2/92, the percent resulting from
       Fraction Percent                                     dividing the days by the average length of stay
                                                            for capital PPS transfer cases (PRICER review
                                                            codes 03, 05, 06) not to exceed 1.

                                                            1.4 DIGITS SIGNED

                                                            DB2 ALIAS: PPS_DSCHRG_PCT
                                                            SAS ALIAS: DSCHFRCT
                                                            STANDARD ALIAS: CLM_PPS_CPTL_DSCHRG_FRCTN_PCT
                                                            TITLE ALIAS: PPS_CAPITL_DSCHRG_FRACTION_PCT

                                                            EDIT-RULES:
                                                            +9.9(4)

                                                            SOURCE:
                                                            CWF

   34. Claim PPS Capital            NUM      13   147  159  Effective 3/2/92, the amount of disproportionate
       Disproportionate Share                               share (rate reflecting indigent population served)
       Amount                                               portion of the PPS payment for capital.

                                                            9.2 DIGITS SIGNED

                                                            DB2 ALIAS: PPS_DSPRPRTNT_AMT
                                                            SAS ALIAS: DISP_SHR
                                                            STANDARD ALIAS: CLM_PPS_CPTL_DSPRPRTNT_SHR_AMT
                                                            TITLE ALIAS: PPS_DISP_SHR

                                                            EDIT-RULES:
                                                            +9(9).99

                                                            COMMENT:
                                                            Prior to Version H the size of the field was:
                                                            S9(7)V99.
1                       FI Inpatient SNF Claim Record - Limited Data Set Standard View -- 11/2005

                                                 POSITIONS
                  NAME              TYPE  LENGTH BEG  END                            CONTENTS
       ---------------------------  ----  ------ ---------  ------------------------------------------------------------

                                                            SOURCE:
                                                            CWF

   35. Claim PPS Capital DRG        NUM       9   160  168  Effective 3/2/92, the number used to determine
       Weight Number                                        a transfer adjusted case mix index for capital
                                                            PPS.  The number is determined by multiplying
                                                            the DRG weight times the discharge fraction.

                                                            3.4 DIGITS SIGNED

                                                            DB2 ALIAS: PPS_DRG_WT_NUM
                                                            SAS ALIAS: DRGWTAMT
                                                            STANDARD ALIAS: CLM_PPS_CPTL_DRG_WT_NUM
                                                            TITLE ALIAS: PPS_CAPITAL_DRG_WEIGHT_NUM

                                                            EDIT-RULES:
                                                            +999.9(4)

                                                            SOURCE:
                                                            CWF

   36. Claim PPS Capital Exception  NUM      13   169  181  Effective 3/2/92, the capital PPS amount of
       Amount                                               exception payments provided for hospitals
                                                            with inordinately high levels of capital
                                                            obligations. Exception payments expire at the
                                                            end of the 10-year transition period.

                                                            9.2 DIGITS SIGNED

                                                            DB2 ALIAS: PPS_EXCPTN_AMT
                                                            SAS ALIAS: CPTL_EXP
                                                            STANDARD ALIAS: CLM_PPS_CPTL_EXCPTN_AMT
                                                            TITLE ALIAS: PPS_CPTL_EXCP

                                                            EDIT-RULES:
                                                            +9(9).99

                                                            COMMENT:
                                                            Prior to Version H the size of this field was:
                                                            S9(7)V99.

                                                            SOURCE:
                                                            CWF

   37. Claim PPS Capital FSP        NUM      13   182  194  Effective 3/2/92, the amount of the federal specific
       Amount                                               portion of the PPS payment for capital.

                                                            9.2 DIGITS SIGNED

                                                            DB2 ALIAS: PPS_CPTL_FSP_AMT
                                                            SAS ALIAS: CPTL_FSP
                                                            STANDARD ALIAS: CLM_PPS_CPTL_FSP_AMT
                                                            TITLE ALIAS: PPS_CAPITAL_FSP

1                       FI Inpatient SNF Claim Record - Limited Data Set Standard View -- 11/2005

                                                 POSITIONS
                  NAME              TYPE  LENGTH BEG  END                            CONTENTS
       ---------------------------  ----  ------ ---------  ------------------------------------------------------------

                                                            EDIT-RULES:
                                                            +9(9).99

                                                            COMMENT:
                                                            Prior to Version H the size of this field was:
                                                            S9(7)V99.

                                                            SOURCE:
                                                            CWF

   38. Claim PPS Capital HSP        NUM      13   195  207  Effective 3/2/92, the hospital specific portion
       Amount                                               of the PPS payment for capital.

                                                            9.2 DIGITS SIGNED

                                                            DB2 ALIAS: PPS_CPTL_HSP_AMT
                                                            SAS ALIAS: CPTL_HSP
                                                            STANDARD ALIAS: CLM_PPS_CPTL_HSP_AMT
                                                            TITLE ALIAS: PPS_CAPITAL_HSP

                                                            EDIT-RULES:
                                                            +9(9).99

                                                            COMMENT:
                                                            Prior to Version H the size of this field was:
                                                            S9(7)V99.

                                                            SOURCE:
                                                            CWF

   39. Claim PPS Capital IME        NUM      13   208  220  Effective 3/2/92, the amount of the indirect medical
       Amount                                               education (IME) (reimbursable amount for teaching
                                                            hospitals only; an added amount passed by Congress
                                                            to augment normal PPS payments for teaching
                                                            hospitals to compensate them for higher patient
                                                            costs resulting from medical education programs for
                                                            interns and residents) portion of the PPS payment
                                                            for capital.

                                                            9.2 DIGITS SIGNED

                                                            DB2 ALIAS: PPS_CPTL_IME_AMT
                                                            SAS ALIAS: IME_AMT
                                                            STANDARD ALIAS: CLM_PPS_CPTL_IME_AMT
                                                            TITLE ALIAS: PPS_CPTL_IME

                                                            EDIT-RULES:
                                                            +9(9).99

                                                            COMMENT:
                                                            Prior to Version H the size of this field was:
                                                            S9(7)V99.

                                                            SOURCE:
                                                            CWF
1                       FI Inpatient SNF Claim Record - Limited Data Set Standard View -- 11/2005

                                                 POSITIONS
                  NAME              TYPE  LENGTH BEG  END                            CONTENTS
       ---------------------------  ----  ------ ---------  ------------------------------------------------------------


   40. Claim PPS Capital Outlier    NUM      13   221  233  Effective 3/2/92, the amount of the outlier portion
       Amount                                               of the PPS payment for capital.

                                                            9.2 DIGITS SIGNED

                                                            DB2 ALIAS: PPS_OUTLIER_AMT
                                                            SAS ALIAS: CPTLOUTL
                                                            STANDARD ALIAS: CLM_PPS_CPTL_OUTLIER_AMT
                                                            TITLE ALIAS: PPS_CPTL_OUTLIER

                                                            EDIT-RULES:
                                                            +9(9).99

                                                            COMMENT:
                                                            Prior to Version H the size of this field was:
                                                            S9(7)V99.

                                                            SOURCE:
                                                            CWF

   41. Claim PPS Indicator Code     CHAR      1   234  234  Effective with Version H, the code indicating
                                                            whether or not the (1) claim is PPS and/or (2)
                                                            the beneficiary is a deemed insured Medicare
                                                            Qualified Government Employee (MQGE).

                                                            NOTE:  Beginning with NCH weekly process date
                                                            10/3/97 through 5/29/98, this field was pop-
                                                            ulated with only the PPS indicator.  Beginning with
                                                            NCH weekly process date 6/5/98, this field was
                                                            additionally populated with the deemed MQGE
                                                            indicator. Claims processed prior to 10/3/97
                                                            will contain spaces.

                                                            COBOL ALIAS: PPS_IND
                                                            DB2 ALIAS: CLM_PPS_IND_CD
                                                            SAS ALIAS: PPS_IND
                                                            STANDARD ALIAS: CLM_PPS_IND_CD
                                                            TITLE ALIAS: PPS_IND

                                                            CODES:
                                                              REFER TO: CLM_PPS_IND_TB
                                                                        IN THE CODES APPENDIX

                                                            SOURCE:
                                                            CWF

   42. Claim PPS Old Capital Hold   NUM      13   235  247  Effective 3/2/92, this amount is the hold harmless amount
       Harmless Amount                                      payable for old capital as computed by PRICER for
                                                            providers with a payment code equal to 'A'. The hold
                                                            harmless amount-old capital is 100 percent of the
                                                            reasonable costs of old capital for sole community
                                                            sole community hospitals, or 85 percent of
                                                            the reasonable costs associated with old capital for
                                                            all other hospitals, plus a payment for new capital.
1                       FI Inpatient SNF Claim Record - Limited Data Set Standard View -- 11/2005

                                                 POSITIONS
                  NAME              TYPE  LENGTH BEG  END                            CONTENTS
       ---------------------------  ----  ------ ---------  ------------------------------------------------------------

                                                            9.2 DIGITS SIGNED

                                                            DB2 ALIAS: PPS_CPTL_HRMLS_AMT
                                                            SAS ALIAS: HLDHRMLS
                                                            STANDARD ALIAS: CLM_PPS_OLD_CPTL_HLD_HRMLS_AMT
                                                            TITLE ALIAS: PPS_CPTL_HOLD_HRMLS

                                                            EDIT-RULES:
                                                            +9(9).99

                                                            COMMENT:
                                                            Prior to Version H the size of this field was:
                                                            S9(7)V99.

                                                            SOURCE:
                                                            CWF

   43. Claim Query Code             CHAR      1   248  248  Code indicating the type of claim record being processed
                                                            with respect to payment (debit/credit indicator;
                                                            interim/final indicator).

                                                            DB2 ALIAS: CLM_QUERY_CD
                                                            SAS ALIAS: QUERY_CD
                                                            STANDARD ALIAS: CLM_QUERY_CD
                                                            TITLE ALIAS: QUERY_CD

                                                            CODES:
                                                            0 = Credit adjustment
                                                            1 = Interim bill
                                                            2 = Home Health Agency (HHA) benefits
                                                                exhausted (obsolete 7/98)
                                                            3 = Final bill
                                                            4 = Discharge notice (obsolete 7/98)
                                                            5 = Debit adjustment

                                                            SOURCE:
                                                            CWF

   44. Claim Service                CHAR      1   249  249  The second digit of the type of bill (TOB2) submitted on an
       Classification Type Code                             institutional claim record to indicate the classification of
                                                            the type of service provided to the beneficiary.

                                                            COMMON ALIAS: TOB2
                                                            DB2 ALIAS: SRVC_CLSFCTN_CD
                                                            SAS ALIAS: TYPESRVC
                                                            STANDARD ALIAS: CLM_SRVC_CLSFCTN_TYPE_CD
                                                            TITLE ALIAS: TOB2

                                                            CODES:
                                                              REFER TO: CLM_SRVC_CLSFCTN_TYPE_TB
                                                                        IN THE CODES APPENDIX

                                                            SOURCE:
                                                            CWF

1                       FI Inpatient SNF Claim Record - Limited Data Set Standard View -- 11/2005

                                                 POSITIONS
                  NAME              TYPE  LENGTH BEG  END                            CONTENTS
       ---------------------------  ----  ------ ---------  ------------------------------------------------------------

   45. Claim Source Inpatient       CHAR      1   250  250  The code indicating the means by which the
       Admission Code                                       beneficiary was admitted to the inpatient health
                                                            care facility or SNF if the type of admission is
                                                            (1) emergency, (2) urgent, or (3) elective.

                                                            DB2 ALIAS: SRC_IP_ADMSN_CD
                                                            SAS ALIAS: SRC_ADMS
                                                            STANDARD ALIAS: CLM_SRC_IP_ADMSN_CD
                                                            TITLE ALIAS: IP_ADMISSION_SOURCE

                                                            CODES:
                                                              REFER TO: CLM_SRC_IP_ADMSN_TB
                                                                        IN THE CODES APPENDIX

                                                            SOURCE:
                                                            CWF

   46. Claim Through Date           NUM       8   251  258  The last day on the billing statement covering
                                                            services rendered to the beneficiary (a.k.a
                                                            'Statement Covers Thru Date').

                                                            For the Limited Data Set Standard View of the
                                                            Inpatient/SNF files, the claim through
                                                            date is coded as the quarter of the
                                                            calendar year when the claim through
                                                            date occurred.

                                                            NOTE:  For Home Health PPS claims, the 'from'
                                                            date and the 'thru' date on the RAP (initial
                                                            claim) must always match.

                                                            8 DIGITS UNSIGNED

                                                            DB2 ALIAS: CLM_THRU_DT
                                                            SAS ALIAS: THRU_DT
                                                            STANDARD ALIAS: CLM_THRU_DT
                                                            TITLE ALIAS: THRU_DATE

                                                            EDIT-RULES FOR LIMITED DATA SET DATA:
                                                            YYYYQ000 WHERE Q IS ONE OF THE
                                                            FOLLOWING VALUES.
                                                            1 = FIRST QUARTER OF THE CALENDAR YEAR
                                                            2 = SECOND QUARTER OF THE CALENDAR YEAR
                                                            3 = THIRD QUARTER OF THE CALENDAR YEAR
                                                            4 = FOURTH QUARTER OF THE CALENDAR YEAR

                                                            SOURCE:
                                                            CWF

   47. Claim Total Charge Amount    NUM      13   259  271  Effective with Version G, the total charges for
                                                            all services included on the institutional claim.
                                                            This field is redundant with revenue center
                                                            code 0001/total charges.

1                       FI Inpatient SNF Claim Record - Limited Data Set Standard View -- 11/2005

                                                 POSITIONS
                  NAME              TYPE  LENGTH BEG  END                            CONTENTS
       ---------------------------  ----  ------ ---------  ------------------------------------------------------------

                                                            9.2 DIGITS SIGNED

                                                            DB2 ALIAS: CLM_TOT_CHRG_AMT
                                                            SAS ALIAS: TOT_CHRG
                                                            STANDARD ALIAS: CLM_TOT_CHRG_AMT
                                                            TITLE ALIAS: CLAIM_TOTAL_CHARGES

                                                            EDIT-RULES:
                                                            +9(9).99

                                                            COMMENT:
                                                            Prior to Version H the size of this field was
                                                            S9(7)V99.

                                                            SOURCE:
                                                            CWF

   48. Claim Total PPS Capital      NUM      13   272  284  The total amount that is payable for capital
       Amount                                               PPS for the claim.   This is the sum of the
                                                            capital hospital specific portion, federal
                                                            specific portion, outlier portion,
                                                            disproportionate share portion, indirect
                                                            medical education portion, exception payments,
                                                            and hold harmless payments.

                                                            9.2 DIGITS SIGNED

                                                            DB2 ALIAS: TOT_PPS_CPTL_AMT
                                                            SAS ALIAS: PPS_CPTL
                                                            STANDARD ALIAS: CLM_TOT_PPS_CPTL_AMT
                                                            TITLE ALIAS: PPS_CAPITAL

                                                            EDIT-RULES:
                                                            +9(9).99

                                                            COMMENT:
                                                            Prior to Version H the size of this field was:
                                                            S9(7)V99.

                                                            SOURCE:
                                                            CWF

   49. Claim Transaction Code       CHAR      1   285  285  The code derived by CWF to indicate the type of claim
                                                            submitted by an institutional provider.

                                                            DB2 ALIAS: CLM_TRANS_CD
                                                            SAS ALIAS: TRANS_CD
                                                            STANDARD ALIAS: CLM_TRANS_CD
                                                            SYSTEM ALIAS: LTCLTRAN
                                                            TITLE ALIAS: TRANSACTION_CODE

                                                            CODES:
                                                              REFER TO: CLM_TRANS_TB
                                                                        IN THE CODES APPENDIX

1                       FI Inpatient SNF Claim Record - Limited Data Set Standard View -- 11/2005

                                                 POSITIONS
                  NAME              TYPE  LENGTH BEG  END                            CONTENTS
       ---------------------------  ----  ------ ---------  ------------------------------------------------------------

                                                            SOURCE:
                                                            CWF

   50. Claim Utilization Day Count  NUM       4   286  289  On an institutional claim, the number of
                                                            covered days of care that are chargeable
                                                            to Medicare facility utilization that
                                                            includes full days, coinsurance days, and
                                                            lifetime reserve days.

                                                            3 DIGITS SIGNED

                                                            DB2 ALIAS: CLM_UTLZTN_DAY_CNT
                                                            SAS ALIAS: UTIL_DAY
                                                            STANDARD ALIAS: CLM_UTLZTN_DAY_CNT
                                                            TITLE ALIAS: UTILIZATION_DAYS

                                                            EDIT-RULES:
                                                            +999

                                                            SOURCE:
                                                            CWF

   51. CWF Beneficiary Medicare     CHAR      2   290  291  The CWF-derived reason for a beneficiary's
       Status Code                                          entitlement to Medicare benefits, as of the
                                                            reference date (CLM_THRU_DT).

                                                            COBOL ALIAS: MSC
                                                            COMMON ALIAS: MSC
                                                            DB2 ALIAS: BENE_MDCR_STUS_CD
                                                            SAS ALIAS: MS_CD
                                                            STANDARD ALIAS: CWF_BENE_MDCR_STUS_CD
                                                            SYSTEM ALIAS: LTMSC
                                                            TITLE ALIAS: MSC

                                                            DERIVATION:
                                                            CWF derives MSC from the following:
                                                              1.  Date of Birth
                                                              2.  Claim Through Date
                                                              3.  Original/Current Reasons for entitlement
                                                              4.  ESRD Indicator
                                                              5.  Beneficiary Claim Number
                                                            Items 1,3,4,5 come from the CWF Beneficiary
                                                            Master Record; item 2 comes from the FI/Carrier
                                                            claim record.  MSC is assigned as follows:

                                                              MSC   OASI   DIB    ESRD    AGE          BIC
                                                            ______ _____  _____  _____   _____        ______
                                                             10      YES   N/A    NO     65 and over   N/A
                                                             11      YES   N/A    YES    65 and over   N/A
                                                             20      NO    YES    NO     under 65      N/A
                                                             21      NO    YES    YES    under 65      N/A
                                                             31      NO    NO     YES    any age       T.

1                       FI Inpatient SNF Claim Record - Limited Data Set Standard View -- 11/2005

                                                 POSITIONS
                  NAME              TYPE  LENGTH BEG  END                            CONTENTS
       ---------------------------  ----  ------ ---------  ------------------------------------------------------------

                                                            CODES:
                                                            10 = Aged without ESRD
                                                            11 = Aged with ESRD
                                                            20 = Disabled without ESRD
                                                            21 = Disabled with ESRD
                                                            31 = ESRD only

                                                            COMMENT:
                                                            Prior to Version H this field was named:

                                                            BENE_MDCR_STUS_CD.  The name has been changed
                                                            to distinguish this CWF-derived field from the
                                                            EDB-derived MSC (BENE_MDCR_STUS_CD).

                                                            SOURCE:
                                                            CWF

   52. FI Claim Action Code         CHAR      1   292  292  The type of action requested by the intermediary
                                                            to be taken on an institutional claim.

                                                            DB2 ALIAS: FI_CLM_ACTN_CD
                                                            SAS ALIAS: ACTIONCD
                                                            STANDARD ALIAS: FI_CLM_ACTN_CD
                                                            TITLE ALIAS: ACTION_CD

                                                            CODES:
                                                              REFER TO: FI_CLM_ACTN_TB
                                                                        IN THE CODES APPENDIX

                                                            COMMENT:
                                                            Prior to Version H this field was named:
                                                            INTRMDRY_CLM_ACTN_CD.

                                                            SOURCE:
                                                            CWF

   53. FI Number                    CHAR      5   293  297  The identification number assigned by CMS to a fiscal
                                                            intermediary authorized to process institutional claim
                                                            records.

                                                            DB2 ALIAS: FI_NUM
                                                            SAS ALIAS: FI_NUM
                                                            STANDARD ALIAS: FI_NUM
                                                            SYSTEM ALIAS: LTFI
                                                            TITLE ALIAS: INTERMEDIARY

                                                            CODES:
                                                              REFER TO: FI_NUM_TB
                                                                        IN THE CODES APPENDIX

                                                            COMMENT:
                                                            Prior to Version H this field was named:
                                                            FICARR_IDENT_NUM.

1                       FI Inpatient SNF Claim Record - Limited Data Set Standard View -- 11/2005

                                                 POSITIONS
                  NAME              TYPE  LENGTH BEG  END                            CONTENTS
       ---------------------------  ----  ------ ---------  ------------------------------------------------------------

                                                            SOURCE:
                                                            CWF

   54. FI Requested Claim Cancel    CHAR      1   298  298  The reason that an intermediary requested cancelling
       Reason Code                                          a previously submitted institutional claim.

                                                            DB2 ALIAS: RQST_CNCL_RSN_CD
                                                            SAS ALIAS: CANCELCD
                                                            STANDARD ALIAS: FI_RQST_CLM_CNCL_RSN_CD
                                                            TITLE ALIAS: CANCEL_CD

                                                            CODES:
                                                              REFER TO: FI_RQST_CLM_CNCL_RSN_TB
                                                                        IN THE CODES APPENDIX

                                                            COMMENT:
                                                            Prior to Version H this field was named:
                                                            INTRMDRY_RQST_CLM_CNCL_RSN_CD.

                                                            SOURCE:
                                                            CWF

   55. Inpatient/SNF Claim          NUM       2   299  300  The count of the number of diagnosis codes (both principal
       Diagnosis Code Count                                 and other) reported on an inpatient/SNF claim.  The purpose
                                                            of this count is to indicate how many claim diagnosis
                                                            trailers are present.

                                                            2 DIGITS UNSIGNED

                                                            DB2 ALIAS: IP_CLM_DGNS_CD_CNT
                                                            SAS ALIAS: IPDGNCNT
                                                            STANDARD ALIAS: IP_CLM_DGNS_CD_CNT

                                                            EDIT-RULES:
                                                            RANGE: 0 TO 10

                                                            COMMENT:
                                                            Prior to Version H this field was named:
                                                            CLM_OTHR_DGNS_CD_CNT and the principal was
                                                            not included in the count.

                                                            SOURCE:
                                                            CWF

   56. Inpatient/SNF Claim          NUM       2   301  302  The count of the number of procedure codes (both principal
       Procedure Code Count                                 and other) reported on an inpatient/SNF claim.  The purpose
                                                            of this count is to indicate how many claim procedure
                                                            trailers are present.

                                                            2 DIGITS UNSIGNED

                                                            DB2 ALIAS: IP_PRCDR_CD_CNT
                                                            SAS ALIAS: IPPRCNT
                                                            STANDARD ALIAS: IP_CLM_PRCDR_CD_CNT
1                       FI Inpatient SNF Claim Record - Limited Data Set Standard View -- 11/2005

                                                 POSITIONS
                  NAME              TYPE  LENGTH BEG  END                            CONTENTS
       ---------------------------  ----  ------ ---------  ------------------------------------------------------------

                                                            EDIT-RULES:
                                                            RANGE: 0 TO 6

                                                            COMMENT:
                                                            Prior to Version H this field was named:
                                                            CLM_PRCDR_CD_CNT.

                                                            SOURCE:
                                                            CWF

   57. Inpatient/SNF Claim Related  NUM       2   303  304  The count of the number of condition codes reported on an
       Condition Code Count                                 inpatient/SNF claim.  The purpose of this count is to
                                                            indicate how many condition code trailers are present.

                                                            2 DIGITS UNSIGNED

                                                            DB2 ALIAS: IP_RLT_COND_CD_CNT
                                                            SAS ALIAS: IPCONCNT
                                                            STANDARD ALIAS: IP_CLM_RLT_COND_CD_CNT

                                                            EDIT-RULES:
                                                            RANGE: 0 TO 30

                                                            COMMENT:
                                                            Prior to Version H this field was named:
                                                            CLM_RLT_COND_CD_CNT.

                                                            SOURCE:
                                                            CWF

   58. Inpatient/SNF Claim Related  NUM       2   305  306  The count of the number of occurrence codes reported on an
       Occurrence Code Count                                inpatient/SNF claim.  The purpose of this count is to
                                                            indicate how many occurrence code trailers are present.

                                                            2 DIGITS UNSIGNED

                                                            DB2 ALIAS: IP_OCRNC_CD_CNT
                                                            SAS ALIAS: IPOCRCNT
                                                            STANDARD ALIAS: IP_CLM_RLT_OCRNC_CD_CNT

                                                            EDIT-RULES:
                                                            RANGE: 0 TO 30

                                                            COMMENT:
                                                            Prior to Version H this field was named:
                                                            CLM_RLT_OCRNC_CD_CNT.

                                                            SOURCE:
                                                            CWF

   59. Inpatient/SNF Claim Value    NUM       2   307  308  The count of the number of value codes reported on
       Code Count                                           an inpatient/SNF claim.  The purpose of the count
                                                            is to indicate how many value code trailers are
                                                            present.

1                       FI Inpatient SNF Claim Record - Limited Data Set Standard View -- 11/2005

                                                 POSITIONS
                  NAME              TYPE  LENGTH BEG  END                            CONTENTS
       ---------------------------  ----  ------ ---------  ------------------------------------------------------------

                                                            2 DIGITS UNSIGNED

                                                            DB2 ALIAS: IP_VAL_CD_CNT
                                                            SAS ALIAS: IPVALCNT
                                                            STANDARD ALIAS: IP_CLM_VAL_CD_CNT

                                                            EDIT-RULES:
                                                            RANGE: 0 TO 36

                                                            COMMENT:
                                                            Prior to Version H this field was named:
                                                            CLM_VAL_CD_CNT.

                                                            SOURCE:
                                                            CWF

   60. Inpatient/SNF Revenue        NUM       2   309  310  The count of the number of revenue codes
       Center Code Count                                    reported on an inpatient/SNF claim.  The
                                                            purpose of the count is to indicate how
                                                            many revenue center trailers are present.

                                                            2 DIGITS UNSIGNED

                                                            DB2 ALIAS: IP_REV_CNTR_CD_CNT
                                                            SAS ALIAS: IPREVCNT
                                                            STANDARD ALIAS: IP_REV_CNTR_CD_I_CNT

                                                            EDIT-RULES:
                                                            RANGE: 0 TO 45

                                                            COMMENT:
                                                            Prior to Version H this field was named:
                                                            CLM_REV_CNTR_CD_CNT.

                                                            NOTE:  During the Version 'I' conversion the
                                                                   number of occurrences changed to 45 (per
                                                                   segment - 450 total for claim).  For
                                                                   claims prior to Version 'I' the number of
                                                                   occurrences was 58, but in the conversion
                                                                   we made all claims back to service year
                                                                   1991 contain only 45 revenue center lines.
                                                                   It is possible that claims prior to 1991
                                                                   will have 2 segments if they contained
                                                                   more than 45 revenue lines.

                                                            SOURCE:
                                                            CWF

   61. NCH Beneficiary Blood        NUM      13   311  323  The amount of money for which the intermediary
       Deductible Liability Amount                          determined the beneficiary is liable for the blood
                                                            deductible.

                                                            9.2 DIGITS SIGNED

1                       FI Inpatient SNF Claim Record - Limited Data Set Standard View -- 11/2005

                                                 POSITIONS
                  NAME              TYPE  LENGTH BEG  END                            CONTENTS
       ---------------------------  ----  ------ ---------  ------------------------------------------------------------

                                                            DB2 ALIAS: BLOOD_DDCTBL_AMT
                                                            SAS ALIAS: BLDDEDAM
                                                            STANDARD ALIAS: NCH_BENE_BLOOD_DDCTBL_AMT
                                                            TITLE ALIAS: BLOOD_DEDUCTIBLE

                                                            EDIT-RULES:
                                                            +9(9).99

                                                            DERIVATION:
                                                            DERIVED FROM:
                                                              CLM_VAL_CD
                                                              CLM_VAL_AMT

                                                            DERIVATION RULES:
                                                            Based on the presence of value code equal to
                                                            '06' move the corresponding value amount to
                                                            NCH_BENE_BLOOD_DDCTBL_AMT.

                                                            COMMENT:
                                                            Prior to Version H, this field was named:
                                                            BENE_BLOOD_DDCTBL_LBLTY_AMT and the field
                                                            size was S9(5)V99.  Also, for OP claims, this
                                                            field was stored in a blood trailer.  Version
                                                            H eliminated the OP blood trailer.

                                                            SOURCE:
                                                            NCH QA PROCESS

   62. NCH Beneficiary Discharge    NUM       8   324  331  Effective with Version H, on an inpatient and
       Date                                                 HHA claim, the date the beneficiary was discharged
                                                            from the facility or died (used for internal CWFMQA
                                                            editing purposes.)

                                                            For the Limited Data Set Standard View of the
                                                            Inpatient/SNF files, the beneficiary's
                                                            discharge date is coded as the quarter
                                                            of the calendar year when the discharge
                                                            occurred.

                                                            NOTE:  During the Version H conversion this field
                                                            was populated with data throughout history (back to
                                                            service year 1991.)

                                                            8 DIGITS UNSIGNED

                                                            DB2 ALIAS: NCH_BENE_DSCHRG_DT
                                                            SAS ALIAS: DSCHRGDT
                                                            STANDARD ALIAS: NCH_BENE_DSCHRG_DT
                                                            TITLE ALIAS: DISCHARGE_DT

                                                            EDIT-RULES FOR LIMITED DATA SET DATA:
                                                            YYYYQ000 WHERE Q IS ONE OF THE
                                                            FOLLOWING VALUES.
                                                            1 = FIRST QUARTER OF THE CALENDAR YEAR
1                       FI Inpatient SNF Claim Record - Limited Data Set Standard View -- 11/2005

                                                 POSITIONS
                  NAME              TYPE  LENGTH BEG  END                            CONTENTS
       ---------------------------  ----  ------ ---------  ------------------------------------------------------------

                                                            2 = SECOND QUARTER OF THE CALENDAR YEAR
                                                            3 = THIRD QUARTER OF THE CALENDAR YEAR
                                                            4 = FOURTH QUARTER OF THE CALENDAR YEAR

                                                            DERIVATION:
                                                            DERIVED FROM:
                                                              NCH_PTNT_STUS_IND_CD
                                                              CLM_THRU_DT

                                                            DERIVATION RULES:
                                                            Based on the presence of patient discharge status
                                                            code not equal to 30 (still patient), move the claim
                                                            thru date to the NCH_BENE_DSCHRG_DT.

                                                            SOURCE:
                                                            NCH QA Process

   63. NCH Inpatient Total          NUM      13   332  344  Effective with Version H, the total Part A
       Deduction Amount                                     deductions reported on the Inpatient claim (used
                                                            for internal CWFMQA editing purposes).

                                                            NOTE:  During the Version H conversion this field
                                                            was populated with data throughout history (back
                                                            to 1991), but the derivation rule applied was in-
                                                            complete for claims processed prior to 10/93.
                                                            Disregard any data present in this field on claims
                                                            with NCH weekly process date earlier than 10/93.

                                                            9.2 DIGITS SIGNED

                                                            DB2 ALIAS: IP_TOT_DDCTN_AMT
                                                            SAS ALIAS: TDEDAMT
                                                            STANDARD ALIAS: NCH_BENE_IP_DDCTBL_AMT
                                                            TITLE ALIAS: IP_TOT_DEDUCTIONS

                                                            EDIT-RULES:
                                                            +9(9).99

                                                            DERIVATION:
                                                            DERIVED FROM:
                                                              CLM_VAL_CD
                                                              CLM_VAL_AMT

                                                            DERIVATION RULES (Effective 10/93):
                                                            Accumulate the value amounts associated with
                                                            value codes equal to 06, 08 thru 11 and A1, B1
                                                            or C1 and move to NCH_BENE_IP_DDCTBL_AMT.
                                                            NOTE:  Value codes 08-11 did not exist in the
                                                            NCH prior to 2/93; values codes A1, B1, C1 did
                                                            not exist prior to 10/93.

                                                            SOURCE:
                                                            NCH QA Process

1                       FI Inpatient SNF Claim Record - Limited Data Set Standard View -- 11/2005

                                                 POSITIONS
                  NAME              TYPE  LENGTH BEG  END                            CONTENTS
       ---------------------------  ----  ------ ---------  ------------------------------------------------------------

   64. NCH Beneficiary Part A       NUM      13   345  357  The amount of money for which the intermediary has
       Coinsurance Liability                                determined that the beneficiary is liable for
       Amount                                               Part A coinsurance on the institutional claim.

                                                            9.2 DIGITS SIGNED

                                                            DB2 ALIAS: PTA_COINSRNC_AMT
                                                            SAS ALIAS: COIN_AMT
                                                            STANDARD ALIAS: NCH_BENE_PTA_COINSRNC_AMT
                                                            TITLE ALIAS: BENE_PTA_COINSURANCE

                                                            EDIT-RULES:
                                                            +9(9).99

                                                            DERIVATION:
                                                            DERIVED FROM:
                                                              CLM_VAL_CD
                                                              CLM_VAL_AMT

                                                            DERIVATION RULES:
                                                            Based on the presence of value code equal to
                                                            8, 9, 10 or 11 move the corresponding value
                                                            amount to the NCH_BENE_IP_PTA_COINSRC_AMT.

                                                            COMMENT:
                                                            Prior to Version H this field was named:
                                                            BENE_PTA_COINSRNC_LBLTY_AMT and the field size
                                                            was S9(5)V99.

                                                            SOURCE:
                                                            NCH

   65. NCH Blood Deductible Pints   NUM       4   358  361  The quantity of blood pints applied (blood
       Quantity                                             deductible).

                                                            3 DIGITS SIGNED

                                                            DB2 ALIAS: BLOOD_DDCTBL_QTY
                                                            SAS ALIAS: BLDDEDPT
                                                            STANDARD ALIAS: NCH_BLOOD_DDCTBL_PT_QTY
                                                            TITLE ALIAS: BLOOD_PINTS_DEDUCTIBLE

                                                            EDIT-RULES:
                                                            +999

                                                            DERIVATION:
                                                            DERIVED FROM:
                                                              CLM_VAL_CD
                                                              CLM_VAL_AMT

                                                            DERIVATION RULES:
                                                            Based on the presence of value code equal to
                                                            38 move the related value amount to the
                                                            NCH_BLOOD_DDCTBL_PT_QTY.
1                       FI Inpatient SNF Claim Record - Limited Data Set Standard View -- 11/2005

                                                 POSITIONS
                  NAME              TYPE  LENGTH BEG  END                            CONTENTS
       ---------------------------  ----  ------ ---------  ------------------------------------------------------------

                                                            COMMENT:
                                                            Prior to Version H this field was named:
                                                            CLM_BLOOD_DDCTBL_PT_QTY.  Also for outpatient
                                                            claims this field was stored in a blood
                                                            trailer.  Version H eliminated the outpatient
                                                            blood trailer.

                                                            SOURCE:
                                                            NCH QA Process

   66. NCH Blood Non-Covered        NUM      13   362  374  Effective with Version H, the total noncovered
       Charge Amount                                        charges for blood usage (for internal CWFMQA
                                                            editing purposes).

                                                            NOTE:  During the Version H conversion this field
                                                            was populated with data throughout history (back
                                                            to service year 1991).

                                                            9.2 DIGITS SIGNED

                                                            DB2 ALIAS: BLOOD_NCVR_AMT
                                                            DB2 ALIAS: BLOOD_NCVR_AMT
                                                            SAS ALIAS: BLDNCHRG
                                                            STANDARD ALIAS: NCH_BLOOD_NCOV_CHRG_AMT
                                                            TITLE ALIAS: BLOOD_NCV_CHARGES

                                                            EDIT-RULES:
                                                            +9(9).99

                                                            DERIVATION:
                                                            DERIVED FROM:
                                                              REV_CNTR_CD
                                                              REV_CNTR_NCOV_CHRG_AMT

                                                            DERIVATION RULES:
                                                            Based on the presence of revenue center codes equal
                                                            to 0380 thru 0389 move the related noncovered
                                                            charges to NCH_BLOOD_NCOV_CHRG_AMT.

                                                            SOURCE:
                                                            NCH QA Process

   67. NCH Blood Pints Furnished    NUM       4   375  378  Number of whole pints of blood furnished to the
       Quantity                                             beneficiary.

                                                            3 DIGITS SIGNED

                                                            DB2 ALIAS: NCH_BLOOD_PT_FRNSH
                                                            SAS ALIAS: BLDFRNSH
                                                            STANDARD ALIAS: NCH_BLOOD_PT_FRNSH_QTY
                                                            TITLE ALIAS: BLOOD_PINTS_FURNISHED

1                       FI Inpatient SNF Claim Record - Limited Data Set Standard View -- 11/2005

                                                 POSITIONS
                  NAME              TYPE  LENGTH BEG  END                            CONTENTS
       ---------------------------  ----  ------ ---------  ------------------------------------------------------------

                                                            EDIT-RULES:
                                                            +999

                                                            DERIVATION:
                                                            DERIVED FROM:
                                                              CLM_VAL_CD
                                                              CLM_VAL_AMT

                                                            DERIVATION RULES:
                                                            Based on the presence of value code equal to
                                                            37 move the related value amount to the
                                                            NCH_BLOOD_PT_FRNSH_QTY.

                                                            COMMENT:
                                                            Prior to Version H this field was named:
                                                            CLM_BLOOD_PT_FRNSH_QTY.  Also for outpatient
                                                            claims this field was stored in a blood
                                                            trailer.  Version H eliminated the outpatient
                                                            blood trailer.

                                                            SOURCE:
                                                            NCH QA Process

   68. NCH Blood Pints Not          NUM       4   379  382  Number of whole pints of blood not replaced.
       Replaced Quantity
                                                            3 DIGITS SIGNED

                                                            DB2 ALIAS: BLOOD_PT_NRPLC_QTY
                                                            SAS ALIAS: BLDNRPLC
                                                            STANDARD ALIAS: NCH_BLOOD_PT_NRPLC_QTY
                                                            TITLE ALIAS: BLOOD_PINTS_NOT_REPLACED

                                                            EDIT-RULES:
                                                            +999

                                                            DERIVATION:
                                                            DERIVED FROM:
                                                              CLM_VAL_CD
                                                              CLM_VAL_AMT

                                                            DERIVATION RULES:
                                                            Subtract value code 39 amount from value code
                                                            37 amount and move the result to
                                                            NCH_BLOOD_PT_NRPLC_QTY.

                                                            COMMENT:
                                                            Prior to Version H this field was named:
                                                            CLM_BLOOD_PT_NRPLC_QTY.  Also for outpatient
                                                            claims this field was stored in a blood
                                                            trailer.  Version H eliminated the outpatient
                                                            blood trailer.

                                                            SOURCE:
                                                            NCH QA Process

1                       FI Inpatient SNF Claim Record - Limited Data Set Standard View -- 11/2005

                                                 POSITIONS
                  NAME              TYPE  LENGTH BEG  END                            CONTENTS
       ---------------------------  ----  ------ ---------  ------------------------------------------------------------

   69. NCH Blood Pints Replaced     NUM       4   383  386  Number of whole pints of blood replaced.
       Quantity
                                                            3 DIGITS SIGNED

                                                            DB2 ALIAS: BLOOD_PT_RPLC_QTY
                                                            SAS ALIAS: BLD_RPLC
                                                            STANDARD ALIAS: NCH_BLOOD_PT_RPLC_QTY
                                                            TITLE ALIAS: BLOOD_PINTS_REPLACED

                                                            EDIT-RULES:
                                                            +999

                                                            DERIVATION:
                                                            DERIVED FROM:
                                                              CLM_VAL_CD
                                                              CLM_VAL_AMT

                                                            DERIVATION RULES:
                                                            Based on the presence of value code equal to
                                                            39 move the related value amount to the
                                                            NCH_BLOOD_PT_RPLC_QTY.

                                                            COMMENT:
                                                            Prior to Version H this field was named:
                                                            CLM_BLOOD_PT_RPLC_QTY.  Also for outpatient
                                                            claims this field was stored in a blood
                                                            trailer.  Version H eliminated the outpatient
                                                            blood trailer.

                                                            SOURCE:
                                                            NCH QA Process

   70. NCH Blood Total Charge       NUM      13   387  399  Effective with Version H, the total charge for
       Amount                                               blood usage (for internal CWFMQA editing
                                                            purposes).

                                                            NOTE:  During the Version H conversion this field
                                                            was populated with data throughout history (back
                                                            to service year 1991).

                                                            9.2 DIGITS SIGNED

                                                            DB2 ALIAS: BLOOD_TOT_CHRG_AMT
                                                            SAS ALIAS: BLDTCHRG
                                                            STANDARD ALIAS: NCH_BLOOD_TOT_CHRG_AMT
                                                            TITLE ALIAS: BLOOD_CHARGES

                                                            EDIT-RULES:
                                                            +9(9).99

                                                            DERIVATION:
                                                            DERIVED FROM:
                                                               REV_CNTR_CD
                                                               REV_CNTR_TOT_CHRG_AMT

1                       FI Inpatient SNF Claim Record - Limited Data Set Standard View -- 11/2005

                                                 POSITIONS
                  NAME              TYPE  LENGTH BEG  END                            CONTENTS
       ---------------------------  ----  ------ ---------  ------------------------------------------------------------

                                                            DERIVATION RULES:
                                                            Based on the presence of revenue center codes
                                                            0380 thru 0389 move the related total charge
                                                            amount to the NCH_BLOOD_TOT_CHRG_AMT.

                                                            SOURCE:
                                                            NCH QA Process

   71. NCH DRG Outlier Approved     NUM      13   400  412  On an institutional claim, the additional
       Payment Amount                                       payment amount approved by the Peer Review
                                                            Organization due to an outlier situation for
                                                            a beneficiary's stay under the prospective
                                                            payment system, which has been classified
                                                            into a specific diagnosis related group.

                                                            9.2 DIGITS SIGNED

                                                            DB2 ALIAS: DRG_OUTLIER_AMT
                                                            SAS ALIAS: OUTLRPMT
                                                            STANDARD ALIAS: NCH_DRG_OUTLIER_APRV_PMT_AMT
                                                            TITLE ALIAS: DRG_OUTLIER_PMT

                                                            EDIT-RULES:
                                                            +9(9).99

                                                            DERIVATION:
                                                            DERIVED FROM:
                                                              CLM_VAL_CD
                                                              CLM_VAL_AMT

                                                            DERIVATION RULES:
                                                            Based on the presence of value code equal
                                                            to 17 move the related amount to
                                                            NCH_DRG_OUTLIER_APRV_PMT_AMT.

                                                            COMMENT:
                                                            Prior to Version H this field was named:
                                                            CLM_DRG_OUTLIER_APRV_PMT_AMT and field size
                                                            was S9(7)V99.

                                                            SOURCE:
                                                            NCH QA Process

   72. NCH Near Line Record         CHAR      1   413  413  A code defining the type of claim record being processed.
       Identification Code
                                                            COMMON ALIAS:  RIC
                                                            DB2 ALIAS:  NEAR_LINE_RIC_CD
                                                            SAS ALIAS:  RIC_CD
                                                            STANDARD ALIAS:  NCH_NEAR_LINE_RIC_CD
                                                            TITLE ALIAS:  RIC

1                       FI Inpatient SNF Claim Record - Limited Data Set Standard View -- 11/2005

                                                 POSITIONS
                  NAME              TYPE  LENGTH BEG  END                            CONTENTS
       ---------------------------  ----  ------ ---------  ------------------------------------------------------------


                                                            CODES:
                                                              REFER TO: NCH_NEAR_LINE_RIC_TB
                                                                        IN THE CODES APPENDIX

                                                            COMMENT:
                                                            Prior to Version H this field was named:
                                                            RIC_CD.

                                                            SOURCE:
                                                            NCH

   73. NCH Near-Line Record         CHAR      1   414  414  The code indicating the record version of the Nearline file
       Version Code                                         where the institutional, carrier or DMERC claims data are
                                                            stored:

                                                            DB2 ALIAS:  NCH_REC_VRSN_CD
                                                            SAS ALIAS:  REC_LVL
                                                            STANDARD ALIAS:  NCH_NEAR_LINE_REC_VRSN_CD
                                                            TITLE ALIAS:  NCH_VERSION

                                                            CODES:
                                                            A = Record format as of January 1991
                                                            B = Record format as of April 1991
                                                            C = Record format as of May 1991
                                                            D = Record format as of January 1992
                                                            E = Record format as of March 1992
                                                            F = Record format as of May 1992
                                                            G = Record format as of October 1993
                                                            H = Record format as of September 1998
                                                            I = Record format as of July 2000

                                                            COMMENT:
                                                            Prior to Version H this field was named:
                                                            CLM_NEAR_LINE_REC_VRSN_CD

                                                            SOURCE:
                                                            NCH

                                                            COMMENT:
                                                            Prior to Version H this field was named:
                                                            CLM_NEAR_LINE_REC_VRSN_CD

                                                            SOURCE:
                                                            NCH

1                       FI Inpatient SNF Claim Record - Limited Data Set Standard View -- 11/2005

                                                 POSITIONS
                  NAME              TYPE  LENGTH BEG  END                            CONTENTS
       ---------------------------  ----  ------ ---------  ------------------------------------------------------------

   74. NCH Patient Status           CHAR      1   415  415  Effective with Version H, the code on an
       Indicator Code                                       inpatient/SNF and Hospice claim, indicating
                                                            whether the beneficiary was discharged, died
                                                            or still a patient (used for internal CWFMQA
                                                            editing purposes.)

                                                            NOTE:  During the Version H conversion this
                                                            field was populated throughout history (back to
                                                            service year 1991).

                                                            DB2 ALIAS: NCH_PTNT_STUS_IND
                                                            SAS ALIAS: PTNTSTUS
                                                            STANDARD ALIAS: NCH_PTNT_STUS_IND_CD
                                                            TITLE ALIAS: NCH_PATIENT_STUS

                                                            DERIVATION:
                                                            DERIVED FROM:
                                                              NCH PTNT_DSCHRG_STUS_CD

                                                            DERIVATION RULES:

                                                              SET NCH_PTNT_STUS_IND_CD TO 'A' WHERE THE
                                                              PTNT_DSCHRG_STUS_CD NOT EQUAL TO '20'- '30'
                                                              OR '40' - '42'.

                                                              SET NCH_PTNT_STUS_IND_CD TO 'B' WHERE THE
                                                              PTNT_DSCHRG_STUS_CD EQUAL TO '20'- '29'
                                                              OR '40' - '42'.

                                                              SET NCH_PTNT_STUS_IND_CD TO 'C' WHERE THE
                                                              PTNT_DSCHRG_STUS_CD EQUAL TO '30'


                                                            CODES:
                                                            A = Discharged
                                                            B = Died
                                                            C = Still patient

                                                            SOURCE:
                                                            NCH QA Process

   75. NCH Payment and Edit Record  CHAR      1   416  416  The code used for payment and editing purposes that
       Identification Code                                  indicates the type of institutional claim record.

                                                            DB2 ALIAS: PMT_EDIT_RIC_CD
                                                            SAS ALIAS: PE_RIC
                                                            STANDARD ALIAS: NCH_PMT_EDIT_RIC_CD
                                                            TITLE ALIAS: NCH_PAYMENT_EDIT_REC

                                                            CODES:
                                                            C = Inpatient hospital, SNF
                                                            D = Outpatient
                                                            E = Religious Nonmedical Health Care Institutions (eff. 8/00

1                       FI Inpatient SNF Claim Record - Limited Data Set Standard View -- 11/2005

                                                 POSITIONS
                  NAME              TYPE  LENGTH BEG  END                            CONTENTS
       ---------------------------  ----  ------ ---------  ------------------------------------------------------------

                                                                Christian Science, prior to 7/00
                                                            F = Home Health Agency (HHA)
                                                            G = Discharge notice
                                                                (obsoleted 7/98)
                                                            I = Hospice

                                                            COMMENT:
                                                            Prior to Version H this field was named:
                                                            PMT_EDIT_RIC_CD.

                                                            SOURCE:
                                                            NCH QA Process

   76. NCH Primary Payer Claim      NUM      13   417  429  The amount of a payment made on behalf of a Medicare
       Paid Amount                                          beneficiary by a primary payer other than Medicare, that the
                                                            provider is applying to covered Medicare charges on an
                                                            institutional, carrier, or DMERC claim.

                                                            9.2 DIGITS SIGNED

                                                            DB2 ALIAS: PRMRY_PYR_PD_AMT
                                                            SAS ALIAS: PRPAYAMT
                                                            STANDARD ALIAS: NCH_PRMRY_PYR_CLM_PD_AMT
                                                            TITLE ALIAS: PRIMARY_PAYER_AMOUNT

                                                            EDIT-RULES:
                                                            +9(9).99

                                                            COMMENT:
                                                            Prior to Version H this field was named:
                                                            BENE_PRMRY_PYR_CLM_PMT_AMT and the field size
                                                            was S9(7)V99.

                                                            SOURCE:
                                                            NCH

   77. NCH Primary Payer Code       CHAR      1   430  430  The code, on an institutional claim, specifying a federal
                                                            non-Medicare program or other source that has primary
                                                            responsibility for the payment of the Medicare beneficiary's
                                                            health insurance bills.

                                                            DB2 ALIAS: NCH_PRMRY_PYR_CD
                                                            SAS ALIAS: PRPAY_CD
                                                            STANDARD ALIAS: NCH_PRMRY_PYR_CD
                                                            TITLE ALIAS: PRIMARY_PAYER_CD

                                                            DERIVATION:
                                                            DERIVED FROM:
                                                               CLM_VAL_CD
                                                               CLM_VAL_AMT

                                                            DERIVATION RULES

1                       FI Inpatient SNF Claim Record - Limited Data Set Standard View -- 11/2005

                                                 POSITIONS
                  NAME              TYPE  LENGTH BEG  END                            CONTENTS
       ---------------------------  ----  ------ ---------  ------------------------------------------------------------

                                                              SET NCH_PRMRY_PYR_CD TO 'A' WHERE THE
                                                              CLM_VAL_CD = '12'

                                                              SET NCH_PRMRY_PYR_CD TO 'B' WHERE THE
                                                              CLM_VAL_CD = '13'

                                                              SET NCH_PRMRY_PYR_CD TO 'C' WHERE THE
                                                              CLM_VAL_CD = '16' and CLM_VAL_AMT is zeroes

                                                              SET NCH_PRMRY_PYR_CD TO 'D' WHERE THE
                                                              CLM_VAL_CD = '14'

                                                              SET NCH_PRMRY_PYR_CD TO 'E' WHERE THE
                                                              CLM_VAL_CD = '15'

                                                              SET NCH_PRMRY_PYR_CD TO 'F' WHERE THE
                                                              CLM_VAL_CD = '16' (CLM_VAL_AMT not
                                                              equal to zeroes)

                                                              SET NCH_PRMRY_PYR_CD TO 'G' WHERE THE
                                                              CLM_VAL_CD = '43'

                                                              SET NCH_PRMRY_PYR_CD TO 'H' WHERE THE
                                                              CLM_VAL_CD = '41'

                                                              SET NCH_PRMRY_PYR_CD TO 'I' WHERE THE
                                                              CLM_VAL_CD = '42'

                                                              SET NCH_PRMRY_PYR_CD TO 'L' (or prior to 4/97
                                                              set code to 'J') WHERE THE CLM_VAL_CD = '47'

                                                            CODES:
                                                              REFER TO: BENE_PRMRY_PYR_TB
                                                                        IN THE CODES APPENDIX

                                                            COMMENT:
                                                            Prior to Version H this field was named:
                                                            BENE_PRMRY_PYR_CD.

                                                            SOURCE:
                                                            NCH

   78. NCH Professional Component   NUM      13   431  443  Effective with Version H, for inpatient and out-
       Charge Amount                                        patient claims, the amount of physician and other
                                                            professional charges covered under Medicare Part B
                                                            (used for internal CWFMQA editing purposes and other
                                                            internal processes (e.g. if computing interim payment
                                                            these charges are deducted)).

                                                            NOTE:  During the Version H conversion this field
                                                            was populated with data throughout history (back to
                                                            service year 1991).

                                                            9.2 DIGITS SIGNED

1                       FI Inpatient SNF Claim Record - Limited Data Set Standard View -- 11/2005

                                                 POSITIONS
                  NAME              TYPE  LENGTH BEG  END                            CONTENTS
       ---------------------------  ----  ------ ---------  ------------------------------------------------------------

                                                            DB2 ALIAS: PROFNL_CMPNT_AMT
                                                            SAS ALIAS: PCCHGAMT
                                                            STANDARD ALIAS: NCH_PROFNL_CMPNT_CHRG_AMT
                                                            TITLE ALIAS: PROFNL_CMPNT_CHARGES

                                                            EDIT-RULES:
                                                            +9(9).99

                                                            DERIVATION:

                                                            1. IF INPATIENT - DERIVED FROM:
                                                               CLM_VAL_CD
                                                               Clm_VAL_AMT

                                                            DERIVATION RULES:
                                                            Based on the presence of value code 04 or 05
                                                            move the related value amount to the
                                                            NCH_PROFNL_CMPNT_CHRG_AMT.

                                                            2. IF OUTPATIENT - DERIVED FROM:
                                                               REV_CNTR_CD
                                                               REV_CNTR_TOT_CHRG_AMT

                                                            DERIVATION RULES (Effective 10/98):
                                                            Based on the presence of revenue center codes
                                                            096X, 097X & 098X move the related total charge
                                                            amount to NCH_PROFNL_CMPNT_CHRG_AMT.

                                                            NOTE1:  During the Version H conversion, this
                                                            field was populated with data throughout history
                                                            BUT the derivation rule applied to the outpatient
                                                            claim was incomplete (i.e., revenue codes 0972,
                                                            0973, 0974 and 0979 were omitted from the calcu-
                                                            lation).

                                                            SOURCE:
                                                            NCH QA Process

   79. NCH Provider State Code      CHAR      2   444  445  Effective with Version H, the two position SSA state code
                                                            where provider facility is located.

                                                            NOTE:  During the Version H conversion this field was
                                                            populated with data throughout history (back to service year
                                                            1991).

                                                            DB2 ALIAS: NCH_PRVDR_STATE_CD
                                                            SAS ALIAS: PRSTATE
                                                            STANDARD ALIAS: NCH_PRVDR_STATE_CD
                                                            TITLE ALIAS: PROVIDER_STATE_CD

                                                            DERIVATION:
                                                            DERIVED FROM:
                                                               NCH PRVDR_NUM

1                       FI Inpatient SNF Claim Record - Limited Data Set Standard View -- 11/2005

                                                 POSITIONS
                  NAME              TYPE  LENGTH BEG  END                            CONTENTS
       ---------------------------  ----  ------ ---------  ------------------------------------------------------------

                                                            DERIVATION RULES:

                                                              SET NCH_PRVDR_STATE_CD TO
                                                                  PRVDR_NUM POS1-2.
                                                              FOR PRVDR_NUM POS1-2 EQUAL '55
                                                                SET NCH_PRVDR_STATE_CD TO '05'.
                                                              FOR PRVDR_NUM POS1-2 EQUAL '67
                                                                SET NCH_PRVDR_STATE_CD TO '45'.
                                                              FOR PRVDR_NUM POS1-2 EQUAL '68
                                                                SET NCH_PRVDR_STATE_CD TO '10'.

                                                            CODES:
                                                              REFER TO: GEO_SSA_STATE_TB
                                                                        IN THE CODES APPENDIX

                                                            SOURCE:
                                                            NCH

   80. NCH Qualify Stay Through     NUM       8   446  453  Effective with Version H, the ending date of
       Date                                                 the beneficiary's qualifying stay (used for internal
                                                            CWFMQA editing purposes.)   For inpatient claims, the
                                                            date relates to the PPS portion of the inlier for
                                                            which there is no utilization to benefits. For
                                                            SNF claims, the date relates to a qualifying stay
                                                            from a hospital that is at least two days in a row
                                                            if the source of admission is an 'A', or at least
                                                            three days in a row if the source of admission
                                                            is other than 'A'.

                                                            For the Limited Data Set Standard View of the
                                                            Inpatient/SNF files, the beneficiary's qualifying
                                                            stay through date is coded as the quarter of
                                                            calendar year when the stay through date
                                                            occurred.

                                                            NOTE:  During the Version H, conversion this field
                                                            was populated with data throughout history (back to
                                                            service year 1991).

                                                            8 DIGITS UNSIGNED

                                                            DB2 ALIAS: QLFY_STAY_THRU_DT
                                                            SAS ALIAS: QLFYTHRU
                                                            STANDARD ALIAS: NCH_QLFY_STAY_THRU_DT
                                                            TITLE ALIAS: QLFYG_STAY_THRU_DT

                                                            EDIT-RULES FOR LIMITED DATA SET DATA:
                                                            YYYYQ000 WHERE Q IS ONE OF THE
                                                            FOLLOWING VALUES.
                                                            1 = FIRST QUARTER OF THE CALENDAR YEAR
                                                            2 = SECOND QUARTER OF THE CALENDAR YEAR
                                                            3 = THIRD QUARTER OF THE CALENDAR YEAR
                                                            4 = FOURTH QUARTER OF THE CALENDAR YEAR

1                       FI Inpatient SNF Claim Record - Limited Data Set Standard View -- 11/2005

                                                 POSITIONS
                  NAME              TYPE  LENGTH BEG  END                            CONTENTS
       ---------------------------  ----  ------ ---------  ------------------------------------------------------------

                                                            DERIVATION:
                                                            DERIVED FROM:
                                                              CLM_OCRNC_SPAN_CD
                                                              CLM_OCRNC_SPAN_THRU_DT

                                                            DERIVATION RULES:
                                                            Based on the presence of occurrence code 70
                                                            move the related occurrence thru date to
                                                            NCH_QLFY_STAY_THRU_DT.

                                                            SOURCE:
                                                            NCH QA Process

   81. Patient Discharge Status     CHAR      2   454  455  The code used to identify the status of the
       Code                                                 patient as of the CLM_THRU_DT.

                                                            COMMON ALIAS: DISCHARGE_DESTINATION/PATIENT_STATUS
                                                            DB2 ALIAS: PTNT_DSCHRG_STUS
                                                            SAS ALIAS: STUS_CD
                                                            STANDARD ALIAS: PTNT_DSCHRG_STUS_CD
                                                            SYSTEM ALIAS: LTCLMST
                                                            TITLE ALIAS: PTNT_DSCHRG_STUS_CD

                                                            CODES:
                                                              REFER TO: PTNT_DSCHRG_STUS_TB
                                                                        IN THE CODES APPENDIX

                                                            COMMENT:
                                                            Prior to Version H this field was named:
                                                            CLM_STUS_CD.

                                                            SOURCE:
                                                            CWF

   82. Provider Number              CHAR      6   456  461  The identification number of the institutional provider
                                                            certified by Medicare to provide services to the
                                                            beneficiary.

                                                            DB2 ALIAS: PRVDR_NUM
                                                            SAS ALIAS: PROVIDER
                                                            STANDARD ALIAS: PRVDR_NUM
                                                            TITLE ALIAS: PROVIDER_NUMBER

                                                            CODES:
                                                              REFER TO: PRVDR_NUM_TB
                                                                        IN THE CODES APPENDIX

                                                              SOURCE:
                                                              OSCAR

1                       FI Inpatient SNF Claim Record - Limited Data Set Standard View -- 11/2005

                                                 POSITIONS
                  NAME              TYPE  LENGTH BEG  END                            CONTENTS
       ---------------------------  ----  ------ ---------  ------------------------------------------------------------

  *** DESY Trailer Group            GROUP     50  462  511  DESY trailer

   83. DESY System User             CHAR      30  462  491  A user-defined field that holds the description
                                                            of the request.  For example, "Cross-referenced
                                                            HICs".
                                                            This field is blank for limited data set files.

                                                            STANDARD ALIAS: SYSTEM_USER

   84. Filler                       CHAR      11  492  502  Filler
                                                            This field is blank for limited data set files.

                                                            STANDARD ALIAS: FILLER

   85. DESY Sort Key                CHAR       9  503  511  This field contains the key to tie claims
                                                            together for one beneficiary regardless of HICAN
                                                            This field is blank for limited data set files.

                                                            STANDARD ALIAS: DESY_SORT_KEY

1                       FI Inpatient SNF Claim Record - Limited Data Set Standard View -- 11/2005


       ******************************************************************************************************************

                              C L A I M     D I A G N O S I S     G R O U P     R E C O R D

       *****************************************************************************************************************


                                                 POSITIONS
                  NAME              TYPE  LENGTH BEG  END                            CONTENTS
       ---------------------------  ----  ------ ---------  ------------------------------------------------------------

 ****  FI Inpatient/Skilled         GROUP    26             Claim Diagnosis Group Record for the
       Nursing Facility Claim                               Limited Data Set Standard View of the
       Diagnosis Group Record -                             Inpatient/Skilled Nursing Facility
       Limited Data Set Standard                            version I NCH Nearline File.
       View
                                                            The number of claim diagnosis trailers is
                                                            determined by the claim diagnosis code
                                                            count.  The principal diagnosis is the first occurrence.
                                                            The 'E' code (ICD-9-CM code for the external cause
                                                            of an injury, poisoning, or adverse affect) is
                                                            stored as the last occurrence.
                                                            The principal diagnosis and the 'E' code are also
                                                            stored (redundantly) in the fixed record.

                                                            NOTE:
                                                            Prior to Version H this group was named:
                                                            CLM_OTHR_DGNS_GRP and did not contain the
                                                            CLM_PRNCPAL_DGNS_CD.

                                                            OCCURS: UP TO 10 TIMES
                                                                    DEPENDING ON IP_CLM_DGNS_CD_CNT

                                                            STANDARD ALIAS: CLM_DGNS_GRP

    1. Record Length Count          NUM       5     1    5  The length of the Claim Diagnosis Group Record.

                                                            5 DIGITS UNSIGNED

                                                            STANDARD ALIAS: DSY_VW_BYTE_CNT

    2. Record Number                NUM       9     6   14  A sequentially assigned number for the claims included
                                                            in the file. This number allows the user to link all of
                                                            the records associated with one claim.

                                                            STANDARD ALIAS: DSY_VW_REC_LNK_NUM

    3. Record Type                  NUM       2    15   16  Type of Record.

                                                            STANDARD ALIAS: DSY_VW_REC_TYPE

                                                            CODES:
                                                            00 = Fixed/Main Group
                                                            01 = Carrier Line Group
                                                            02 = Claim Demonstration ID Group
                                                            03 = Claim Diagnosis Group

1                       FI Inpatient SNF Claim Record - Limited Data Set Standard View -- 11/2005

                                                 POSITIONS
                  NAME              TYPE  LENGTH BEG  END                            CONTENTS
       ---------------------------  ----  ------ ---------  ------------------------------------------------------------

                                                            04 = Claim Health PlanID Group
                                                            05 = Claim Occurrence Span Group
                                                            06 = Claim Procedure Group
                                                            07 = Claim Related Condition Group
                                                            08 = Claim Related Occurrence Group
                                                            09 = Claim Value Group
                                                            10 = MCO Period Group
                                                            11 = NCH Edit Group
                                                            12 = NCH Patch Group
                                                            13 = DMERC Line Group
                                                            14 = Revenue Center Group

    4. Claim Sequence Number        NUM       3    17   19  A counter for records that consist of trailer
                                                            information, such as claim line and revenue center
                                                            data, which can occur multiple times for one claim.

                                                            STANDARD ALIAS: DSY_VW_REC_SEQ

    5. NCH Claim Type Code          CHAR      2    20   21  The code used to identify the type of claim record being
                                                            processed in NCH.

                                                            NOTE1:  During the Version H conversion this field was
                                                                    populated with data through- out history (back to
                                                                    service year 1991).

                                                            NOTE2:  During the Version I conversion this field was
                                                                    expanded to include inpatient 'full' encounter
                                                                    claims (for service dates after 6/30/97).
                                                                    Placeholders for Physician and Outpatient encounters
                                                                    (available in NMUD) have also been added.

                                                            STANDARD ALIAS: NCH_CLM_TYPE_CD

                                                            DERIVATION:
                                                            FFS CLAIM TYPE CODES DERIVED FROM:
                                                              NCH CLM_NEAR_LINE_RIC_CD
                                                              NCH PMT_EDIT_RIC_CD
                                                              NCH CLM_TRANS_CD
                                                              NCH PRVDR_NUM

                                                            INPATIENT 'FULL' ENCOUNTER TYPE CODE DERIVED FROM:
                                                              (Pre-HDC processing -- AVAILABLE IN NCH)
                                                              CLM_MCO_PD_SW
                                                              CLM_RLT_COND_CD
                                                              MCO_CNTRCT_NUM
                                                              MCO_OPTN_CD
                                                              MCO_PRD_EFCTV_DT
                                                              MCO_PRD_TRMNTN_DT

                                                            INPATIENT 'FULL' ENCOUNTER TYPE CODE DERIVED FROM:
                                                              (HDC processing -- AVAILABLE IN NMUD)
                                                              FI_NUM

1                       FI Inpatient SNF Claim Record - Limited Data Set Standard View -- 11/2005

                                                 POSITIONS
                  NAME              TYPE  LENGTH BEG  END                            CONTENTS
       ---------------------------  ----  ------ ---------  ------------------------------------------------------------

                                                            INPATIENT 'ABBREVIATED' ENCOUNTER TYPE CODE DERIVED
                                                            FROM: (HDC processing -- AVAILABLE IN NMUD)
                                                              FI_NUM
                                                              CLM_FAC_TYPE_CD
                                                              CLM_SRVC_CLSFCTN_TYPE_CD
                                                              CLM_FREQ_CD
                                                            NOTE:  From 7/1/97 to the start of HDC processing(?),
                                                            abbreviated inpatient encounter claims are not
                                                            available in NCH or NMUD.

                                                            PHYSICIAN 'FULL' ENCOUNTER TYPE CODE DERIVED FROM:
                                                              (AVAILABLE IN NMUD)
                                                              CARR_NUM
                                                              CLM_DEMO_ID_NUM

                                                            OUTPATIENT 'FULL' ENCOUNTER TYPE CODE DERIVED FROM:
                                                              (AVAILABLE IN NMUD)
                                                              FI_NUM

                                                            OUTPATIENT 'ABBREVIATED' ENCOUNTER TYPE CODE
                                                            DERIVED FROM:  (AVAILABLE IN NMUD)
                                                              FI_NUM
                                                              CLM_FAC_TYPE_CD
                                                              CLM_SRVC_CLSFCTN_TYPE_CD
                                                              CLM_FREQ_CD

                                                            DERIVATION RULES:

                                                              SET CLM_TYPE_CD TO 10 (HHA CLAIM) WHERE THE
                                                              FOLLOWING CONDITIONS ARE MET:
                                                              1.   CLM_NEAR_LINE_RIC_CD EQUAL 'V','W' OR 'U'
                                                              2.   PMT_EDIT_RIC_CD EQUAL 'F'
                                                              3.   CLM_TRANS_CD EQUAL '5'

                                                              SET CLM_TYPE_CD TO 20 (SNF NON-SWING BED CLAIM)
                                                              WHERE THE FOLLOWING CONDITIONS ARE MET:
                                                              1.   CLM_NEAR_LINE_RIC_CD EQUAL 'V'
                                                              2.   PMT_EDIT_RIC_CD EQUAL 'C' OR 'E'
                                                              3.   CLM_TRANS_CD EQUAL '0' OR '4'
                                                              4.   POSITION 3 OF PRVDR_NUM IS NOT 'U', 'W', 'Y'
                                                                   OR 'Z'

                                                              SET CLM_TYPE_CD TO 30 (SNF SWING BED CLAIM)
                                                              WHERE THE FOLLOWING CONDITIONS ARE MET:
                                                              1.   CLM_NEAR_LINE_RIC_CD EQUAL 'V'
                                                              2.   PMT_EDIT_RIC_CD EQUAL 'C' OR 'E'
                                                              3.   CLM_TRANS_CD EQUAL '0' OR '4'
                                                              4.   POSITION 3 OF PRVDR_NUM EQUAL 'U', 'W', 'Y'
                                                                   OR 'Z'
                                                              SET CLM_TYPE_CD TO 40 (OUTPATIENT CLAIM)
                                                              WHERE THE FOLLOWING CONDITIONS ARE MET:
                                                              1.   CLM_NEAR_LINE_RIC_CD EQUAL 'W'
                                                              2.   PMT_EDIT_RIC_CD EQUAL 'D'
                                                              3.   CLM_TRANS_CD EQUAL '6'

1                       FI Inpatient SNF Claim Record - Limited Data Set Standard View -- 11/2005

                                                 POSITIONS
                  NAME              TYPE  LENGTH BEG  END                            CONTENTS
       ---------------------------  ----  ------ ---------  ------------------------------------------------------------

                                                              SET CLM_TYPE_CD TO 41 (OUTPATIENT 'FULL'
                                                              ENCOUNTER CLAIM -- AVAILABLE IN NMUD) WHERE
                                                              THE FOLLOWING CONDITIONS ARE MET:
                                                              1.   CLM_NEAR_LINE_RIC_CD EQUAL 'W'
                                                              2.   PMT_EDIT_RIC_CD EQUAL 'D'
                                                              3.   CLM_TRANS_CD EQUAL '6'
                                                              4.   FI_NUM = 80881

                                                              SET CLM_TYPE_CD TO 42 (OUTPATIENT 'ABBREVIATED'
                                                              ENCOUNTER CLAIMS -- AVAILABLE IN NMUD)
                                                              1.   FI_NUM = 80881
                                                              2.   CLM_FAC_TYPE_CD = '1' OR '8'; CLM_SRVC_
                                                                   CLSFCTN_TYPE_CD = '2', '3' OR '4' &
                                                                   CLM_FREQ_CD = 'Z', 'Y' OR 'X'

                                                              SET CLM_TYPE_CD TO 50 (HOSPICE CLAIM)
                                                              WHERE THE FOLLOWING CONDITIONS ARE MET:
                                                              1.   CLM_NEAR_LINE_RIC_CD EQUAL 'V'
                                                              2.   PMT_EDIT_RIC_CD EQUAL 'I'
                                                              3.   CLM_TRANS_CD EQUAL 'H'

                                                              SET CLM_TYPE_CD TO 60 (INPATIENT CLAIM)
                                                              WHERE THE FOLLOWING CONDITIONS ARE MET:
                                                              1.   CLM_NEAR_LINE_RIC_CD EQUAL 'V'
                                                              2.   PMT_EDIT_RIC_CD EQUAL 'C' OR 'E'
                                                              3.   CLM_TRANS_CD EQUAL '1' '2' OR '3'

                                                              SET CLM_TYPE_CD TO 61 (INPATIENT 'FULL' ENCOUNTER
                                                              CLAIM - PRIOR TO HDC PROCESSING - AFTER 6/30/97 -
                                                              12/4/00) WHERE THE FOLLOWING CONDITIONS ARE MET:
                                                              1.   CLM_MCO_PD_SW = '1'
                                                              2.   CLM_RLT_COND_CD = '04'
                                                              3.   MCO_CNTRCT_NUM
                                                                   MCO_OPTN_CD = 'C'
                                                                   CLM_FROM_DT & CLM_THRU_DT ARE WITHIN THE
                                                                   MCO_PRD_EFCTV_DT & MCO_PRD_TRMNTN_DT
                                                                   ENROLLMENT PERIODS

                                                              SET_CLM_TYPE_CD TO 61 (INPATIENT 'FULL' ENCOUNTER
                                                              CLAIM -- EFFECTIVE WITH HDC PROCESSING) WHERE THE
                                                              FOLLOWING CONDITIONS ARE MET:
                                                              1.   CLM_NEAR_LINE_RIC_CD EQUAL 'V'
                                                              2.   PMT_EDIT_RIC_CD EQUAL 'C' OR 'E'
                                                              3.   CLM_TRANS_CD EQUAL '1' '2' OR '3'
                                                              4.   FI_NUM = 80881

                                                              SET CLM_TYPE_CD TO 62 (INPATIENT 'ABBREVIATED'
                                                              ENCOUNTER CLAIM -- AVAILABLE IN NMUD) WHERE
                                                              THE FOLLOWING CONDITIONS ARE MET:
                                                              1.   FI_NUM = 80881 AND
                                                              2.   CLM_FAC_TYPE_CD = '1'; CLM_SRVC_CLSFCTN_
                                                                   TYPE_CD = '1'; CLM_FREQ_CD = 'Z'

1                       FI Inpatient SNF Claim Record - Limited Data Set Standard View -- 11/2005

                                                 POSITIONS
                  NAME              TYPE  LENGTH BEG  END                            CONTENTS
       ---------------------------  ----  ------ ---------  ------------------------------------------------------------

                                                              SET CLM_TYPE_CD TO 71 (RIC O non-DMEPOS CLAIM)
                                                              WHERE THE FOLLOWING CONDITIONS ARE MET:
                                                              1.   CLM_NEAR_LINE_RIC_CD EQUAL 'O'
                                                              2.   HCPCS_CD not on DMEPOS table

                                                              SET CLM_TYPE_CD TO 72 (RIC O DMEPOS CLAIM)
                                                              WHERE THE FOLLOWING CONDITIONS ARE MET:
                                                              1.   CLM_NEAR_LINE_RIC_CD EQUAL 'O'
                                                              2.   HCPCS_CD on DMEPOS table (NOTE: if one or
                                                                    more line item(s) match the HCPCS on the
                                                                    DMEPOS table).

                                                              SET CLM_TYPE_CD TO 73 (PHYSICIAN ENCOUNTER CLAIM--
                                                              EFFECTIVE WITH HDC PROCESSING) WHERE THE FOLLOWING
                                                              CONDITIONS ARE MET:
                                                              1.   CARR_NUM = 80882 AND
                                                              2.   CLM_DEMO_ID_NUM = 38

                                                              SET CLM_TYPE_CD TO 81 (RIC M non-DMEPOS DMERC
                                                                 CLAIM)
                                                              WHERE THE FOLLOWING CONDITIONS ARE MET:
                                                              1.   CLM_NEAR_LINE_RIC_CD EQUAL 'M'
                                                              2.   HCPCS_CD not on DMEPOS table

                                                              SET CLM_TYPE_CD TO 82 (RIC M DMEPOS DMERC CLAIM)
                                                              WHERE THE FOLLOWING CONDITIONS ARE MET:
                                                              1.   CLM_NEAR_LINE_RIC_CD EQUAL 'M'
                                                              2.   HCPCS_CD on DMEPOS table (NOTE: if one or
                                                                    more line item(s) match the HCPCS on the
                                                                    DMEPOS table).

                                                            CODES:
                                                              REFER TO: NCH_CLM_TYPE_TB
                                                                        IN THE CODES APPENDIX

                                                            SOURCE:
                                                            NCH

    6. Claim Diagnosis Code         CHAR      5    22   26  The ICD-9-CM based code identifying the
                                                            beneficiary's principal or other diagnosis
                                                            (including E code).

                                                            NOTE:
                                                            Prior to Version H, the principal diagnosis
                                                            code was not stored with the 'OTHER' diagnosis
                                                            codes.  During the Version H conversion the
                                                            CLM_PRNCPAL_DGNS_CD was added as the first
                                                            occurrence.

                                                            DB2 ALIAS: CLM_DGNS_CD
                                                            SAS ALIAS: DGNS_CD
                                                            STANDARD ALIAS: CLM_DGNS_CD
                                                            TITLE ALIAS: DIAGNOSIS

1                       FI Inpatient SNF Claim Record - Limited Data Set Standard View -- 11/2005

                                                 POSITIONS
                  NAME              TYPE  LENGTH BEG  END                            CONTENTS
       ---------------------------  ----  ------ ---------  ------------------------------------------------------------

                                                            EDIT-RULES:
                                                            ICD-9-CM

                                                            COMMENT:
                                                            Prior to Version H this field was named:
                                                            CLM_OTHR_DGNS_CD.


1                       FI Inpatient SNF Claim Record - Limited Data Set Standard View -- 11/2005


       *****************************************************************************************************************

                              C L A I M     P R O C E D U R E     G R O U P     R E C O R D

       *****************************************************************************************************************


                                                 POSITIONS
                  NAME              TYPE  LENGTH BEG  END                            CONTENTS
       ---------------------------  ----  ------ ---------  ------------------------------------------------------------

 ****  FI Inpatient/Skilled         GROUP    33             Claim Procedure Group Record for the
       Nursing Facility Claim                               Limited Data Set Standard View of the
       Procedure Group Record -                             Inpatient/Skilled Nursing Facility
       Limited Data Set Standard                            version I Nearline File.
       View
                                                            The number of claim procedure trailers is
                                                            determined by the claim procedure code
                                                            count.  Prior to 10/93 up to 10 occurrences
                                                            could be reported on an institutional claim.
                                                            Beginning 10/93, up to six occurrences (one
                                                            principal; five others) may be reported.

                                                            OCCURS: UP TO 6 TIMES
                                                                    DEPENDING ON IP_CLM_PRCDR_CD_CNT

                                                            STANDARD ALIAS: CLM_PRCDR_GRP

    1. Record Length Count          NUM       5     1    5  The length of the Claim Procedure Group Record.

                                                            5 DIGITS UNSIGNED

                                                            STANDARD ALIAS: DSY_VW_BYTE_CNT

    2. Record Number                NUM       9     6   14  A sequentially assigned number for the claims included
                                                            in the file. This number allows the user to link all of
                                                            the records associated with one claim.

                                                            STANDARD ALIAS: DSY_VW_REC_LNK_NUM

    3. Record Type                  NUM       2    15   16  Type of Record.

                                                            STANDARD ALIAS: DSY_VW_REC_TYPE

                                                            CODES:
                                                            00 = Fixed/Main Group
                                                            01 = Carrier Line Group
                                                            02 = Claim Demonstration ID Group
                                                            03 = Claim Diagnosis Group
                                                            04 = Claim Health PlanID Group
                                                            05 = Claim Occurrence Span Group
                                                            06 = Claim Procedure Group
                                                            07 = Claim Related Condition Group
                                                            08 = Claim Related Occurrence Group
                                                            09 = Claim Value Group
1                       FI Inpatient SNF Claim Record - Limited Data Set Standard View -- 11/2005

                                                 POSITIONS
                  NAME              TYPE  LENGTH BEG  END                            CONTENTS
       ---------------------------  ----  ------ ---------  ------------------------------------------------------------

                                                            10 = MCO Period Group
                                                            11 = NCH Edit Group
                                                            12 = NCH Patch Group
                                                            13 = DMERC Line Group
                                                            14 = Revenue Center Group

    4. Claim Sequence Number        NUM       3    17   19  A counter for records that consist of trailer
                                                            information, such as claim line and revenue center
                                                            data, which can occur multiple times for one claim.

                                                            STANDARD ALIAS: DSY_VW_REC_SEQ

    5. NCH Claim Type Code          CHAR      2    20   21  The code used to identify the type of claim record being
                                                            processed in NCH.

                                                            NOTE1:  During the Version H conversion this field was
                                                                    populated with data through- out history (back to
                                                                    service year 1991).

                                                            NOTE2:  During the Version I conversion this field was
                                                                    expanded to include inpatient 'full' encounter
                                                                    claims (for service dates after 6/30/97).
                                                                    Placeholders for Physician and Outpatient encounters
                                                                    (available in NMUD) have also been added.

                                                            STANDARD ALIAS: NCH_CLM_TYPE_CD

                                                            DERIVATION:
                                                            FFS CLAIM TYPE CODES DERIVED FROM:
                                                              NCH CLM_NEAR_LINE_RIC_CD
                                                              NCH PMT_EDIT_RIC_CD
                                                              NCH CLM_TRANS_CD
                                                              NCH PRVDR_NUM

                                                            INPATIENT 'FULL' ENCOUNTER TYPE CODE DERIVED FROM:
                                                              (Pre-HDC processing -- AVAILABLE IN NCH)
                                                              CLM_MCO_PD_SW
                                                              CLM_RLT_COND_CD
                                                              MCO_CNTRCT_NUM
                                                              MCO_OPTN_CD
                                                              MCO_PRD_EFCTV_DT
                                                              MCO_PRD_TRMNTN_DT

                                                            INPATIENT 'FULL' ENCOUNTER TYPE CODE DERIVED FROM:
                                                              (HDC processing -- AVAILABLE IN NMUD)
                                                              FI_NUM

                                                            INPATIENT 'ABBREVIATED' ENCOUNTER TYPE CODE DERIVED
                                                            FROM: (HDC processing -- AVAILABLE IN NMUD)
                                                              FI_NUM
                                                              CLM_FAC_TYPE_CD
                                                              CLM_SRVC_CLSFCTN_TYPE_CD
                                                              CLM_FREQ_CD

1                       FI Inpatient SNF Claim Record - Limited Data Set Standard View -- 11/2005

                                                 POSITIONS
                  NAME              TYPE  LENGTH BEG  END                            CONTENTS
       ---------------------------  ----  ------ ---------  ------------------------------------------------------------

                                                            NOTE:  From 7/1/97 to the start of HDC processing(?),
                                                            abbreviated inpatient encounter claims are not
                                                            available in NCH or NMUD.

                                                            PHYSICIAN 'FULL' ENCOUNTER TYPE CODE DERIVED FROM:
                                                              (AVAILABLE IN NMUD)
                                                              CARR_NUM
                                                              CLM_DEMO_ID_NUM

                                                            OUTPATIENT 'FULL' ENCOUNTER TYPE CODE DERIVED FROM:
                                                              (AVAILABLE IN NMUD)
                                                              FI_NUM

                                                            OUTPATIENT 'ABBREVIATED' ENCOUNTER TYPE CODE
                                                            DERIVED FROM:  (AVAILABLE IN NMUD)
                                                              FI_NUM
                                                              CLM_FAC_TYPE_CD
                                                              CLM_SRVC_CLSFCTN_TYPE_CD
                                                              CLM_FREQ_CD

                                                            DERIVATION RULES:

                                                              SET CLM_TYPE_CD TO 10 (HHA CLAIM) WHERE THE
                                                              FOLLOWING CONDITIONS ARE MET:
                                                              1.   CLM_NEAR_LINE_RIC_CD EQUAL 'V','W' OR 'U'
                                                              2.   PMT_EDIT_RIC_CD EQUAL 'F'
                                                              3.   CLM_TRANS_CD EQUAL '5'

                                                              SET CLM_TYPE_CD TO 20 (SNF NON-SWING BED CLAIM)
                                                              WHERE THE FOLLOWING CONDITIONS ARE MET:
                                                              1.   CLM_NEAR_LINE_RIC_CD EQUAL 'V'
                                                              2.   PMT_EDIT_RIC_CD EQUAL 'C' OR 'E'
                                                              3.   CLM_TRANS_CD EQUAL '0' OR '4'
                                                              4.   POSITION 3 OF PRVDR_NUM IS NOT 'U', 'W', 'Y'
                                                                   OR 'Z'

                                                              SET CLM_TYPE_CD TO 30 (SNF SWING BED CLAIM)
                                                              WHERE THE FOLLOWING CONDITIONS ARE MET:
                                                              1.   CLM_NEAR_LINE_RIC_CD EQUAL 'V'
                                                              2.   PMT_EDIT_RIC_CD EQUAL 'C' OR 'E'
                                                              3.   CLM_TRANS_CD EQUAL '0' OR '4'
                                                              4.   POSITION 3 OF PRVDR_NUM EQUAL 'U', 'W', 'Y'
                                                                   OR 'Z'

                                                              SET CLM_TYPE_CD TO 40 (OUTPATIENT CLAIM)
                                                              WHERE THE FOLLOWING CONDITIONS ARE MET:
                                                              1.   CLM_NEAR_LINE_RIC_CD EQUAL 'W'
                                                              2.   PMT_EDIT_RIC_CD EQUAL 'D'
                                                              3.   CLM_TRANS_CD EQUAL '6'
                                                              SET CLM_TYPE_CD TO 41 (OUTPATIENT 'FULL'
                                                              ENCOUNTER CLAIM -- AVAILABLE IN NMUD) WHERE
                                                              THE FOLLOWING CONDITIONS ARE MET:
                                                              1.   CLM_NEAR_LINE_RIC_CD EQUAL 'W'

1                       FI Inpatient SNF Claim Record - Limited Data Set Standard View -- 11/2005

                                                 POSITIONS
                  NAME              TYPE  LENGTH BEG  END                            CONTENTS
       ---------------------------  ----  ------ ---------  ------------------------------------------------------------

                                                              2.   PMT_EDIT_RIC_CD EQUAL 'D'
                                                              3.   CLM_TRANS_CD EQUAL '6'
                                                              4.   FI_NUM = 80881

                                                              SET CLM_TYPE_CD TO 42 (OUTPATIENT 'ABBREVIATED'
                                                              ENCOUNTER CLAIMS -- AVAILABLE IN NMUD)
                                                              1.   FI_NUM = 80881
                                                              2.   CLM_FAC_TYPE_CD = '1' OR '8'; CLM_SRVC_
                                                                   CLSFCTN_TYPE_CD = '2', '3' OR '4' &
                                                                   CLM_FREQ_CD = 'Z', 'Y' OR 'X'

                                                              SET CLM_TYPE_CD TO 50 (HOSPICE CLAIM)
                                                              WHERE THE FOLLOWING CONDITIONS ARE MET:
                                                              1.   CLM_NEAR_LINE_RIC_CD EQUAL 'V'
                                                              2.   PMT_EDIT_RIC_CD EQUAL 'I'
                                                              3.   CLM_TRANS_CD EQUAL 'H'

                                                              SET CLM_TYPE_CD TO 60 (INPATIENT CLAIM)
                                                              WHERE THE FOLLOWING CONDITIONS ARE MET:
                                                              1.   CLM_NEAR_LINE_RIC_CD EQUAL 'V'
                                                              2.   PMT_EDIT_RIC_CD EQUAL 'C' OR 'E'
                                                              3.   CLM_TRANS_CD EQUAL '1' '2' OR '3'

                                                              SET CLM_TYPE_CD TO 61 (INPATIENT 'FULL' ENCOUNTER
                                                              CLAIM - PRIOR TO HDC PROCESSING - AFTER 6/30/97 -
                                                              12/4/00) WHERE THE FOLLOWING CONDITIONS ARE MET:
                                                              1.   CLM_MCO_PD_SW = '1'
                                                              2.   CLM_RLT_COND_CD = '04'
                                                              3.   MCO_CNTRCT_NUM
                                                                   MCO_OPTN_CD = 'C'
                                                                   CLM_FROM_DT & CLM_THRU_DT ARE WITHIN THE
                                                                   MCO_PRD_EFCTV_DT & MCO_PRD_TRMNTN_DT
                                                                   ENROLLMENT PERIODS

                                                              SET_CLM_TYPE_CD TO 61 (INPATIENT 'FULL' ENCOUNTER
                                                              CLAIM -- EFFECTIVE WITH HDC PROCESSING) WHERE THE
                                                              FOLLOWING CONDITIONS ARE MET:
                                                              1.   CLM_NEAR_LINE_RIC_CD EQUAL 'V'
                                                              2.   PMT_EDIT_RIC_CD EQUAL 'C' OR 'E'
                                                              3.   CLM_TRANS_CD EQUAL '1' '2' OR '3'
                                                              4.   FI_NUM = 80881

                                                              SET CLM_TYPE_CD TO 62 (INPATIENT 'ABBREVIATED'
                                                              ENCOUNTER CLAIM -- AVAILABLE IN NMUD) WHERE
                                                              THE FOLLOWING CONDITIONS ARE MET:
                                                              1.   FI_NUM = 80881 AND
                                                              2.   CLM_FAC_TYPE_CD = '1'; CLM_SRVC_CLSFCTN_
                                                                   TYPE_CD = '1'; CLM_FREQ_CD = 'Z'

                                                              SET CLM_TYPE_CD TO 71 (RIC O non-DMEPOS CLAIM)
                                                              WHERE THE FOLLOWING CONDITIONS ARE MET:
                                                              1.   CLM_NEAR_LINE_RIC_CD EQUAL 'O'
                                                              2.   HCPCS_CD not on DMEPOS table

1                       FI Inpatient SNF Claim Record - Limited Data Set Standard View -- 11/2005

                                                 POSITIONS
                  NAME              TYPE  LENGTH BEG  END                            CONTENTS
       ---------------------------  ----  ------ ---------  ------------------------------------------------------------

                                                              SET CLM_TYPE_CD TO 72 (RIC O DMEPOS CLAIM)
                                                              WHERE THE FOLLOWING CONDITIONS ARE MET:
                                                              1.   CLM_NEAR_LINE_RIC_CD EQUAL 'O'
                                                              2.   HCPCS_CD on DMEPOS table (NOTE: if one or
                                                                    more line item(s) match the HCPCS on the
                                                                    DMEPOS table).

                                                              SET CLM_TYPE_CD TO 73 (PHYSICIAN ENCOUNTER CLAIM--
                                                              EFFECTIVE WITH HDC PROCESSING) WHERE THE FOLLOWING
                                                              CONDITIONS ARE MET:
                                                              1.   CARR_NUM = 80882 AND
                                                              2.   CLM_DEMO_ID_NUM = 38

                                                              SET CLM_TYPE_CD TO 81 (RIC M non-DMEPOS DMERC
                                                                 CLAIM)
                                                              WHERE THE FOLLOWING CONDITIONS ARE MET:
                                                              1.   CLM_NEAR_LINE_RIC_CD EQUAL 'M'
                                                              2.   HCPCS_CD not on DMEPOS table

                                                              SET CLM_TYPE_CD TO 82 (RIC M DMEPOS DMERC CLAIM)
                                                              WHERE THE FOLLOWING CONDITIONS ARE MET:
                                                              1.   CLM_NEAR_LINE_RIC_CD EQUAL 'M'
                                                              2.   HCPCS_CD on DMEPOS table (NOTE: if one or
                                                                    more line item(s) match the HCPCS on the
                                                                    DMEPOS table).

                                                            CODES:
                                                              REFER TO: NCH_CLM_TYPE_TB
                                                                        IN THE CODES APPENDIX

                                                            SOURCE:
                                                            NCH

    6. Claim Procedure Code         CHAR      4    22   25  The ICD-9-CM code that indicates the principal or other
                                                            procedure performed during the period covered by the
                                                            institutional claim.

                                                            DB2 ALIAS: CLM_PRCDR_CD
                                                            SAS ALIAS: PRCDR_CD
                                                            STANDARD ALIAS: CLM_PRCDR_CD
                                                            TITLE ALIAS: PROCEDURE_CODE

                                                            EDIT-RULES:
                                                            ICD-9-CM

                                                            SOURCE:
                                                            CWF

    7. Claim Procedure Performed    NUM       8    26   33  On an institutional claim, the date on which
       Date                                                 the principal or other procedure was performed.

                                                            For the Limited Data Set Standard View of
                                                            the Inpatient/SNF files, the claim procedure

1                       FI Inpatient SNF Claim Record - Limited Data Set Standard View -- 11/2005

                                                 POSITIONS
                  NAME              TYPE  LENGTH BEG  END                            CONTENTS
       ---------------------------  ----  ------ ---------  ------------------------------------------------------------

                                                            performed date is coded as the quarter
                                                            of the calendar year when the procedure
                                                            was performed.

                                                            8 DIGITS UNSIGNED

                                                            DB2 ALIAS: CLM_PRCDR_PRFRM_DT
                                                            SAS ALIAS: PRCDR_DT
                                                            STANDARD ALIAS: CLM_PRCDR_PRFRM_DT
                                                            TITLE ALIAS: PROCEDURE_DATE

                                                            EDIT-RULES FOR LIMITED DATA SET DATA:
                                                            YYYYQ000 WHERE Q IS ONE OF THE
                                                            FOLLOWING VALUES.
                                                            1 = FIRST QUARTER OF THE CALENDAR YEAR
                                                            2 = SECOND QUARTER OF THE CALENDAR YEAR
                                                            3 = THIRD QUARTER OF THE CALENDAR YEAR
                                                            4 = FOURTH QUARTER OF THE CALENDAR YEAR

                                                            SOURCE:
                                                            CWF


1                       FI Inpatient SNF Claim Record - Limited Data Set Standard View -- 11/2005


       *****************************************************************************************************************

                    C L A I M     R E L A T E D     C O N D I T I O N     G R O U P     R E C O R D

       *****************************************************************************************************************


                                                 POSITIONS
                  NAME              TYPE  LENGTH BEG  END                            CONTENTS
       ---------------------------  ----  ------ ---------  ------------------------------------------------------------

 ****  FI Inpatient/Skilled         GROUP    23             Claim Related Condition Group Record for
       Nursing Facility Claim                               the Limited Data Set Standard View of
       Related Condition Group                              the Inpatient/Skilled Nursing Facility
       Record - Limited Data                                version I NCH Nearline File.
       Set Standard View
                                                            The number of claim related condition
                                                            trailers is determined by the claim related
                                                            condition code count. Effective 10/93,
                                                            up to 30 occurrences can be reported on an
                                                            institutional claim. Prior to 10/93, up
                                                            to 10 occurrences could be reported.

                                                            OCCURS: UP TO 30 TIMES
                                                                    DEPENDING ON IP_CLM_RLT_COND_CD_CNT

                                                            STANDARD ALIAS: CLM_RLT_COND_GRP

    1. Record Length Count          NUM       5     1    5  The length of the Claim Related Condition Group
                                                            Record.

                                                            5 DIGITS UNSIGNED

                                                            STANDARD ALIAS: DSY_VW_BYTE_CNT

    2. Record Number                NUM       9     6   14  A sequentially assigned number for the claims included
                                                            in the file. This number allows the user to link all of
                                                            the records associated with one claim.

                                                            STANDARD ALIAS: DSY_VW_REC_LNK_NUM

    3. Record Type                  NUM       2    15   16  Type of Record.

                                                            STANDARD ALIAS: DSY_VW_REC_TYPE

                                                            CODES:
                                                            00 = Fixed/Main Group
                                                            01 = Carrier Line Group
                                                            02 = Claim Demonstration ID Group
                                                            03 = Claim Diagnosis Group
                                                            04 = Claim Health PlanID Group
                                                            05 = Claim Occurrence Span Group
                                                            06 = Claim Procedure Group
                                                            07 = Claim Related Condition Group
                                                            08 = Claim Related Occurrence Group

1                       FI Inpatient SNF Claim Record - Limited Data Set Standard View -- 11/2005

                                                 POSITIONS
                  NAME              TYPE  LENGTH BEG  END                            CONTENTS
       ---------------------------  ----  ------ ---------  ------------------------------------------------------------

                                                            09 = Claim Value Group
                                                            10 = MCO Period Group
                                                            11 = NCH Edit Group
                                                            12 = NCH Patch Group
                                                            13 = DMERC Line Group
                                                            14 = Revenue Center Group

    4. Claim Sequence Number        NUM       3    17   19  A counter for records that consist of trailer
                                                            information, such as claim line and revenue center
                                                            data, which can occur multiple times for one claim.

                                                            STANDARD ALIAS: DSY_VW_REC_SEQ

    5. NCH Claim Type Code          CHAR      2    20   21  The code used to identify the type of claim record being
                                                            processed in NCH.

                                                            NOTE1:  During the Version H conversion this field was
                                                                    populated with data through- out history (back to
                                                                    service year 1991).

                                                            NOTE2:  During the Version I conversion this field was
                                                                    expanded to include inpatient 'full' encounter
                                                                    claims (for service dates after 6/30/97).
                                                                    Placeholders for Physician and Outpatient encounters
                                                                    (available in NMUD) have also been added.

                                                            STANDARD ALIAS: NCH_CLM_TYPE_CD

                                                            DERIVATION:
                                                            FFS CLAIM TYPE CODES DERIVED FROM:
                                                              NCH_CLM_NEAR_LINE_RIC_CD
                                                              NCH PMT_EDIT_RIC_CD
                                                              NCH CLM_TRANS_CD
                                                              NCH PRVDR_NUM

                                                            INPATIENT 'FULL' ENCOUNTER TYPE CODE DERIVED FROM:
                                                              (Pre-HDC processing -- AVAILABLE IN NCH)
                                                              CLM_MCO_PD_SW
                                                              CLM_RLT_COND_CD
                                                              MCO_CNTRCT_NUM
                                                              MCO_OPTN_CD
                                                              MCO_PRD_EFCTV_DT
                                                              MCO_PRD_TRMNTN_DT

                                                            INPATIENT 'FULL' ENCOUNTER TYPE CODE DERIVED FROM:
                                                              (HDC processing -- AVAILABLE IN NMUD)
                                                              FI_NUM

                                                            INPATIENT 'ABBREVIATED' ENCOUNTER TYPE CODE DERIVED
                                                            FROM: (HDC processing -- AVAILABLE IN NMUD)
                                                              FI_NUM
                                                              CLM_FAC_TYPE_CD
                                                              CLM_SRVC_CLSFCTN_TYPE_CD
                                                              CLM_FREQ_CD
1                       FI Inpatient SNF Claim Record - Limited Data Set Standard View -- 11/2005

                                                 POSITIONS
                  NAME              TYPE  LENGTH BEG  END                            CONTENTS
       ---------------------------  ----  ------ ---------  ------------------------------------------------------------

                                                            NOTE:  From 7/1/97 to the start of HDC processing(?),
                                                            abbreviated inpatient encounter claims are not
                                                            available in NCH or NMUD.

                                                            PHYSICIAN 'FULL' ENCOUNTER TYPE CODE DERIVED FROM:
                                                              (AVAILABLE IN NMUD)
                                                              CARR_NUM
                                                              CLM_DEMO_ID_NUM

                                                            OUTPATIENT 'FULL' ENCOUNTER TYPE CODE DERIVED FROM:
                                                              (AVAILABLE IN NMUD)
                                                              FI_NUM

                                                            OUTPATIENT 'ABBREVIATED' ENCOUNTER TYPE CODE
                                                            DERIVED FROM:  (AVAILABLE IN NMUD)
                                                              FI_NUM
                                                              CLM_FAC_TYPE_CD
                                                              CLM_SRVC_CLSFCTN_TYPE_CD
                                                              CLM_FREQ_CD

                                                            DERIVATION RULES:

                                                              SET CLM_TYPE_CD TO 10 (HHA CLAIM) WHERE THE
                                                              FOLLOWING CONDITIONS ARE MET:
                                                              1.   CLM_NEAR_LINE_RIC_CD EQUAL 'V','W' OR 'U'
                                                              2.   PMT_EDIT_RIC_CD EQUAL 'F'
                                                              3.   CLM_TRANS_CD EQUAL '5'

                                                              SET CLM_TYPE_CD TO 20 (SNF NON-SWING BED CLAIM)
                                                              WHERE THE FOLLOWING CONDITIONS ARE MET:
                                                              1.   CLM_NEAR_LINE_RIC_CD EQUAL 'V'
                                                              2.   PMT_EDIT_RIC_CD EQUAL 'C' OR 'E'
                                                              3.   CLM_TRANS_CD EQUAL '0' OR '4'
                                                              4.   POSITION 3 OF PRVDR_NUM IS NOT 'U', 'W', 'Y'
                                                                   OR 'Z'

                                                              SET CLM_TYPE_CD TO 30 (SNF SWING BED CLAIM)
                                                              WHERE THE FOLLOWING CONDITIONS ARE MET:
                                                              1.   CLM_NEAR_LINE_RIC_CD EQUAL 'V'
                                                              2.   PMT_EDIT_RIC_CD EQUAL 'C' OR 'E'
                                                              3.   CLM_TRANS_CD EQUAL '0' OR '4'
                                                              4.   POSITION 3 OF PRVDR_NUM EQUAL 'U', 'W', 'Y'
                                                                   OR 'Z'

                                                              SET CLM_TYPE_CD TO 40 (OUTPATIENT CLAIM)
                                                              WHERE THE FOLLOWING CONDITIONS ARE MET:
                                                              1.   CLM_NEAR_LINE_RIC_CD EQUAL 'W'
                                                              2.   PMT_EDIT_RIC_CD EQUAL 'D'
                                                              3.   CLM_TRANS_CD EQUAL '6'

                                                              SET CLM_TYPE_CD TO 41 (OUTPATIENT 'FULL'
                                                              ENCOUNTER CLAIM -- AVAILABLE IN NMUD) WHERE
                                                              THE FOLLOWING CONDITIONS ARE MET:

1                       FI Inpatient SNF Claim Record - Limited Data Set Standard View -- 11/2005

                                                 POSITIONS
                  NAME              TYPE  LENGTH BEG  END                            CONTENTS
       ---------------------------  ----  ------ ---------  ------------------------------------------------------------

                                                              1.   CLM_NEAR_LINE_RIC_CD EQUAL 'W'
                                                              2.   PMT_EDIT_RIC_CD EQUAL 'D'
                                                              3.   CLM_TRANS_CD EQUAL '6'
                                                              4.   FI_NUM = 80881

                                                              SET CLM_TYPE_CD TO 42 (OUTPATIENT 'ABBREVIATED'
                                                              ENCOUNTER CLAIMS -- AVAILABLE IN NMUD)
                                                              1.   FI_NUM = 80881
                                                              2.   CLM_FAC_TYPE_CD = '1' OR '8'; CLM_SRVC_
                                                                   CLSFCTN_TYPE_CD = '2', '3' OR '4' &
                                                                   CLM_FREQ_CD = 'Z', 'Y' OR 'X'

                                                              SET CLM_TYPE_CD TO 50 (HOSPICE CLAIM)
                                                              WHERE THE FOLLOWING CONDITIONS ARE MET:
                                                              1.   CLM_NEAR_LINE_RIC_CD EQUAL 'V'
                                                              2.   PMT_EDIT_RIC_CD EQUAL 'I'
                                                              3.   CLM_TRANS_CD EQUAL 'H'

                                                              SET CLM_TYPE_CD TO 60 (INPATIENT CLAIM)
                                                              WHERE THE FOLLOWING CONDITIONS ARE MET:
                                                              1.   CLM_NEAR_LINE_RIC_CD EQUAL 'V'
                                                              2.   PMT_EDIT_RIC_CD EQUAL 'C' OR 'E'
                                                              3.   CLM_TRANS_CD EQUAL '1' '2' OR '3'

                                                              SET CLM_TYPE_CD TO 61 (INPATIENT 'FULL' ENCOUNTER
                                                              CLAIM - PRIOR TO HDC PROCESSING - AFTER 6/30/97 -
                                                              12/4/00) WHERE THE FOLLOWING CONDITIONS ARE MET:
                                                              1.   CLM_MCO_PD_SW = '1'
                                                              2.   CLM_RLT_COND_CD = '04'
                                                              3.   MCO_CNTRCT_NUM
                                                                   MCO_OPTN_CD = 'C'
                                                                   CLM_FROM_DT & CLM_THRU_DT ARE WITHIN THE
                                                                   MCO_PRD_EFCTV_DT & MCO_PRD_TRMNTN_DT
                                                                   ENROLLMENT PERIODS

                                                              SET_CLM_TYPE_CD TO 61 (INPATIENT 'FULL' ENCOUNTER
                                                              CLAIM -- EFFECTIVE WITH HDC PROCESSING) WHERE THE
                                                              FOLLOWING CONDITIONS ARE MET:
                                                              1.   CLM_NEAR_LINE_RIC_CD EQUAL 'V'
                                                              2.   PMT_EDIT_RIC_CD EQUAL 'C' OR 'E'
                                                              3.   CLM_TRANS_CD EQUAL '1' '2' OR '3'
                                                              4.   FI_NUM = 80881

                                                              SET CLM_TYPE_CD TO 62 (INPATIENT 'ABBREVIATED'
                                                              ENCOUNTER CLAIM -- AVAILABLE IN NMUD) WHERE
                                                              THE FOLLOWING CONDITIONS ARE MET:
                                                              1.   FI_NUM = 80881 AND
                                                              2.   CLM_FAC_TYPE_CD = '1'; CLM_SRVC_CLSFCTN_
                                                                   TYPE_CD = '1'; CLM_FREQ_CD = 'Z'

                                                              SET CLM_TYPE_CD TO 71 (RIC O non-DMEPOS CLAIM)
                                                              WHERE THE FOLLOWING CONDITIONS ARE MET:
                                                              1.   CLM_NEAR_LINE_RIC_CD EQUAL 'O'

1                       FI Inpatient SNF Claim Record - Limited Data Set Standard View -- 11/2005

                                                 POSITIONS
                  NAME              TYPE  LENGTH BEG  END                            CONTENTS
       ---------------------------  ----  ------ ---------  ------------------------------------------------------------

                                                              2.   HCPCS_CD not on DMEPOS table

                                                              SET CLM_TYPE_CD TO 72 (RIC O DMEPOS CLAIM)
                                                              WHERE THE FOLLOWING CONDITIONS ARE MET:
                                                              1.   CLM_NEAR_LINE_RIC_CD EQUAL 'O'
                                                              2.   HCPCS_CD on DMEPOS table (NOTE: if one or
                                                                    more line item(s) match the HCPCS on the
                                                                    DMEPOS table).

                                                              SET CLM_TYPE_CD TO 73 (PHYSICIAN ENCOUNTER CLAIM--
                                                              EFFECTIVE WITH HDC PROCESSING) WHERE THE FOLLOWING
                                                              CONDITIONS ARE MET:
                                                              1.   CARR_NUM = 80882 AND
                                                              2.   CLM_DEMO_ID_NUM = 38

                                                              SET CLM_TYPE_CD TO 81 (RIC M non-DMEPOS DMERC
                                                                 CLAIM)
                                                              WHERE THE FOLLOWING CONDITIONS ARE MET:
                                                              1.   CLM_NEAR_LINE_RIC_CD EQUAL 'M'
                                                              2.   HCPCS_CD not on DMEPOS table

                                                              SET CLM_TYPE_CD TO 82 (RIC M DMEPOS DMERC CLAIM)
                                                              WHERE THE FOLLOWING CONDITIONS ARE MET:
                                                              1.   CLM_NEAR_LINE_RIC_CD EQUAL 'M'
                                                              2.   HCPCS_CD on DMEPOS table (NOTE: if one or
                                                                    more line item(s) match the HCPCS on the
                                                                    DMEPOS table).

                                                            CODES:
                                                              REFER TO: NCH_CLM_TYPE_TB
                                                                        IN THE CODES APPENDIX

                                                            SOURCE:
                                                            NCH

    6. Claim Related Condition      CHAR      2    22   23  The code that indicates a condition relating to
       Code                                                 an institutional claim that may affect payer
                                                            processing.

                                                            DB2 ALIAS: CLM_RLT_COND_CD
                                                            SAS ALIAS: RLT_COND
                                                            STANDARD ALIAS: CLM_RLT_COND_CD
                                                            SYSTEM ALIAS: LTCOND
                                                            TITLE ALIAS: RELATED_CONDITION_CD

                                                            CODES:
                                                            01 THRU 16 = Insurance related
                                                            17 THRU 30 = Special condition
                                                            31 THRU 35 = Student status codes which are required
                                                                         when a patient is a dependent child
                                                                         over 18 years old
                                                            36 THRU 45 = Accommodation
                                                            46 THRU 54 = CHAMPUS information
                                                            55 THRU 59 = Skilled nursing facility
1                       FI Inpatient SNF Claim Record - Limited Data Set Standard View -- 11/2005

                                                 POSITIONS
                  NAME              TYPE  LENGTH BEG  END                            CONTENTS
       ---------------------------  ----  ------ ---------  ------------------------------------------------------------

                                                            60 THRU 70 = Prospective payment
                                                            71 THRU 99 = Renal dialysis setting
                                                            A0 THRU B9 = Special program codes
                                                            C0 THRU C9 = PRO approval services
                                                            D0 THRU W0 = Change conditions

                                                            CODES:
                                                              REFER TO: CLM_RLT_COND_TB
                                                                        IN THE CODES APPENDIX
                                                            SOURCE:
                                                            CWF

1                       FI Inpatient SNF Claim Record - Limited Data Set Standard View -- 11/2005


       *****************************************************************************************************************

                   C L A I M     R E L A T E D     O C C U R R E N C E     G R O U P     R E C O R D

       *****************************************************************************************************************


                                                 POSITIONS
                  NAME              TYPE  LENGTH BEG  END                            CONTENTS
       ---------------------------  ----  ------ ---------  ------------------------------------------------------------

 ****  FI Inpatient/Skilled         GROUP    31             Claim Related Occurrence Group Record for
       Nursing Facility Claim                               the Limited Data Set Standard View of the
       Related Occurrence Group                             Inpatient/SNF files version I
       Record - Limited Data Set                            NCH Nearline File.
       Standard View
                                                            The number of claim related occurrence
                                                            trailers is determined by the claim related
                                                            occurrence code count. Effective 10/93,
                                                            up to 30 occurrences can be reported on an
                                                            institutional claim. Prior to 10/93, up
                                                            to 10 occurrences could be reported.

                                                            OCCURS: UP TO 30 TIMES
                                                                    DEPENDING ON IP_CLM_RLT_OCRNC_CD_CNT

                                                            STANDARD ALIAS: CLM_RLT_OCRNC_GRP

    1. Record Length Count          NUM       5     1    5  The length of the Claim Related Occurrence Group
                                                            Record.

                                                            5 DIGITS UNSIGNED

                                                            STANDARD ALIAS: DSY_VW_BYTE_CNT

    2. Record Number                NUM       9     6   14  A sequentially assigned number for the claims included
                                                            in the file. This number allows the user to link all of
                                                            the records associated with one claim.

                                                            STANDARD ALIAS: DSY_VW_REC_LNK_NUM

    3. Record Type                  NUM       2    15   16  Type of Record.

                                                            STANDARD ALIAS: DSY_VW_REC_TYPE

                                                            CODES:
                                                            00 = Fixed/Main Group
                                                            01 = Carrier Line Group
                                                            02 = Claim Demonstration ID Group
                                                            03 = Claim Diagnosis Group
                                                            04 = Claim Health PlanID Group
                                                            05 = Claim Occurrence Span Group
                                                            06 = Claim Procedure Group
                                                            07 = Claim Related Condition Group
                                                            08 = Claim Related Occurrence Group
                                                            09 = Claim Value Group
                                                            10 = MCO Period Group

1                       FI Inpatient SNF Claim Record - Limited Data Set Standard View -- 11/2005

                                                 POSITIONS
                  NAME              TYPE  LENGTH BEG  END                            CONTENTS
       ---------------------------  ----  ------ ---------  ------------------------------------------------------------

                                                            11 = NCH Edit Group
                                                            12 = NCH Patch Group
                                                            13 = DMERC Line Group
                                                            14 = Revenue Center Group

    4. Claim Sequence Number        NUM       3    17   19  A counter for records that consist of trailer
                                                            information, such as claim line and revenue center
                                                            data, which can occur multiple times for one claim.

                                                            STANDARD ALIAS: DSY_VW_REC_SEQ

    5. NCH Claim Type Code          CHAR      2    20   21  The code used to identify the type of claim record being
                                                            processed in NCH.

                                                            NOTE1:  During the Version H conversion this field was
                                                                    populated with data through- out history (back to
                                                                    service year 1991).

                                                            NOTE2:  During the Version I conversion this field was
                                                                    expanded to include inpatient 'full' encounter
                                                                    claims (for service dates after 6/30/97).
                                                                    Placeholders for Physician and Outpatient encounters
                                                                    (available in NMUD) have also been added.

                                                            STANDARD ALIAS: NCH_CLM_TYPE_CD

                                                            DERIVATION:
                                                            FFS CLAIM TYPE CODES DERIVED FROM:
                                                              NCH CLM_NEAR_LINE_RIC_CD
                                                              NCH PMT_EDIT_RIC_CD
                                                              NCH CLM_TRANS_CD
                                                              NCH PRVDR_NUM

                                                            INPATIENT 'FULL' ENCOUNTER TYPE CODE DERIVED FROM:
                                                              (Pre-HDC processing -- AVAILABLE IN NCH)
                                                              CLM_MCO_PD_SW
                                                              CLM_RLT_COND_CD
                                                              MCO_CNTRCT_NUM
                                                              MCO_OPTN_CD
                                                              MCO_PRD_EFCTV_DT
                                                              MCO_PRD_TRMNTN_DT

                                                            INPATIENT 'FULL' ENCOUNTER TYPE CODE DERIVED FROM:
                                                              (HDC processing -- AVAILABLE IN NMUD)
                                                              FI_NUM

                                                            INPATIENT 'ABBREVIATED' ENCOUNTER TYPE CODE DERIVED
                                                            FROM: (HDC processing -- AVAILABLE IN NMUD)
                                                              FI_NUM
                                                              CLM_FAC_TYPE_CD
                                                              CLM_SRVC_CLSFCTN_TYPE_CD
                                                              CLM_FREQ_CD

1                       FI Inpatient SNF Claim Record - Limited Data Set Standard View -- 11/2005

                                                 POSITIONS
                  NAME              TYPE  LENGTH BEG  END                            CONTENTS
       ---------------------------  ----  ------ ---------  ------------------------------------------------------------

                                                            NOTE:  From 7/1/97 to the start of HDC processing(?),
                                                            abbreviated inpatient encounter claims are not
                                                            available in NCH or NMUD.

                                                            PHYSICIAN 'FULL' ENCOUNTER TYPE CODE DERIVED FROM:
                                                              (AVAILABLE IN NMUD)
                                                              CARR_NUM
                                                              CLM_DEMO_ID_NUM

                                                            OUTPATIENT 'FULL' ENCOUNTER TYPE CODE DERIVED FROM:
                                                              (AVAILABLE IN NMUD)
                                                              FI_NUM

                                                            OUTPATIENT 'ABBREVIATED' ENCOUNTER TYPE CODE
                                                            DERIVED FROM:  (AVAILABLE IN NMUD)
                                                              FI_NUM
                                                              CLM_FAC_TYPE_CD
                                                              CLM_SRVC_CLSFCTN_TYPE_CD
                                                              CLM_FREQ_CD

                                                            DERIVATION RULES:

                                                              SET CLM_TYPE_CD TO 10 (HHA CLAIM) WHERE THE
                                                              FOLLOWING CONDITIONS ARE MET:
                                                              1.   CLM_NEAR_LINE_RIC_CD EQUAL 'V','W' OR 'U'
                                                              2.   PMT_EDIT_RIC_CD EQUAL 'F'
                                                              3.   CLM_TRANS_CD EQUAL '5'

                                                              SET CLM_TYPE_CD TO 20 (SNF NON-SWING BED CLAIM)
                                                              WHERE THE FOLLOWING CONDITIONS ARE MET:
                                                              1.   CLM_NEAR_LINE_RIC_CD EQUAL 'V'
                                                              2.   PMT_EDIT_RIC_CD EQUAL 'C' OR 'E'
                                                              3.   CLM_TRANS_CD EQUAL '0' OR '4'
                                                              4.   POSITION 3 OF PRVDR_NUM IS NOT 'U', 'W', 'Y'
                                                                   OR 'Z'

                                                              SET CLM_TYPE_CD TO 30 (SNF SWING BED CLAIM)
                                                              WHERE THE FOLLOWING CONDITIONS ARE MET:
                                                              1.   CLM_NEAR_LINE_RIC_CD EQUAL 'V'
                                                              2.   PMT_EDIT_RIC_CD EQUAL 'C' OR 'E'
                                                              3.   CLM_TRANS_CD EQUAL '0' OR '4'
                                                              4.   POSITION 3 OF PRVDR_NUM EQUAL 'U', 'W', 'Y'
                                                                   OR 'Z'

                                                              SET CLM_TYPE_CD TO 40 (OUTPATIENT CLAIM)
                                                              WHERE THE FOLLOWING CONDITIONS ARE MET:
                                                              1.   CLM_NEAR_LINE_RIC_CD EQUAL 'W'
                                                              2.   PMT_EDIT_RIC_CD EQUAL 'D'
                                                              3.   CLM_TRANS_CD EQUAL '6'

                                                              SET CLM_TYPE_CD TO 41 (OUTPATIENT 'FULL'
                                                              ENCOUNTER CLAIM -- AVAILABLE IN NMUD) WHERE
                                                              THE FOLLOWING CONDITIONS ARE MET:
                                                              1.   CLM_NEAR_LINE_RIC_CD EQUAL 'W'

1                       FI Inpatient SNF Claim Record - Limited Data Set Standard View -- 11/2005

                                                 POSITIONS
                  NAME              TYPE  LENGTH BEG  END                            CONTENTS
       ---------------------------  ----  ------ ---------  ------------------------------------------------------------

                                                              2.   PMT_EDIT_RIC_CD EQUAL 'D'
                                                              3.   CLM_TRANS_CD EQUAL '6'
                                                              4.   FI_NUM = 80881

                                                              SET CLM_TYPE_CD TO 42 (OUTPATIENT 'ABBREVIATED'
                                                              ENCOUNTER CLAIMS -- AVAILABLE IN NMUD)
                                                              1.   FI_NUM = 80881
                                                              2.   CLM_FAC_TYPE_CD = '1' OR '8'; CLM_SRVC_
                                                                   CLSFCTN_TYPE_CD = '2', '3' OR '4' &
                                                                   CLM_FREQ_CD = 'Z', 'Y' OR 'X'

                                                              SET CLM_TYPE_CD TO 50 (HOSPICE CLAIM)
                                                              WHERE THE FOLLOWING CONDITIONS ARE MET:
                                                              1.   CLM_NEAR_LINE_RIC_CD EQUAL 'V'
                                                              2.   PMT_EDIT_RIC_CD EQUAL 'I'
                                                              3.   CLM_TRANS_CD EQUAL 'H'

                                                              SET CLM_TYPE_CD TO 60 (INPATIENT CLAIM)
                                                              WHERE THE FOLLOWING CONDITIONS ARE MET:
                                                              1.   CLM_NEAR_LINE_RIC_CD EQUAL 'V'
                                                              2.   PMT_EDIT_RIC_CD EQUAL 'C' OR 'E'
                                                              3.   CLM_TRANS_CD EQUAL '1' '2' OR '3'

                                                              SET CLM_TYPE_CD TO 61 (INPATIENT 'FULL' ENCOUNTER
                                                              CLAIM - PRIOR TO HDC PROCESSING - AFTER 6/30/97 -
                                                              12/4/00) WHERE THE FOLLOWING CONDITIONS ARE MET:
                                                              1.   CLM_MCO_PD_SW = '1'
                                                              2.   CLM_RLT_COND_CD = '04'
                                                              3.   MCO_CNTRCT_NUM
                                                                   MCO_OPTN_CD = 'C'
                                                                   CLM_FROM_DT & CLM_THRU_DT ARE WITHIN THE
                                                                   MCO_PRD_EFCTV_DT & MCO_PRD_TRMNTN_DT
                                                                   ENROLLMENT PERIODS

                                                              SET_CLM_TYPE_CD TO 61 (INPATIENT 'FULL' ENCOUNTER
                                                              CLAIM -- EFFECTIVE WITH HDC PROCESSING) WHERE THE
                                                              FOLLOWING CONDITIONS ARE MET:
                                                              1.   CLM_NEAR_LINE_RIC_CD EQUAL 'V'
                                                              2.   PMT_EDIT_RIC_CD EQUAL 'C' OR 'E'
                                                              3.   CLM_TRANS_CD EQUAL '1' '2' OR '3'
                                                              4.   FI_NUM = 80881

                                                              SET CLM_TYPE_CD TO 62 (INPATIENT 'ABBREVIATED'
                                                              ENCOUNTER CLAIM -- AVAILABLE IN NMUD) WHERE
                                                              THE FOLLOWING CONDITIONS ARE MET:
                                                              1.   FI_NUM = 80881 AND
                                                              2.   CLM_FAC_TYPE_CD = '1'; CLM_SRVC_CLSFCTN_
                                                                   TYPE_CD = '1'; CLM_FRQ_CD = 'Z'
                                                              SET CLM_TYPE_CD TO 71 (RIC O non-DMEPOS CLAIM)
                                                              WHERE THE FOLLOWING CONDITIONS ARE MET:
                                                              1.   CLM_NEAR_LINE_RIC_CD EQUAL 'O'
                                                              2.   HCPCS_CD not on DMEPOS table

1                       FI Inpatient SNF Claim Record - Limited Data Set Standard View -- 11/2005

                                                 POSITIONS
                  NAME              TYPE  LENGTH BEG  END                            CONTENTS
       ---------------------------  ----  ------ ---------  ------------------------------------------------------------

                                                              SET CLM_TYPE_CD TO 72 (RIC O DMEPOS CLAIM)
                                                              WHERE THE FOLLOWING CONDITIONS ARE MET:
                                                              1.   CLM_NEAR_LINE_RIC_CD EQUAL 'O'
                                                              2.   HCPCS_CD on DMEPOS table (NOTE: if one or
                                                                    more line item(s) match the HCPCS on the
                                                                    DMEPOS table).

                                                              SET CLM_TYPE_CD TO 73 (PHYSICIAN ENCOUNTER CLAIM--
                                                              EFFECTIVE WITH HDC PROCESSING) WHERE THE FOLLOWING
                                                              CONDITIONS ARE MET:
                                                              1.   CARR_NUM = 80882 AND
                                                              2.   CLM_DEMO_ID_NUM = 38

                                                              SET CLM_TYPE_CD TO 81 (RIC M non-DMEPOS DMERC
                                                                 CLAIM)
                                                              WHERE THE FOLLOWING CONDITIONS ARE MET:
                                                              1.   CLM_NEAR_LINE_RIC_CD EQUAL 'M'
                                                              2.   HCPCS_CD not on DMEPOS table

                                                              SET CLM_TYPE_CD TO 82 (RIC M DMEPOS DMERC CLAIM)
                                                              WHERE THE FOLLOWING CONDITIONS ARE MET:
                                                              1.   CLM_NEAR_LINE_RIC_CD EQUAL 'M'
                                                              2.   HCPCS_CD on DMEPOS table (NOTE: if one or
                                                                    more line item(s) match the HCPCS on the
                                                                    DMEPOS table).

                                                            CODES:
                                                              REFER TO: NCH_CLM_TYPE_TB

                                                            SOURCE:
                                                            NCH

    6. Claim Related Occurrence     CHAR      2    22   23  The code that identifies a significant event
       Code                                                 relating to an institutional claim that may
                                                            affect payer processing.  These codes are
                                                            claim-related occurrences that are related
                                                            to a specific date.

                                                            DB2 ALIAS: CLM_RLT_OCRNC_CD
                                                            SAS ALIAS: OCRNC_CD
                                                            STANDARD ALIAS: CLM_RLT_OCRNC_CD
                                                            SYSTEM ALIAS: LTOCRNC
                                                            TITLE ALIAS: OCCURRENCE_CD

                                                            CODES:
                                                            01 THRU 09 = Accident
                                                            10 THRU 19 = Medical condition
                                                            20 THRU 39 = Insurance related
                                                            40 THRU 69 = Service related
                                                            A1-A3 = Miscellaneous

1                       FI Inpatient SNF Claim Record - Limited Data Set Standard View -- 11/2005

                                                 POSITIONS
                  NAME              TYPE  LENGTH BEG  END                            CONTENTS
       ---------------------------  ----  ------ ---------  ------------------------------------------------------------

                                                            CODES:
                                                              REFER TO: CLM_RLT_OCRNC_TB
                                                                        IN THE CODES APPENDIX

                                                            SOURCE:
                                                            CWF

    7. Claim Related Occurrence     NUM       8    24   31  The date associated with a significant event
       Date                                                 related to an institutional claim that may
                                                            affect payer processing.

                                                            For the Limited Data Set Standard View of
                                                            the Inpatient/SNF files, the claim procedure
                                                            performed date is coded as the quarter
                                                            of the calendar year when the procedure
                                                            was performed.

                                                            8 DIGITS UNSIGNED

                                                            DB2 ALIAS: CLM_RLT_OCRNC_DT
                                                            SAS ALIAS: OCRNCDT
                                                            STANDARD ALIAS: CLM_RLT_OCRNC_DT
                                                            TITLE ALIAS: RLT_OCRNC_DT

                                                            EDIT-RULES FOR LIMITED DATA SET DATA:
                                                            YYYYQ000 WHERE Q IS ONE OF THE
                                                            FOLLOWING VALUES.
                                                            1 = FIRST QUARTER OF THE CALENDAR YEAR
                                                            2 = SECOND QUARTER OF THE CALENDAR YEAR
                                                            3 = THIRD QUARTER OF THE CALENDAR YEAR
                                                            4 = FOURTH QUARTER OF THE CALENDAR YEAR

                                                            SOURCE:
                                                            CWF

1                       FI Inpatient SNF Claim Record - Limited Data Set Standard View -- 11/2005


       *****************************************************************************************************************

                                 C L A I M     V A L U E     G R O U P     R E C O R D

       *****************************************************************************************************************


                                                 POSITIONS
                  NAME              TYPE  LENGTH BEG  END                            CONTENTS
       ---------------------------  ----  ------ ---------  ------------------------------------------------------------

 ****  FI Inpatient/Skilled         GROUP    36             Claim Value Group Record for the
       Nursing Facility Claim                               Limited Data Set Standard View of
       Value Group Record -                                 the Inpatient/Skilled Nursing Facility
       Limited Data Set Standard                            version I NCH Nearline File.
       View
                                                            The number of claim value trailers
                                                            present is determined by the claim
                                                            value code count. Effective 10/93,
                                                            up to 36 occurrences can be reported on an
                                                            institutional claim. Prior to 10/93, up
                                                            to 10 occurrences could be reported.

                                                            OCCURS: UP TO 36 TIMES
                                                                    DEPENDING ON IP_CLM_VAL_CD_CNT

                                                            STANDARD ALIAS: CLM_VAL_GRP

    1. Record Length Count          NUM       5     1    5  The length of the Claim Value Group Record.

                                                            5 DIGITS UNSIGNED

                                                            STANDARD ALIAS: DSY_VW_BYTE_CNT

    2. Record Number                NUM       9     6   14  A sequentially assigned number for the claims included
                                                            in the file. This number allows the user to link all of
                                                            the records associated with one claim.

                                                            STANDARD ALIAS: DSY_VW_REC_LNK_NUM

    3. Record Type                  NUM       2    15   16  Type of Record.

                                                            STANDARD ALIAS: DSY_VW_REC_TYPE

                                                            CODES:
                                                            00 = Fixed/Main Group
                                                            01 = Carrier Line Group
                                                            02 = Claim Demonstration ID Group
                                                            03 = Claim Diagnosis Group
                                                            04 = Claim Health PlanID Group
                                                            05 = Claim Occurrence Span Group
                                                            06 = Claim Procedure Group
                                                            07 = Claim Related Condition Group
                                                            08 = Claim Related Occurrence Group
                                                            09 = Claim Value Group
                                                            10 = MCO Period Group
                                                            11 = NCH Edit Group

1                       FI Inpatient SNF Claim Record - Limited Data Set Standard View -- 11/2005

                                                 POSITIONS
                  NAME              TYPE  LENGTH BEG  END                            CONTENTS
       ---------------------------  ----  ------ ---------  ------------------------------------------------------------

                                                            12 = NCH Patch Group
                                                            13 = DMERC Line Group
                                                            14 = Revenue Center Group

    4. Claim Sequence Number        NUM       3    17   19  A counter for records that consist of trailer
                                                            information, such as claim line and revenue center
                                                            data, which can occur multiple times for one claim.

                                                            STANDARD ALIAS: DSY_VW_REC_SEQ

    5. NCH Claim Type Code          CHAR      2    20   21  The code used to identify the type of claim record being
                                                            processed in NCH.

                                                            NOTE1:  During the Version H conversion this field was
                                                                    populated with data through- out history (back to
                                                                    service year 1991).

                                                            NOTE2:  During the Version I conversion this field was
                                                                    expanded to include inpatient 'full' encounter
                                                                    claims (for service dates after 6/30/97).
                                                                    Placeholders for Physician and Outpatient encounters
                                                                    (available in NMUD) have also been added.

                                                            SYSTEM ALIAS: NCH_CLM_TYPE_CD

                                                            DERIVATION:
                                                            FFS CLAIM TYPE CODES DERIVED FROM:
                                                              NCH CLM_NEAR_LINE_RIC_CD
                                                              NCH PMT_EDIT_RIC_CD
                                                              NCH CLM_TRANS_CD
                                                              NCH PRVDR_NUM

                                                            INPATIENT 'FULL' ENCOUNTER TYPE CODE DERIVED FROM:
                                                              (Pre-HDC processing -- AVAILABLE IN NCH)
                                                              CLM_MCO_PD_SW
                                                              CLM_RLT_COND_CD
                                                              MCO_CNTRCT_NUM
                                                              MCO_OPTN_CD
                                                              MCO_PRD_EFCTV_DT
                                                              MCO_PRD_TRMNTN_DT

                                                            INPATIENT 'FULL' ENCOUNTER TYPE CODE DERIVED FROM:
                                                              (HDC processing -- AVAILABLE IN NMUD)
                                                              FI_NUM

                                                            INPATIENT 'ABBREVIATED' ENCOUNTER TYPE CODE DERIVED
                                                            FROM: (HDC processing -- AVAILABLE IN NMUD)
                                                              FI_NUM
                                                              CLM_FAC_TYPE_CD
                                                              CLM_SRVC_CLSFCTN_TYPE_CD
                                                              CLM_FREQ_CD
                                                            NOTE:  From 7/1/97 to the start of HDC processing(?),
                                                            abbreviated inpatient encounter claims are not
                                                            available in NCH or NMUD.

1                       FI Inpatient SNF Claim Record - Limited Data Set Standard View -- 11/2005

                                                 POSITIONS
                  NAME              TYPE  LENGTH BEG  END                            CONTENTS
       ---------------------------  ----  ------ ---------  ------------------------------------------------------------

                                                            PHYSICIAN 'FULL' ENCOUNTER TYPE CODE DERIVED FROM:
                                                              (AVAILABLE IN NMUD)
                                                              CARR_NUM
                                                              CLM_DEMO_ID_NUM

                                                            OUTPATIENT 'FULL' ENCOUNTER TYPE CODE DERIVED FROM:
                                                              (AVAILABLE IN NMUD)
                                                              FI_NUM

                                                            OUTPATIENT 'ABBREVIATED' ENCOUNTER TYPE CODE
                                                            DERIVED FROM:  (AVAILABLE IN NMUD)
                                                              FI_NUM
                                                              CLM_FAC_TYPE_CD
                                                              CLM_SRVC_CLSFCTN_TYPE_CD
                                                              CLM_FREQ_CD

                                                            DERIVATION RULES:

                                                              SET CLM_TYPE_CD TO 10 (HHA CLAIM) WHERE THE
                                                              FOLLOWING CONDITIONS ARE MET:
                                                              1.   CLM_NEAR_LINE_RIC_CD EQUAL 'V','W' OR 'U'
                                                              2.   PMT_EDIT_RIC_CD EQUAL 'F'
                                                              3.   CLM_TRANS_CD EQUAL '5'

                                                              SET CLM_TYPE_CD TO 20 (SNF NON-SWING BED CLAIM)
                                                              WHERE THE FOLLOWING CONDITIONS ARE MET:
                                                              1.   CLM_NEAR_LINE_RIC_CD EQUAL 'V'
                                                              2.   PMT_EDIT_RIC_CD EQUAL 'C' OR 'E'
                                                              3.   CLM_TRANS_CD EQUAL '0' OR '4'
                                                              4.   POSITION 3 OF PRVDR_NUM IS NOT 'U', 'W', 'Y'
                                                                   OR 'Z'

                                                              SET CLM_TYPE_CD TO 30 (SNF SWING BED CLAIM)
                                                              WHERE THE FOLLOWING CONDITIONS ARE MET:
                                                              1.   CLM_NEAR_LINE_RIC_CD EQUAL 'V'
                                                              2.   PMT_EDIT_RIC_CD EQUAL 'C' OR 'E'
                                                              3.   CLM_TRANS_CD EQUAL '0' OR '4'
                                                              4.   POSITION 3 OF PRVDR_NUM EQUAL 'U', 'W', 'Y'
                                                                   OR 'Z'

                                                              SET CLM_TYPE_CD TO 40 (OUTPATIENT CLAIM)
                                                              WHERE THE FOLLOWING CONDITIONS ARE MET:
                                                              1.   CLM_NEAR_LINE_RIC_CD EQUAL 'W'
                                                              2.   PMT_EDIT_RIC_CD EQUAL 'D'
                                                              3.   CLM_TRANS_CD EQUAL '6'

                                                              SET CLM_TYPE_CD TO 41 (OUTPATIENT 'FULL'
                                                              ENCOUNTER CLAIM -- AVAILABLE IN NMUD) WHERE
                                                              THE FOLLOWING CONDITIONS ARE MET:
                                                              1.   CLM_NEAR_LINE_RIC_CD EQUAL 'W'
                                                              2.   PMT_EDIT_RIC_CD EQUAL 'D'
                                                              3.   CLM_TRANS_CD EQUAL '6'
                                                              4.   FI_NUM = 80881

1                       FI Inpatient SNF Claim Record - Limited Data Set Standard View -- 11/2005

                                                 POSITIONS
                  NAME              TYPE  LENGTH BEG  END                            CONTENTS
       ---------------------------  ----  ------ ---------  ------------------------------------------------------------

                                                              SET CLM_TYPE_CD TO 42 (OUTPATIENT 'ABBREVIATED'
                                                              ENCOUNTER CLAIMS -- AVAILABLE IN NMUD)
                                                              1.   FI_NUM = 80881
                                                              2.   CLM_FAC_TYPE_CD = '1' OR '8'; CLM_SRVC_
                                                                   CLSFCTN_TYPE_CD = '2', '3' OR '4' &
                                                                   CLM_FREQ_CD = 'Z', 'Y' OR 'X'

                                                              SET CLM_TYPE_CD TO 50 (HOSPICE CLAIM)
                                                              WHERE THE FOLLOWING CONDITIONS ARE MET:
                                                              1.   CLM_NEAR_LINE_RIC_CD EQUAL 'V'
                                                              2.   PMT_EDIT_RIC_CD EQUAL 'I'
                                                              3.   CLM_TRANS_CD EQUAL 'H'

                                                              SET CLM_TYPE_CD TO 60 (INPATIENT CLAIM)
                                                              WHERE THE FOLLOWING CONDITIONS ARE MET:
                                                              1.   CLM_NEAR_LINE_RIC_CD EQUAL 'V'
                                                              2.   PMT_EDIT_RIC_CD EQUAL 'C' OR 'E'
                                                              3.   CLM_TRANS_CD EQUAL '1' '2' OR '3'

                                                              SET CLM_TYPE_CD TO 61 (INPATIENT 'FULL' ENCOUNTER
                                                              CLAIM - PRIOR TO HDC PROCESSING - AFTER 6/30/97 -
                                                              12/4/00) WHERE THE FOLLOWING CONDITIONS ARE MET:
                                                              1.   CLM_MCO_PD_SW = '1'
                                                              2.   CLM_RLT_COND_CD = '04'
                                                              3.   MCO_CNTRCT_NUM
                                                                   MCO_OPTN_CD = 'C'
                                                                   CLM_FROM_DT & CLM_THRU_DT ARE WITHIN THE
                                                                   MCO_PRD_EFCTV_DT & MCO_PRD_TRMNTN_DT
                                                                   ENROLLMENT PERIODS

                                                              SET_CLM_TYPE_CD TO 61 (INPATIENT 'FULL' ENCOUNTER
                                                              CLAIM -- EFFECTIVE WITH HDC PROCESSING) WHERE THE
                                                              FOLLOWING CONDITIONS ARE MET:
                                                              1.   CLM_NEAR_LINE_RIC_CD EQUAL 'V'
                                                              2.   PMT_EDIT_RIC_CD EQUAL 'C' OR 'E'
                                                              3.   CLM_TRANS_CD EQUAL '1' '2' OR '3'
                                                              4.   FI_NUM = 80881

                                                              SET CLM_TYPE_CD TO 62 (INPATIENT 'ABBREVIATED'
                                                              ENCOUNTER CLAIM -- AVAILABLE IN NMUD) WHERE
                                                              THE FOLLOWING CONDITIONS ARE MET:
                                                              1.   FI_NUM = 80881 AND
                                                              2.   CLM_FAC_TYPE_CD = '1'; CLM_SRVC_CLSFCTN_
                                                                   TYPE_CD = '1'; CLM_FREQ_CD = 'Z'
                                                              SET CLM_TYPE_CD TO 71 (RIC O non-DMEPOS CLAIM)
                                                              WHERE THE FOLLOWING CONDITIONS ARE MET:
                                                              1.   CLM_NEAR_LINE_RIC_CD EQUAL TO '0'
                                                              2.   HCPCS_CD not on DMEPOS table

                                                              SET CLM_TYPE_CD TO 72 (RIC O DMEPOS CLAIM)
                                                              WHERE THE FOLLOWING CONDITIONS ARE MET:
                                                              1.   CLM_NEAR_LINE_RIC_CD EQUAL 'O'

1                       FI Inpatient SNF Claim Record - Limited Data Set Standard View -- 11/2005

                                                 POSITIONS
                  NAME              TYPE  LENGTH BEG  END                            CONTENTS
       ---------------------------  ----  ------ ---------  ------------------------------------------------------------

                                                              2.   HCPCS_CD on DMEPOS table (NOTE: if one or
                                                                    more line item(s) match the HCPCS on the
                                                                    DMEPOS table).

                                                              SET CLM_TYPE_CD TO 73 (PHYSICIAN ENCOUNTER CLAIM--
                                                              EFFECTIVE WITH HDC PROCESSING) WHERE THE FOLLOWING
                                                              CONDITIONS ARE MET:
                                                              1.   CARR_NUM = 80882 AND
                                                              2.   CLM_DEMO_ID_NUM = 38

                                                              SET CLM_TYPE_CD TO 81 (RIC M non-DMEPOS DMERC
                                                                 CLAIM)
                                                              WHERE THE FOLLOWING CONDITIONS ARE MET:
                                                              1.   CLM_NEAR_LINE_RIC_CD EQUAL 'M'
                                                              2.   HCPCS_CD not on DMEPOS table

                                                              SET CLM_TYPE_CD TO 82 (RIC M DMEPOS DMERC CLAIM)
                                                              WHERE THE FOLLOWING CONDITIONS ARE MET:
                                                              1.   CLM_NEAR_LINE_RIC_CD EQUAL 'M'
                                                              2.   HCPCS_CD on DMEPOS table (NOTE: if one or
                                                                    more line item(s) match the HCPCS on the
                                                                    DMEPOS table).

                                                            CODES:
                                                              REFER TO: NCH_CLM_TYPE_TB
                                                                        IN THE CODES APPENDIX

                                                            SOURCE:
                                                            NCH

    6. Claim Value Code             CHAR      2    22   23  The code indicating the value of a monetary
                                                            condition which was used by the intermediary
                                                            to process an institutional claim.

                                                            DB2 ALIAS: CLM_VAL_CD
                                                            SAS ALIAS: VAL_CD
                                                            STANDARD ALIAS: CLM_VAL_CD
                                                            SYSTEM ALIAS: LTVALUE
                                                            TITLE ALIAS: VALUE_CD

                                                            CODES:
                                                              REFER TO: CLM_VAL_TB
                                                                        IN THE CODES APPENDIX

                                                            SOURCE:
                                                            CWF

    7. Claim Value Amount           NUM      13    24   36  The amount related to the condition identified
                                                            in the CLM_VAL_CD which was used by the
                                                            intermediary to process the institutional
                                                            claim.

                                                            9.2 DIGITS SIGNED

1                       FI Inpatient SNF Claim Record - Limited Data Set Standard View -- 11/2005

                                                 POSITIONS
                  NAME              TYPE  LENGTH BEG  END                            CONTENTS
       ---------------------------  ----  ------ ---------  ------------------------------------------------------------

                                                            DB2 ALIAS: CLM_VAL_AMT
                                                            SAS ALIAS: VAL_AMT
                                                            STANDARD ALIAS: CLM_VAL_AMT
                                                            TITLE ALIAS: VALUE_AMOUNT

                                                            EDIT-RULES:
                                                            +9(9).99

                                                            SOURCE:
                                                            CWF

1                       FI Inpatient SNF Claim Record - Limited Data Set Standard View -- 11/2005


       *****************************************************************************************************************

                       C L A I M     R E V E N U E     C E N T E R     G R O U P     R E C O R D

       *****************************************************************************************************************


                                                 POSITIONS
                  NAME              TYPE  LENGTH BEG  END                            CONTENTS
       ---------------------------  ----  ------ ---------  ------------------------------------------------------------

 ****  FI Inpatient/Skilled         GROUP   262             Claim Revenue Center Group Record for
       Nursing Facility Claim                               the Limited Data Set Standard View of
       Revenue Center Group                                 the Inpatient/Skilled Nursing Facility
       Record - Limited Data                                version I Nearline File.
       Set Standard View
                                                            The number of claim revenue center group
                                                            trailers present is determined by the claim
                                                            revenue center code count. Effective 7/7/00,
                                                            up to 450 occurrences may be reported for an
                                                            institutional claim. The increase in the number
                                                            of revenue center lines causes each claim to
                                                            be broken out into records/segments (up to 10).
                                                            Each record can have up to 45 occurrences of
                                                            revenue center lines. Prior to 7/7/00, up to
                                                            58 occurrences may be reported on an institutional
                                                            claim. Claims submitted prior to 10/93, contained
                                                            up to 28 occurrences.

                                                            OCCURS: UP TO 45 TIMES

                                                            STANDARD ALIAS: CLM_REV_CNTR_GRP

                                                            COMMENT:
                                                            ****************** FOR SNF PPS *********************
                                                            The Balanced Budget Act modified how payment will be
                                                            made for skilled nursing facility (SNF) services.
                                                            Effective with cost reporting periods beginning on or
                                                            after 7/1/98 (with all providers transitioning by
                                                            6/30/99, SNFs will be paid on a prospective payment
                                                            system (PPS).

                                                            SNFs will classify beneficiaries on the basis of
                                                            residents' characteristics and resource needs, using
                                                            the 44-group patient classification system known as
                                                            Resource Utilization Groups (RUGS), Version III.
                                                            Facilities will use information from the Minimum Data
                                                            Set (MDS), Version 2.0, Resident Assessment Instrument
                                                            (RAI) to classify residents into the RUG-III groups.

                                                            ***************** FOR OUTPATIENT PPS ***************
                                                            The Balanced Budget Act modified how payment will be
                                                            made for hospital outpatient services, certain PTB
                                                            services furnished to inpatients who have no PTA
                                                            coverage, CMHCs, and limited services provided by

1                       FI Inpatient SNF Claim Record - Limited Data Set Standard View -- 11/2005

                                                 POSITIONS
                  NAME              TYPE  LENGTH BEG  END                            CONTENTS
       ---------------------------  ----  ------ ---------  ------------------------------------------------------------

                                                            CORFs, Home Health Agencies or to hospice patients
                                                            for the treatment of a non-terminal illness.  Imple-
                                                            mentation for Outpatient PPS (OPPS) will be effective
                                                            for claims with dates of service on or after
                                                            July 1, 2000.

                                                            Payment for services under the OPPS system is
                                                            calculated based on grouping outpatient services
                                                            into ambulatory payment classifications (APC) groups.

                                                            ************** FOR HOME HEALTH PPS ***************
                                                            The Balanced Budget Act of 1997 mandated changes in
                                                            payment and other provider requirements for home
                                                            health.  All home health agencies will be paid
                                                            through a prospective payment system beginning
                                                            October 1, 2000.

                                                            Under Home Health PPS (HH PPS) the unit of payment
                                                            will be a 60-day episode.  Home Health Resources
                                                            Groups (HHRGs), also called HRGs represented by
                                                            HCFA HIPPS coding, will be the basis of payment for
                                                            each episode; HHRGs will be produced through pubicly
                                                            available Grouper software that will determine the
                                                            appropriate HHRG when results of comprehensive
                                                            assessments of the beneficiary (made incorporating
                                                            the OASIS data set) are input or grouped in this
                                                            software.

    1. Record Length Count          NUM       5     1    5  The length of the Claim Revenue Center Group
                                                            Record.

                                                            5 DIGITS UNSIGNED

                                                            STANDARD ALIAS: DSY_VW_BYTE_CNT

    2. Record Number                NUM       9     6   14  A sequentially assigned number for the claims included
                                                            in the file. This number allows the user to link all of
                                                            the records associated with one claim.

                                                            STANDARD ALIAS: DSY_VW_REC_LNK_NUM

    3. Record Type                  NUM       2    15   16  Type of Record.

                                                            STANDARD ALIAS: DSY_VW_REC_TYPE

                                                            CODES:
                                                            00 = Fixed/Main Group
                                                            01 = Carrier Line Group
                                                            02 = Claim Demonstration ID Group
                                                            03 = Claim Diagnosis Group
                                                            04 = Claim Health PlanID Group
                                                            05 = Claim Occurrence Span Group

1                       FI Inpatient SNF Claim Record - Limited Data Set Standard View -- 11/2005

                                                 POSITIONS
                  NAME              TYPE  LENGTH BEG  END                            CONTENTS
       ---------------------------  ----  ------ ---------  ------------------------------------------------------------

                                                            06 = Claim Procedure Group
                                                            07 = Claim Related Condition Group
                                                            08 = Claim Related Occurrence Group
                                                            09 = Claim Value Group
                                                            10 = MCO Period Group
                                                            11 = NCH Edit Group
                                                            12 = NCH Patch Group
                                                            13 = DMERC Line Group
                                                            14 = Revenue Center Group

    4. Claim Sequence Number        NUM       3    17   19  A counter for records that consist of trailer
                                                            information, such as claim line and revenue center
                                                            data, which can occur multiple times for one claim.

                                                            STANDARD ALIAS: DSY_VW_REC_SEQ

    5. NCH Claim Type Code          CHAR      2    20   21  The code used to identify the type of claim record being
                                                            processed in NCH.

                                                            NOTE1:  During the Version H conversion this field was
                                                                    populated with data through- out history (back to
                                                                    service year 1991).

                                                            NOTE2:  During the Version I conversion this field was
                                                                    expanded to include inpatient 'full' encounter
                                                                    claims (for service dates after 6/30/97).
                                                                    Placeholders for Physician and Outpatient encounters
                                                                    (available in NMUD) have also been added.

                                                            STANDARD ALIAS: NCH_CLM_TYPE_CD

                                                            DERIVATION:
                                                            FFS CLAIM TYPE CODES DERIVED FROM:
                                                              NCH CLM_NEAR_LINE_RIC_CD
                                                              NCH PMT_EDIT_RIC_CD
                                                              NCH CLM_TRANS_CD
                                                              NCH PRVDR_NUM

                                                            INPATIENT 'FULL' ENCOUNTER TYPE CODE DERIVED FROM:
                                                              (Pre-HDC processing -- AVAILABLE IN NCH)
                                                              CLM_MCO_PD_SW
                                                              CLM_RLT_COND_CD
                                                              MCO_CNTRCT_NUM
                                                              MCO_OPTN_CD
                                                              MCO_PRD_EFCTV_DT
                                                              MCO_PRD_TRMNTN_DT

                                                            INPATIENT 'FULL' ENCOUNTER TYPE CODE DERIVED FROM:
                                                              (HDC processing -- AVAILABLE IN NMUD)
                                                              FI_NUM

1                       FI Inpatient SNF Claim Record - Limited Data Set Standard View -- 11/2005

                                                 POSITIONS
                  NAME              TYPE  LENGTH BEG  END                            CONTENTS
       ---------------------------  ----  ------ ---------  ------------------------------------------------------------

                                                            INPATIENT 'ABBREVIATED' ENCOUNTER TYPE CODE DERIVED
                                                            FROM: (HDC processing -- AVAILABLE IN NMUD)
                                                              FI_NUM
                                                              CLM_FAC_TYPE_CD
                                                              CLM_SRVC_CLSFCTN_TYPE_CD
                                                              CLM_FREQ_CD
                                                            NOTE:  From 7/1/97 to the start of HDC processing(?),
                                                            abbreviated inpatient encounter claims are not
                                                            available in NCH or NMUD.

                                                            PHYSICIAN 'FULL' ENCOUNTER TYPE CODE DERIVED FROM:
                                                              (AVAILABLE IN NMUD)
                                                              CARR_NUM
                                                              CLM_DEMO_ID_NUM

                                                            OUTPATIENT 'FULL' ENCOUNTER TYPE CODE DERIVED FROM:
                                                              (AVAILABLE IN NMUD)
                                                              FI_NUM

                                                            OUTPATIENT 'ABBREVIATED' ENCOUNTER TYPE CODE
                                                            DERIVED FROM:  (AVAILABLE IN NMUD)
                                                              FI_NUM
                                                              CLM_FAC_TYPE_CD
                                                              CLM_SRVC_CLSFCTN_TYPE_CD
                                                              CLM_FREQ_CD

                                                            DERIVATION RULES:

                                                              SET CLM_TYPE_CD TO 10 (HHA CLAIM) WHERE THE
                                                              FOLLOWING CONDITIONS ARE MET:
                                                              1.   CLM_NEAR_LINE_RIC_CD EQUAL 'V','W' OR 'U'
                                                              2.   PMT_EDIT_RIC_CD EQUAL 'F'
                                                              3.   CLM_TRANS_CD EQUAL '5'

                                                              SET CLM_TYPE_CD TO 20 (SNF NON-SWING BED CLAIM)
                                                              WHERE THE FOLLOWING CONDITIONS ARE MET:
                                                              1.   CLM_NEAR_LINE_RIC_CD EQUAL 'V'
                                                              2.   PMT_EDIT_RIC_CD EQUAL 'C' OR 'E'
                                                              3.   CLM_TRANS_CD EQUAL '0' OR '4'
                                                              4.   POSITION 3 OF PRVDR_NUM IS NOT 'U', 'W', 'Y'
                                                                   OR 'Z'

                                                              SET CLM_TYPE_CD TO 30 (SNF SWING BED CLAIM)
                                                              WHERE THE FOLLOWING CONDITIONS ARE MET:
                                                              1.   CLM_NEAR_LINE_RIC_CD EQUAL 'V'
                                                              2.   PMT_EDIT_RIC_CD EQUAL 'C' OR 'E'
                                                              3.   CLM_TRANS_CD EQUAL '0' OR '4'
                                                              4.   POSITION 3 OF PRVDR_NUM EQUAL 'U', 'W', 'Y'
                                                                   OR 'Z'

                                                              SET CLM_TYPE_CD TO 40 (OUTPATIENT CLAIM)
                                                              WHERE THE FOLLOWING CONDITIONS ARE MET:

1                       FI Inpatient SNF Claim Record - Limited Data Set Standard View -- 11/2005

                                                 POSITIONS
                  NAME              TYPE  LENGTH BEG  END                            CONTENTS
       ---------------------------  ----  ------ ---------  ------------------------------------------------------------

                                                              1.   CLM_NEAR_LINE_RIC_CD EQUAL 'W'
                                                              2.   PMT_EDIT_RIC_CD EQUAL 'D'
                                                              3.   CLM_TRANS_CD EQUAL '6'

                                                              SET CLM_TYPE_CD TO 41 (OUTPATIENT 'FULL'
                                                              ENCOUNTER CLAIM -- AVAILABLE IN NMUD) WHERE
                                                              THE FOLLOWING CONDITIONS ARE MET:
                                                              1.   CLM_NEAR_LINE_RIC_CD EQUAL 'W'
                                                              2.   PMT_EDIT_RIC_CD EQUAL 'D'
                                                              3.   CLM_TRANS_CD EQUAL '6'
                                                              4.   FI_NUM = 80881

                                                              SET CLM_TYPE_CD TO 42 (OUTPATIENT 'ABBREVIATED'
                                                              ENCOUNTER CLAIMS -- AVAILABLE IN NMUD)
                                                              1.   FI_NUM = 80881
                                                              2.   CLM_FAC_TYPE_CD = '1' OR '8'; CLM_SRVC_
                                                                   CLSFCTN_TYPE_CD = '2', '3' OR '4' &
                                                                   CLM_FREQ_CD = 'Z', 'Y' OR 'X'

                                                              SET CLM_TYPE_CD TO 50 (HOSPICE CLAIM)
                                                              WHERE THE FOLLOWING CONDITIONS ARE MET:
                                                              1.   CLM_NEAR_LINE_RIC_CD EQUAL 'V'
                                                              2.   PMT_EDIT_RIC_CD EQUAL 'I'
                                                              3.   CLM_TRANS_CD EQUAL 'H'

                                                              SET CLM_TYPE_CD TO 60 (INPATIENT CLAIM)
                                                              WHERE THE FOLLOWING CONDITIONS ARE MET:
                                                              1.   CLM_NEAR_LINE_RIC_CD EQUAL 'V'
                                                              2.   PMT_EDIT_RIC_CD EQUAL 'C' OR 'E'
                                                              3.   CLM_TRANS_CD EQUAL '1' '2' OR '3'

                                                              SET CLM_TYPE_CD TO 61 (INPATIENT 'FULL' ENCOUNTER
                                                              CLAIM - PRIOR TO HDC PROCESSING - AFTER 6/30/97 -
                                                              12/4/00) WHERE THE FOLLOWING CONDITIONS ARE MET:
                                                              1.   CLM_MCO_PD_SW = '1'
                                                              2.   CLM_RLT_COND_CD = '04'
                                                              3.   MCO_CNTRCT_NUM
                                                                   MCO_OPTN_CD = 'C'
                                                                   CLM_FROM_DT & CLM_THRU_DT ARE WITHIN THE
                                                                   MCO_PRD_EFCTV_DT & MCO_PRD_TRMNTN_DT
                                                                   ENROLLMENT PERIODS

                                                              SET_CLM_TYPE_CD TO 61 (INPATIENT 'FULL' ENCOUNTER
                                                              CLAIM -- EFFECTIVE WITH HDC PROCESSING) WHERE THE
                                                              FOLLOWING CONDITIONS ARE MET:
                                                              1.   CLM_NEAR_LINE_RIC_CD EQUAL 'V'
                                                              2.   PMT_EDIT_RIC_CD EQUAL 'C' OR 'E'
                                                              3.   CLM_TRANS_CD EQUAL '1' '2' OR '3'
                                                              4.   FI_NUM = 80881

                                                              SET CLM_TYPE_CD TO 62 (INPATIENT 'ABBREVIATED'
                                                              ENCOUNTER CLAIM -- AVAILABLE IN NMUD) WHERE
                                                              THE FOLLOWING CONDITIONS ARE MET:

1                       FI Inpatient SNF Claim Record - Limited Data Set Standard View -- 11/2005

                                                 POSITIONS
                  NAME              TYPE  LENGTH BEG  END                            CONTENTS
       ---------------------------  ----  ------ ---------  ------------------------------------------------------------

                                                              1.   FI_NUM = 80881 AND
                                                              2.   CLM_FAC_TYPE_CD = '1'; CLM_SRVC_CLSFCTN_
                                                                   TYPE_CD = '1'; CLM_FREQ_CD = 'Z'

                                                              SET CLM_TYPE_CD TO 71 (RIC O non-DMEPOS CLAIM)
                                                              WHERE THE FOLLOWING CONDITIONS ARE MET:
                                                              1.   CLM_NEAR_LINE_RIC_CD EQUAL 'O'
                                                              2.   HCPCS_CD not on DMEPOS table

                                                              SET CLM_TYPE_CD TO 72 (RIC O DMEPOS CLAIM)
                                                              WHERE THE FOLLOWING CONDITIONS ARE MET:
                                                              1.   CLM_NEAR_LINE_RIC_CD EQUAL 'O'
                                                              2.   HCPCS_CD on DMEPOS table (NOTE: if one or
                                                                    more line item(s) match the HCPCS on the
                                                                    DMEPOS table).

                                                              SET CLM_TYPE_CD TO 73 (PHYSICIAN ENCOUNTER CLAIM--
                                                              EFFECTIVE WITH HDC PROCESSING) WHERE THE FOLLOWING
                                                              CONDITIONS ARE MET:
                                                              1.   CARR_NUM = 80882 AND
                                                              2.   CLM_DEMO_ID_NUM = 38

                                                              SET CLM_TYPE_CD TO 81 (RIC M non-DMEPOS DMERC
                                                                 CLAIM)
                                                              WHERE THE FOLLOWING CONDITIONS ARE MET:
                                                              1.   CLM_NEAR_LINE_RIC_CD EQUAL 'M'
                                                              2.   HCPCS_CD not on DMEPOS table

                                                              SET CLM_TYPE_CD TO 82 (RIC M DMEPOS DMERC CLAIM)
                                                              WHERE THE FOLLOWING CONDITIONS ARE MET:
                                                              1.   CLM_NEAR_LINE_RIC_CD EQUAL 'M'
                                                              2.   HCPCS_CD on DMEPOS table (NOTE: if one or
                                                                    more line item(s) match the HCPCS on the
                                                                    DMEPOS table).

                                                            CODES:
                                                              REFER TO: NCH_CLM_TYPE_TB
                                                                        IN THE CODES APPENDIX

                                                            SOURCE:
                                                            NCH

    6. Revenue Center Code          CHAR      4    22   25  The provider-assigned revenue code for each cost center for
                                                            which a separate charge is billed (type of accommodation or
                                                            ancillary).  A cost center is a division or unit within a
                                                            hospital (e.g., radiology, emergency room, pathology).
                                                            EXCEPTION:  Revenue center code 0001 represents the total of
                                                            all revenue centers included on the claim.

                                                            COBOL ALIAS: REV_CD
                                                            DB2 ALIAS: REV_CNTR_CD
                                                            SAS ALIAS: REV_CNTR
                                                            STANDARD ALIAS: REV_CNTR_CD

1                       FI Inpatient SNF Claim Record - Limited Data Set Standard View -- 11/2005

                                                 POSITIONS
                  NAME              TYPE  LENGTH BEG  END                            CONTENTS
       ---------------------------  ----  ------ ---------  ------------------------------------------------------------

                                                            SYSTEM ALIAS: LTRC
                                                            TITLE ALIAS: REVENUE_CENTER_CD

                                                            CODES:
                                                              REFER TO: REV_CNTR_TB
                                                                        IN THE CODES APPENDIX

                                                            SOURCE:
                                                            CWF

    7. Revenue Center Date          NUM       8    26   33  Effective with Version H, the date applicable
                                                            to the service represented by the revenue center
                                                            code.   This field may be present on any of the
                                                            institutional claim types.  For home health claims
                                                            the service date should be present on all bills
                                                            with from date greater than 3/31/98.  With the
                                                            implementation of outpatient PPS, hospitals will
                                                            be required to enter line item dates of service
                                                            for all outpatient services which require a HCPCS.

                                                            For the Limited Data Set Standard View of the
                                                            Inpatient/SNF, the date applicable to the service
                                                            represented by the revenue center code is
                                                            coded as the quarter of the calendar year
                                                            when the service represented by the revenue
                                                            center code occurred.

                                                            NOTE1:  Beginning with NCH weekly process date
                                                            10/3/97 this field was populated with data.
                                                            Claims processed prior to 10/3/97 will contain
                                                            zeroes in this field.

                                                            NOTE2:  When revenue center code equals '0022'
                                                            (SNF PPS) and revenue center HCPCS code not equal
                                                            to 'AAA00' (default for no assessment), date re-
                                                            presents the MDS RAI assessment reference date.

                                                            NOTE3:  When revenue center code equals '0023'
                                                            (HHPPS), the  date on the initial claim (RAP) must
                                                            represent the first date of service in the episode.
                                                            The final claim will match the '0023' information
                                                            submitted on the initial claim.  The SCIC
                                                            (significant change in condition) claims may show
                                                            additional '0023' revenue lines in which the
                                                            date represents the date of the first service
                                                            under the revised plan of treatment.

                                                            8 DIGITS UNSIGNED

                                                            DB2 ALIAS: REV_CNTR_DT
                                                            SAS ALIAS: REV_DT
                                                            STANDARD ALIAS: REV_CNTR_DT
                                                            TITLE ALIAS: REV_CNTR_DATE

1                       FI Inpatient SNF Claim Record - Limited Data Set Standard View -- 11/2005

                                                 POSITIONS
                  NAME              TYPE  LENGTH BEG  END                            CONTENTS
       ---------------------------  ----  ------ ---------  ------------------------------------------------------------

                                                            EDIT-RULES FOR LIMITED DATA SET DATA:
                                                            YYYYQ000 WHERE Q IS ONE OF THE
                                                            FOLLOWING VALUES.
                                                            1 = FIRST QUARTER OF THE CALENDAR YEAR
                                                            2 = SECOND QUARTER OF THE CALENDAR YEAR
                                                            3 = THIRD QUARTER OF THE CALENDAR YEAR
                                                            4 = FOURTH QUARTER OF THE CALENDAR YEAR

                                                            SOURCE:
                                                            CWF

    8. Revenue Center APC/HIPPS     CHAR      5    34   38  Effective with Outpatient PPS (OPPS), the Ambulatory
       Code                                                 Payment Classification (APC) code used to identify
                                                            groupings of outpatient services.  APC codes are
                                                            used to calculate payment for services under
                                                            OPPS.

                                                            Effective with Home Health PPS (HHPPS), this field
                                                            will only be populated with a HIPPS code if the HIPPS
                                                            code that is stored in the HCPCS field has been
                                                            downcoded and the new code will be placed in this
                                                            field.

                                                            NOTE1: Under SNF PPS and HHPPS, HIPPS codes are
                                                            stored in the HCPCS field. **EXCEPTION: if a
                                                            HHPPS HIPPS code is downcoded the downcoded
                                                            HIPPS will be stored in this field.

                                                            NOTE2:  Beginning with NCH weekly process date
                                                            8/18/00, this field will be populated with data.
                                                            Claims processed prior to 8/18/00 will contain
                                                            spaces in this field.

                                                            DB2 ALIAS: REV_APC_HIPPS_CD
                                                            SAS ALIAS: APCHIPPS
                                                            STANDARD ALIAS: REV_CNTR_APC_HIPPS_CD
                                                            SYSTEM ALIAS: LTAPC
                                                            TITLE ALIAS: APC_HIPPS

                                                            CODES:
                                                              REFER TO: REV_CNTR_APC_TB
                                                                        IN THE CODES APPENDIX

                                                            SOURCE:
                                                            CWF

    9. Revenue Center HCFA Common   CHAR      5    39   43  HCFA's Common Procedure Coding System (HCPCS)
       Procedure Coding System                              is a collection of codes that represent procedures,
       Code                                                 supplies, products and services which may be
                                                            provided to Medicare beneficiaries and to
                                                            individuals enrolled in private health
                                                            insurance programs.  The codes are divided
                                                            into three levels, or groups, as described
                                                            below:

1                       FI Inpatient SNF Claim Record - Limited Data Set Standard View -- 11/2005

                                                 POSITIONS
                  NAME              TYPE  LENGTH BEG  END                            CONTENTS
       ---------------------------  ----  ------ ---------  ------------------------------------------------------------

                                                            DB2 ALIAS: REV_CNTR_HCPCS_CD
                                                            SAS ALIAS: HCPCS_CD
                                                            STANDARD ALIAS: REV_CNTR_HCPCS_CD
                                                            SYSTEM ALIAS: LTHIPPS
                                                            TITLE ALIAS: HCPCS_CD

                                                            CODES:
                                                              REFER TO: CLM_HIPPS_TB
                                                                        IN THE CODES APPENDIX

                                                            COMMENT:
                                                            Prior to Version H this field was named:
                                                            HCPCS_CD.  With Version H, a prefix
                                                            was added to denote the location of this field
                                                            on each claim type (institutional: REV_CNTR and
                                                            non-institutional: LINE).

                                                            NOTE:  When revenue center code = '0022' (SNF PPS)
                                                            or '0023' (HH PPS), this field contains the Health
                                                            Insurance PPS (HIPPS) code.  The HIPPS code for
                                                            SNF PPS contains the rate code/assessment type that
                                                            identifies (1) RUG-III group the beneficiary was
                                                            classified into as of the RAI MDS assessment reference
                                                            date and (2) the type of assessment for payment pur-
                                                            poses.

                                                            The HIPPS code for Home Health PPS identifies
                                                            (1) the three case-mix dimensions of the HHRG system,
                                                            clinical, functional and utilization, from which a
                                                            beneficiary is assigned to one of the 80 HHRG
                                                            categories and (2) it identifies whether or not
                                                            the elements of the code were computed or derived.
                                                            The HHRGs, represented bythe HIPPS coding, will be
                                                            the basis of payment for each episode.

                                                            For both SNF PPS & HH PPS HIPPS values see CLM_HIPPS_TB.

                                                            Level I
                                                               Codes and descriptors copyrighted by the American
                                                               Medical Association's Current Procedural
                                                               Terminology, Fourth Edition (CPT-4).  These are
                                                               5 position numeric codes representing physician
                                                               and nonphysician services.

                                                               **** Note: ****
                                                               CPT-4 codes including both long and short
                                                               descriptions shall be used in accordance with the
                                                               HCFA/AMA agreement.  Any other use violates the
                                                               AMA copyright.

                                                            Level II
                                                               Includes codes and descriptors copyrighted by
                                                               the American Dental Association's Current Dental
1                       FI Inpatient SNF Claim Record - Limited Data Set Standard View -- 11/2005

                                                 POSITIONS
                  NAME              TYPE  LENGTH BEG  END                            CONTENTS
       ---------------------------  ----  ------ ---------  ------------------------------------------------------------

                                                               Terminology, Second Edition (CDT-2).  These are
                                                               5 position alpha-numeric codes comprising
                                                               the D series.  All other level II codes and
                                                               descriptors are approved and maintained jointly
                                                               by the alpha-numeric editorial panel (consisting
                                                               of HCFA, the Health Insurance Association of
                                                               America, and the Blue Cross and Blue Shield
                                                               Association).  These are 5 position alpha-
                                                               numeric codes representing primarily items and
                                                               nonphysician services that are not
                                                               represented in the level I codes.

                                                            Level III
                                                               Codes and descriptors developed by Medicare
                                                               carriers for use at the local (carrier) level.
                                                               These are 5 position alpha-numeric codes in the
                                                               W, X, Y or Z series representing physician
                                                               and nonphysician services that are not
                                                               represented in the level I or level II codes.

   10. Revenue Center HCPCS         CHAR      2    44   45  A first modifier to the procedure code to enable a more
       Initial Modifier Code                                specific procedure identification for the claim.

                                                            DB2 ALIAS: REV_HCPCS_MDFR_CD
                                                            SAS ALIAS: MDFR_CD1
                                                            STANDARD ALIAS: REV_CNTR_HCPCS_INITL_MDFR_CD
                                                            TITLE ALIAS: INITIAL_MODIFIER

                                                            EDIT-RULES:
                                                            Carrier Information File

                                                            COMMENT:
                                                            Prior to Version H this field was named:
                                                            HCPCS_INITL_MDRFR_CD. With Version H, a prefix
                                                            was added to denote the location of this field
                                                            on each claim type (institutional: REV_CNTR and
                                                            non-institutional: LINE).

                                                            SOURCE:
                                                            CWF

   11. Revenue Center HCPCS Second  CHAR      2    46   47  A second modifier to the procedure code to make it more
       Modifier Code                                        specific than the first modifier code to identify the
                                                            procedures performed on the beneficiary for the claim.

                                                            DB2 ALIAS: REV_HCPCS_2ND_CD
                                                            SAS ALIAS: MDFR_CD2
                                                            STANDARD ALIAS: REV_CNTR_HCPCS_2ND_MDFR_CD
                                                            TITLE ALIAS: SECOND_MODIFIER

                                                            EDIT-RULES:
                                                            CARRIER INFORMATION FILE

1                       FI Inpatient SNF Claim Record - Limited Data Set Standard View -- 11/2005

                                                 POSITIONS
                  NAME              TYPE  LENGTH BEG  END                            CONTENTS
       ---------------------------  ----  ------ ---------  ------------------------------------------------------------

                                                            COMMENT:
                                                            Prior to Version H this field was named:
                                                            HCPCS_2ND_MDFR_CD.  With Version H, a prefix
                                                            was added to denote the location of this field
                                                            on each claim type (institutional: REV_CNTR and
                                                            non-institutional: LINE).

                                                            SOURCE:
                                                            CWF

   12. Revenue Center HCPCS Third   CHAR      2    48   49  Effective with Version I, a third modifier to the
       Modifier Code                                        procedure code to make  it more specific than the
                                                            second modifier code to identify the procedures
                                                            performed on the beneficiary for the claim.

                                                            DB2 ALIAS: REV_HCPCS_3RD_CD
                                                            SAS ALIAS: MDFR_CD3
                                                            STANDARD ALIAS: REV_CNTR_HCPCS_3RD_MDFR_CD
                                                            TITLE ALIAS: THIRD_MODIFIER

                                                            EDIT-RULES:
                                                            CARRIER INFORMATION FILE

                                                            COMMENT:
                                                            NOTE:  Beginning with NCH weekly process date
                                                            8/18/00, this field will be populated with data.
                                                            Claims processed prior to 8/18/00 will contain
                                                            spaces in this field.

                                                            SOURCE:
                                                            CWF

   13. Revenue Center HCPCS Fourth  CHAR      2    50   51  Effective with Version I, a fourth modifier to the
       Modifier Code                                        procedure code to make it more specific than the
                                                            third modifier code to identify the procedures
                                                            performed on the beneficiary for the claim.

                                                            DB2 ALIAS: REV_HCPCS_4TH_CD
                                                            SAS ALIAS: MDFR_CD4
                                                            STANDARD ALIAS: REV_CNTR_HCPCS_4TH_MDFR_CD
                                                            TITLE ALIAS: FOURTH_MODIFIER

                                                            EDIT-RULES:
                                                            CARRIER INFORMATION FILE

                                                            COMMENT:
                                                            NOTE:  Beginning with NCH weekly process date
                                                            8/18/00, this field will be populated with data.
                                                            Claims processed prior to 8/18/00 will contain
                                                            spaces in this field.

                                                            SOURCE:
                                                            CWF

1                       FI Inpatient SNF Claim Record - Limited Data Set Standard View -- 11/2005

                                                 POSITIONS
                  NAME              TYPE  LENGTH BEG  END                            CONTENTS
       ---------------------------  ----  ------ ---------  ------------------------------------------------------------

   14. Revenue Center HCPCS Fifth   CHAR      2    52   53  Effective with Version I, a fifth modifier to the
       Modifier Code                                        procedure code to make it more specific than the
                                                            fourth modifier code to identify the procedures
                                                            performed on the beneficiary for the claim.

                                                            DB2 ALIAS: REV_HCPCS_5TH_CD
                                                            SAS ALIAS: MDFR_CD5
                                                            STANDARD ALIAS: REV_CNTR_HCPCS_5TH_MDFR_CD
                                                            TITLE ALIAS: FIFTH_MODIFIER

                                                            EDIT-RULES:
                                                            CARRIER INFORMATION FILE

                                                            COMMENT:
                                                            NOTE:  Beginning with NCH weekly process date
                                                            8/18/00, this field will be populated with data.
                                                            Claims processed prior to 8/18/00 will contain
                                                            spaces in this field.

                                                            SOURCE:
                                                            CWF

   15. Revenue Center Payment       CHAR      2    54   55  Effective with Version 'I', the code used to
       Method Indicator Code                                identify how the service is priced for payment.
                                                            This field is made up of two pieces of data,
                                                            1st position being the service indicator and
                                                            the 2nd position being the payment indicator.

                                                            NOTE:  Beginning with NCH weekly process date
                                                            8/18/00, this field will be populated with data.
                                                            Claims processed prior to 8/18/00 will contain
                                                            spaces in this field.

                                                            DB2 ALIAS: REV_PMT_MTHD_CD
                                                            SAS ALIAS: PMTMTHD
                                                            STANDARD ALIAS: REV_CNTR_PMT_MTHD_IND_CD
                                                            SYSTEM ALIAS: LTPMTHD
                                                            TITLE ALIAS: PMT_MTHD

                                                            CODES:
                                                              REFER TO: REV_CNTR_PMT_MTHD_IND_TB
                                                                        IN THE CODES APPENDIX

                                                            SOURCE:
                                                            CWF

   16. Revenue Center Discount      CHAR      1    56   56  Effective with Version 'I', for all services
       Indicator Code                                       subject to Outpatient PPS, this code represents
                                                            a factor that specifies the amount of any APC
                                                            discount.  The discounting factor is applied
                                                            to a line item with a service indicator (part
                                                            of the REV_CNTR_PMT_MTHD_IND_CD) of 'T'.  The
                                                            flag is applicable when more than one significant
                                                            procedure is performed. **If there is no dis-

1                       FI Inpatient SNF Claim Record - Limited Data Set Standard View -- 11/2005

                                                 POSITIONS
                  NAME              TYPE  LENGTH BEG  END                            CONTENTS
       ---------------------------  ----  ------ ---------  ------------------------------------------------------------

                                                            counting the factor will be 1.0.**

                                                            NOTE1:  Beginning with NCH weekly process date
                                                            8/18/00, this field will be populated with data.
                                                            Claims processed prior to 8/18/00 will contain
                                                            spaces in this field.

                                                            DB2 ALIAS: REV_DSCNT_IND_CD
                                                            SAS ALIAS: DSCNTIND
                                                            STANDARD ALIAS: REV_CNTR_DSCNT_IND_CD
                                                            SYSTEM ALIAS: LTDSCNT
                                                            TITLE ALIAS: REV_CNTR_DSCNT_IND_CD

                                                            CODES:
                                                            *DISCOUNTING FORMULAS*
                                                            1 = 1.0
                                                            2 = (1.0+D(U-1))/U
                                                            3 = T/U
                                                            4 = (1+D)/U
                                                            5 = D
                                                            6 = TD/U
                                                            7 = D(1+D)/U
                                                            8 = 2.0/U

                                                            SOURCE:
                                                            CWF

   17. Revenue Center Packaging     CHAR      1    57   57  Effective with Version 'I', for all services
       Indicator Code                                       subject to Outpatient PPS, the code used to
                                                            identify those services that are packaged/
                                                            bundled with another service.

                                                            NOTE:  Beginning with NCH weekly process date
                                                            8/18/00, this field will be populated with data.
                                                            Claims processed prior to 8/18/00 will contain
                                                            spaces in this field.

                                                            DB2 ALIAS: REV_PACKG_IND_CD
                                                            SAS ALIAS: PACKGIND
                                                            STANDARD ALIAS: REV_CNTR_PACKG_IND_CD
                                                            SYSTEM ALIAS: LTPACKG
                                                            TITLE ALIAS: REV_CNTR_PACKG_IND

                                                            CODES:
                                                            0 = Not packaged
                                                            1 = Packaged service (service indicator N)
                                                            2 = Packaged as part of partial hospitalization
                                                                per diem or daily mental health service
                                                                per diem

                                                            SOURCE:
                                                            CWF

1                       FI Inpatient SNF Claim Record - Limited Data Set Standard View -- 11/2005

                                                 POSITIONS
                  NAME              TYPE  LENGTH BEG  END                            CONTENTS
       ---------------------------  ----  ------ ---------  ------------------------------------------------------------

   18. Revenue Center Pricing       CHAR      2    58   59  Effective with Version 'I', the code used
       Indicator Code                                       to identify if there was a deviation from
                                                            the standard method of calculating payment
                                                            amount.

                                                            NOTE:  Beginning with NCH weekly process date
                                                            8/18/00, this field will be populated with data.
                                                            Claims processed prior to 8/18/00 will contain
                                                            spaces in this field.

                                                            DB2 ALIAS: REV_PRICNG_IND_CD
                                                            SAS ALIAS: PRICNG
                                                            STANDARD ALIAS: REV_CNTR_PRICNG_IND_CD
                                                            SYSTEM ALIAS: LTPRICNG
                                                            TITLE ALIAS: REV_CNTR_PRICNG_IND

                                                            CODES:
                                                              REFER TO: REV_CNTR_PRICNG_IND_TB
                                                                        IN THE CODES APPENDIX

                                                            SOURCE:
                                                            CWF

   19. Revenue Center Obligation    CHAR      1    60   60  Effective with Version 'I' the code used
       to Accept As Full (OTAF)                             to indicate that the provider was obligated
       Payment Code                                         to accept as full payment the amount re-
                                                            ceived from the primary (or secondary) payer.

                                                            NOTE:  Beginning with NCH weekly process date
                                                            7/7/00, this field will be populated with data.
                                                            Claims processed prior to 7/7/00 will contain
                                                            spaces in this field.
                                                            DB2 ALIAS: REV_OTAF1_IND_CD
                                                            SAS ALIAS: OTAF_1
                                                            STANDARD ALIAS: REV_CNTR_OTAF_1_IND_CD
                                                            TITLE ALIAS: REV_CNTR_OTAF_1_IND_CD

                                                            EDIT-RULES:
                                                            Y = provider is obligated to accept the payment
                                                                as payment in full for the service.
                                                            N or blank = provider is not obligated to accept
                                                                the payment, or there is no payment by a prior
                                                                payer.

                                                            SOURCE:
                                                            CWF

   20. Revenue Center IDE, NDC,     CHAR     24    61   84  Effective with Version H, the exemption number
       UPC Number                                           assigned by the Food and Drug Administration (FDA)
                                                            to an investigational device after a manufacturer
                                                            has been approved by FDA to conduct a clinical
                                                            trial on that device.   CMS established a new
                                                            policy of covering certain IDE's which was

1                       FI Inpatient SNF Claim Record - Limited Data Set Standard View -- 11/2005

                                                 POSITIONS
                  NAME              TYPE  LENGTH BEG  END                            CONTENTS
       ---------------------------  ----  ------ ---------  ------------------------------------------------------------

                                                            implemented in claims processing on 10/1/96
                                                            (which is NCH weekly process 10/4/96) for service
                                                            dates beginning 10/1/95.  IDE's are always
                                                            associated with revenue center code '0624'.

                                                            NOTE1:  Prior to Version H a 'dummy' revenue
                                                            center code '0624' trailer was created to store
                                                            IDE's.   The IDE number was housed in two fields:
                                                            HCPCS code and HCPCS initial modifier; the second
                                                            modifier contained the value 'ID'.  There can be
                                                            up to 7 distinct IDE numbers associated with an
                                                            '0624' dummy trailer.  During the Version H con-
                                                            version IDE's were moved from the dummy '0624'
                                                            trailer to this dedicated field.

                                                            NOTE2:  Effective with Version 'I', this field was
                                                            renamed to eventually accommodate the National Drug Code
                                                            (NDC) and the Universal Product Code (UPC).  This field
                                                            could contain either of these 3 fields (there would never
                                                            be an instance where more than one would come in on
                                                            a claim).  The size of this field was expanded to X(24)
                                                            to accommodate either of the new fields (under Version
                                                            'H' it was X(7).  DATA ANAMOLY/LIMITATION:  During an
                                                            CWFMQA review an edit revealed the IDE was missing.
                                                            The problem occurs in claim with an NCH weekly pro-
                                                            cess dates of 6/9/00 through 9/8/00.  During processing
                                                            of the new format the program receives the IDE but
                                                            then blanked out the data.

                                                            DB2 ALIAS: IDE_NDC_UPC_NUM
                                                            SAS ALIAS: IDENDC
                                                            STANDARD ALIAS: REV_CNTR_IDE_NDC_UPC_NUM
                                                            TITLE ALIAS: IDE_NDC_UPC

                                                            SOURCE:
                                                            CWF

   21. Revenue Center Unit Count    NUM       8    85   92  A quantitative measure (unit) of the number of times the
                                                            service or procedure being reported was performed according
                                                            to the revenue center/HCPCS code definition as described on
                                                            an institutional claim.

                                                            Depending on type of service, units are measured by number
                                                            of covered days in a particular accommodation, pints of

                                                            blood, emergency room visits, clinic visits, dialysis
                                                            treatments (sessions or days), outpatient therapy visits,
                                                            and outpatient clinical diagnostic laboratory tests.

                                                            NOTE1:  When revenue center code = '0022' (SNF PPS) the unit
                                                            count will reflect the number of covered days for each HIPPS
                                                            code and, if applicable, the number of visits for each rehab
                                                            therapy code.

1                       FI Inpatient SNF Claim Record - Limited Data Set Standard View -- 11/2005

                                                 POSITIONS
                  NAME              TYPE  LENGTH BEG  END                            CONTENTS
       ---------------------------  ----  ------ ---------  ------------------------------------------------------------

                                                            7 DIGITS SIGNED

                                                            DB2 ALIAS: REV_CNTR_UNIT_CNT
                                                            SAS ALIAS: REV_UNIT
                                                            STANDARD ALIAS: REV_CNTR_UNIT_CNT
                                                            TITLE ALIAS: UNITS

                                                            EDIT-RULES:
                                                            +9(7)

                                                            SOURCE:
                                                            CWF

   22. Revenue Center Rate Amount   NUM      13    93  105  Charges relating to unit cost associated with
                                                            the revenue center code.  Exception (encounter
                                                            data only):  If plan (e.g. MCO) does not know
                                                            the actual rate for the accommodations, $1 will
                                                            be reported in the field.

                                                            NOTE1:  For SNF PPS claims (when revenue center
                                                            code equals '0022'), HCFA has developed a SNF
                                                            PRICER to compute the rate based on the provider
                                                            supplied coding for the MDS RUGS III group and
                                                            assessment type (HIPPS code, stored in revenue
                                                            center HCPCS code field).

                                                            NOTE2:  For OP PPS claims, HCFA has developed a
                                                            PRICER to compute the rate based on the Ambulatory
                                                            Payment Classification (APC), discount factor,
                                                            units of service and the wage index.

                                                            NOTE3:  Under HH PPS (when revenue center
                                                            code equals '0023'), HCFA has developed a HHA
                                                            PRICER to compute the rate.  On the RAP, the rate is
                                                            determined using the case mix weight associated with
                                                            the HIPPS code, adjusting it for the wage index
                                                            for the beneficiary's site of service, then
                                                            multiplying the result by 60% or 50%, depending on
                                                            whether or not the RAP is for a first episode.

                                                            On the final claim, the HIPPS code could change the
                                                            payment if the therapy threshold is not met, or
                                                            partial episode payment (PEP) adjustment or a
                                                            significant change in condition (SCIC) adjustment.
                                                            In cases of SCICs, there will be more than one
                                                            '0023' revenue center line, each representing the
                                                            payment made at each case-mix level.

                                                            9.2 DIGITS SIGNED

                                                            DB2 ALIAS: REV_CNTR_RATE_AMT
                                                            SAS ALIAS: REV_RATE

1                       FI Inpatient SNF Claim Record - Limited Data Set Standard View -- 11/2005

                                                 POSITIONS
                  NAME              TYPE  LENGTH BEG  END                            CONTENTS
       ---------------------------  ----  ------ ---------  ------------------------------------------------------------

                                                            STANDARD ALIAS: REV_CNTR_RATE_AMT
                                                            TITLE ALIAS: CHARGE_PER_UNIT

                                                            EDIT-RULES:
                                                            +9(9).99

                                                            EFFECTIVE-DATE: 10/01/1993

                                                            COMMENT:
                                                            Prior to Version H the size of this field was:
                                                            S9(7)V99.

                                                            SOURCE:
                                                            CWF

   23. Revenue Center Blood         NUM      13   106  118  Effective with Version 'I', the amount of money
       Deductible Amount                                    for which the intermediary determined the
                                                            beneficiary is liable for the blood deductible
                                                            for the line item service.

                                                            NOTE:  Beginning with NCH weekly process date
                                                            7/7/00, this field will be populated with data.
                                                            Claims processed prior to 7/7/00 will contain
                                                            spaces in this field.

                                                            9.2 DIGITS SIGNED

                                                            DB2 ALIAS: REV_BLOOD_DDCTBL
                                                            SAS ALIAS: REVBLOOD
                                                            STANDARD ALIAS: REV_CNTR_BLOOD_DDCTBL_AMT
                                                            TITLE ALIAS: BLOOD_DDCTBL_AMT

                                                            EDIT-RULES:
                                                            +9(9).99

                                                            SOURCE:
                                                            CWF

   24. Revenue Center Cash          NUM      13   119  131  Effective with Version 'I' the amount of cash
       Deductible Amount                                    deductible the beneficiary paid for the line
                                                            item service.

                                                            NOTE:  Beginning with NCH weekly process date
                                                            7/7/00, this field will be populated with data.
                                                            Claims processed prior to 7/7/00 will contain
                                                            spaces in this field.

                                                            9.2 DIGITS SIGNED

                                                            DB2 ALIAS: REV_CASH_DDCTBL
                                                            SAS ALIAS: REVDCTBL
                                                            STANDARD ALIAS: REV_CNTR_CASH_DDCTBL_AMT
                                                            TITLE ALIAS: CASH_DDCTBL

1                       FI Inpatient SNF Claim Record - Limited Data Set Standard View -- 11/2005

                                                 POSITIONS
                  NAME              TYPE  LENGTH BEG  END                            CONTENTS
       ---------------------------  ----  ------ ---------  ------------------------------------------------------------

                                                            EDIT-RULES:
                                                            +9(9).99

                                                            SOURCE:
                                                            CWF

   25. Revenue Center               NUM      13   132  144  Effective with Version 'I', the amount of
       Coinsurance/Wage Adjusted                            coinsurance applicable to the line item
       Coinsurance Amount                                   service defined by the revenue center and
                                                            HCPCS codes.  For those services subject to
                                                            Outpatient PPS, the applicable coinsurance
                                                            is wage adjusted.

                                                            NOTE1:  This field will have either a zero
                                                            (for services for which coinsurance is not
                                                            applicable), a regular coinsurance amount
                                                            (calculated on either charges or a fee
                                                            schedule) or if subject to OP PPS the national
                                                            coinsurance amount will be wage adjusted.
                                                            The wage adjusted coinsurance is based on the
                                                            MSA where the provider is located or assigned
                                                            as a result of a reclassification.

                                                            NOTE2:  Beginning with NCH weekly process date
                                                            8/18/00, this field will be populated with data.
                                                            Claims processed prior to 8/18/00 will contain
                                                            spaces in this field.

                                                            9.2 DIGITS SIGNED

                                                            DB2 ALIAS: ADJSTD_COINSRNC
                                                            SAS ALIAS: WAGEADJ
                                                            STANDARD ALIAS: REV_CNTR_WAGE_ADJSTD_COINS_AMT
                                                            TITLE ALIAS: WAGE_ADJSTD_COINS

                                                            EDIT-RULES:
                                                            +9(9).99

                                                            SOURCE:
                                                            CWF

   26. Revenue Center Reduced       NUM      13   145  157  Effective with Version 'I', for all services
       Coinsurance Amount                                   subject to Outpatient PPS, the amount of
                                                            coinsurance applicable to the line for a
                                                            particular service (HCPCS) for which the
                                                            provider has elected to reduce the coinsurance
                                                            amount.

                                                            NOTE1:  The reduced coinsurance amount cannot
                                                            be lower than 20% of the payment rate for the
                                                            APC line.

                                                            NOTE2:  Beginning with NCH weekly process date
                                                            8/18/00, this field will be populated with data.
                                                            Claims processed prior to 8/18/00 will contain
1                       FI Inpatient SNF Claim Record - Limited Data Set Standard View -- 11/2005

                                                 POSITIONS
                  NAME              TYPE  LENGTH BEG  END                            CONTENTS
       ---------------------------  ----  ------ ---------  ------------------------------------------------------------

                                                            spaces in this field.

                                                            9.2 DIGITS SIGNED

                                                            DB2 ALIAS: RDCD_COINSRNC
                                                            SAS ALIAS: RDCDCOIN
                                                            STANDARD ALIAS: REV_CNTR_RDCD_COINS_AMT
                                                            TITLE ALIAS: REDUCED_COINS

                                                            EDIT-RULES:
                                                            +9(9).99

                                                            SOURCE:
                                                            CWF

   27. Revenue Center 1st Medicare  NUM      13   158  170  Effective with Version 'I', the amount paid by
       Secondary Payer Paid                                 the primary payer when the payer is primary to
       Amount                                               Medicare (Medicare is secondary or tertiary).

                                                            NOTE:  Beginning with NCH weekly process date
                                                            7/7/00, this field will be populated with data.
                                                            Claims processed prior to 7/7/00 will contain
                                                            spaces in this field.

                                                            9.2 DIGITS SIGNED

                                                            DB2 ALIAS: REV_MSP1_PD_AMT
                                                            SAS ALIAS: REV_MSP1
                                                            STANDARD ALIAS: REV_CNTR_MSP1_PD_AMT
                                                            TITLE ALIAS: MSP PAID AMOUNT

                                                            EDIT-RULES:
                                                            +9(9).99

                                                            SOURCE:
                                                            CWF

   28. Revenue Center 2nd Medicare  NUM      13   171  183  Effective with Version 'I', the amount paid by
       Secondary Payer Paid                                 the secondary payer when two payers are primary
       Amount                                               to Medicare (Medicare is the tertiary payer).

                                                            NOTE:  Beginning with NCH weekly process date
                                                            7/7/00, this field will be populated with data.
                                                            Claims processed prior to 7/7/00 will contain
                                                            spaces in this field.

                                                            9.2 DIGITS SIGNED

                                                            DB2 ALIAS: REV_MSP2_PD_AMT
                                                            SAS ALIAS: REV_MSP2
                                                            STANDARD ALIAS: REV_CNTR_MSP2_PD_AMT
                                                            TITLE ALIAS: MSP PAID AMOUNT

1                       FI Inpatient SNF Claim Record - Limited Data Set Standard View -- 11/2005

                                                 POSITIONS
                  NAME              TYPE  LENGTH BEG  END                            CONTENTS
       ---------------------------  ----  ------ ---------  ------------------------------------------------------------

                                                            EDIT-RULES:
                                                            +9(9).99

                                                            SOURCE:
                                                            CWF

   29. Revenue Center Provider      NUM      13   184  196  Effective with Version 'I', the amount paid
       Payment Amount                                       to the provider for the services reported
                                                            on the line item.

                                                            NOTE:  Beginning with NCH weekly process date
                                                            7/7/00, this field will be populated with data.
                                                            Claims processed prior to 7/7/00 will contain
                                                            spaces in this field.

                                                            9.2 DIGITS SIGNED

                                                            DB2 ALIAS: REV_PRVDR_PMT_AMT
                                                            SAS ALIAS: RPRVDPMT
                                                            STANDARD ALIAS: REV_CNTR_PRVDR_PMT_AMT
                                                            TITLE ALIAS: REV_PRVDR_PMT

                                                            EDIT-RULES:
                                                            +9(9).99

                                                            SOURCE:
                                                            CWF

   30. Revenue Center Beneficiary   NUM      13   197  209  Effective with Version I, the amount paid
       Payment Amount                                       to the beneficiary for the services reported
                                                            on the line item.

                                                            NOTE:  Beginning with NCH weekly process date
                                                            7/7/00, this field will be populated with data.
                                                            Claims processed prior to 7/7/00 will contain
                                                            spaces in this field.

                                                            9.2 DIGITS SIGNED

                                                            DB2 ALIAS: REV_BENE_PMT_AMT
                                                            SAS ALIAS: RBENEPMT
                                                            STANDARD ALIAS: REV_CNTR_BENE_PMT_AMT
                                                            TITLE ALIAS: REV_BENE_PMT

                                                            EDIT-RULES:
                                                            +9(9).99

                                                            SOURCE:
                                                            CWF

   31. Revenue Center Patient       NUM      13   210  222  Effective with Version I, the amount paid
       Responsibility Payment                               by the beneficiary to the provider for the
       Amount                                               line item service.

1                       FI Inpatient SNF Claim Record - Limited Data Set Standard View -- 11/2005

                                                 POSITIONS
                  NAME              TYPE  LENGTH BEG  END                            CONTENTS
       ---------------------------  ----  ------ ---------  ------------------------------------------------------------

                                                            NOTE:  Beginning with NCH weekly process date
                                                            7/7/00 this field was populated with data.
                                                            Claims processed prior to 7/7/00 will contain
                                                            zeroes in this field.

                                                            9.2 DIGITS SIGNED

                                                            DB2 ALIAS: REV_PTNT_RESP_AMT
                                                            SAS ALIAS: PTNTRESP
                                                            STANDARD ALIAS: REV_CNTR_PTNT_RESP_PMT_AMT
                                                            TITLE ALIAS: REV_PTNT_RESP

                                                            EDIT-RULES:
                                                            +9(9).99

                                                            SOURCE:
                                                            CWF

   32. Revenue Center Payment       CHAR     13   223  235  Effective with Version 'I', the line item
       Amount                                               Medicare payment amount for the specific
                                                            revenue center.

                                                            Under OP PPS, PRICER will compute the
                                                            standard OPPS payment for a line item based
                                                            on the payment APC.

                                                            Under OP PPS, PRICER will compute the
                                                            standard OPPS payment for a line item based
                                                            on the payment APC.

                                                            Under HH PPS, PRICER will compute/return
                                                            a line item payment amount for the case-mixed,
                                                            wage-index adjusted HIPPS code assigned to
                                                            the '0023' revenue center line.  The HIPPS
                                                            code will be stored in the Revenue Center
                                                            HCPCS code field.

                                                            9.2 DIGITS SIGNED

                                                            COMMON ALIAS: REIMBURSEMENT
                                                            DB2 ALIAS: REV_CNTR_PMT_AMT
                                                            SAS ALIAS: REVPMT
                                                            STANDARD ALIAS: REV_CNTR_PMT_AMT
                                                            TITLE ALIAS: REIMBURSEMENT

                                                            EDIT-RULES:
                                                            +9(9).99

                                                            SOURCE:
                                                            CWF

   33. Revenue Center Total Charge  NUM      13   236  248  The total charges (covered and non-covered) for all
       Amount                                               accommodations and services (related to the revenue code)

1                       FI Inpatient SNF Claim Record - Limited Data Set Standard View -- 11/2005

                                                 POSITIONS
                  NAME              TYPE  LENGTH BEG  END                            CONTENTS
       ---------------------------  ----  ------ ---------  ------------------------------------------------------------

                                                            for a billing period before reduction for the deductible and
                                                            coinsurance amounts and before an adjustment for the cost of
                                                            services provided.  NOTE: For accommodation revenue center
                                                            total charges must equal the rate times units (days).

                                                            EXCEPTIONS:
                                                            (1)  For SNF RUGS demo claims only (9000 series revenue
                                                            center codes), this field contains SNF customary
                                                            accommodation charge, (ie., charges related to the
                                                            accommodation revenue center code that would have been
                                                            applicable if the provider had not been participating in the
                                                            demo).

                                                            (2)  For SNF PPS (non demo claims), when revenue center code
                                                            = '0022', the total charges will be zero.

                                                            (3)  For Home Health PPS (RAPs), when revenue center code =
                                                            '0023', the total charges will equal the dollar amount for
                                                            the '0023' line.

                                                            (4) For Home Health PPS (final claim), when revenue center
                                                            code = '0023', the total charges will be the sum of the
                                                            revenue center code lines (other than '0023').

                                                            (5)  For encounter data, if the plan (e.g. MCO) does not
                                                            know the actual charges for the accommodations the total
                                                            charges will be $1 (rate) times units (days).

                                                            9.2 DIGITS SIGNED

                                                            DB2 ALIAS: REV_TOT_CHRG_AMT
                                                            SAS ALIAS: REV_CHRG
                                                            STANDARD ALIAS: REV_CNTR_TOT_CHRG_AMT
                                                            TITLE ALIAS: REVENUE_CENTER_CHARGES

                                                            EDIT-RULES:
                                                            +9(9).99

                                                            COMMENT:
                                                            Prior to Version H the size of this field was:
                                                            S9(7)V99.

                                                            SOURCE:
                                                            CWF

   34. Revenue Center Non-Covered   NUM      13   249  261  The charge amount related to a revenue center code for
       Charge Amount                                        services that are not covered by Medicare.

                                                            NOTE:  Prior to Version H the field size was S9(7)V99 and
                                                            the element was only present on the Inpatient/SNF format.
                                                            As of NCH weekly process date 10/3/97 this field was added
                                                            to all institutional claim types.

                                                            9.2 DIGITS SIGNED

1                       FI Inpatient SNF Claim Record - Limited Data Set Standard View -- 11/2005

                                                 POSITIONS
                  NAME              TYPE  LENGTH BEG  END                            CONTENTS
       ---------------------------  ----  ------ ---------  ------------------------------------------------------------

                                                            DB2 ALIAS: REV_NCVR_CHRG_AMT
                                                            SAS ALIAS: REV_NCVR
                                                            STANDARD ALIAS: REV_CNTR_NCVR_CHRG_AMT
                                                            TITLE ALIAS: REV_CENTER_NONCOVERED_CHARGES

                                                            EDIT-RULES:
                                                            +9(9).99

                                                            SOURCE:
                                                            CWF

   35. Revenue Center Deductible    CHAR      1   262  262  Code indicating whether the revenue center charges
       Coinsurance Code                                     are subject to deductible and/or coinsurance.

                                                            DB2 ALIAS: DDCTBL_COINSRNC_CD
                                                            SAS ALIAS: REVDEDCD
                                                            STANDARD ALIAS: REV_CNTR_DDCTBL_COINSRNC_CD
                                                            TITLE ALIAS: REVENUE_CENTER_DEDUCTIBLE_CD

                                                            CODES:
                                                              REFER TO: REV_CNTR_DDCTBL_COINSRNC_TB
                                                                        IN THE CODES APPENDIX

                                                            SOURCE:
                                                            CWF

1        BENE_IDENT_TB                       Beneficiary Identification Code (BIC) Table
         -------------                       -------------------------------------------

                                   Social Security Administration:

                                   A  = Primary claimant
                                   B  = Aged wife, age 62 or over (1st
                                        claimant)
                                   B1 = Aged husband, age 62 or over (1st
                                        claimant)
                                   B2 = Young wife, with a child in her care
                                        (1st claimant)
                                   B3 = Aged wife (2nd claimant)
                                   B4 = Aged husband (2nd claimant)
                                   B5 = Young wife (2nd claimant)
                                   B6 = Divorced wife, age 62 or over (1st
                                        claimant)
                                   B7 = Young wife (3rd claimant)
                                   B8 = Aged wife (3rd claimant)
                                   B9 = Divorced wife (2nd claimant)
                                   BA = Aged wife (4th claimant)
                                   BD = Aged wife (5th claimant)
                                   BG = Aged husband (3rd claimant)
                                   BH = Aged husband (4th claimant)
                                   BJ = Aged husband (5th claimant)
                                   BK = Young wife (4th claimant)
                                   BL = Young wife (5th claimant)
                                   BN = Divorced wife (3rd claimant)
                                   BP = Divorced wife (4th claimant)
                                   BQ = Divorced wife (5th claimant)
                                   BR = Divorced husband (1st claimant)
                                   BT = Divorced husband (2nd claimant)
                                   BW = Young husband (2nd claimant)
                                   BY = Young husband (1st claimant)
                                   C1-C9,CA-CZ = Child (includes minor, student
                                                 or disabled child)
                                   D  = Aged widow, 60 or over (1st claimant)
                                   D1 = Aged widower, age 60 or over (1st
                                        claimant)
                                   D2 = Aged widow (2nd claimant)
                                   D3 = Aged widower (2nd claimant)
                                   D4 = Widow (remarried after attainment of
                                        age 60) (1st claimant)
                                   D5 = Widower (remarried after attainment of
                                        age 60) (1st claimant)
                                   D6 = Surviving divorced wife, age 60 or over
                                        (1st claimant)
                                   D7 = Surviving divorced wife (2nd claimant)
                                   D8 = Aged widow (3rd claimant)
                                   D9 = Remarried widow (2nd claimant)
                                   DA = Remarried widow (3rd claimant)
                                   DC = Surviving divorced husband (1st claimant)
                                   DD = Aged widow (4th claimant)
                                   DG = Aged widow (5th claimant)
                                   DH = Aged widower (3rd claimant)
                                   DJ = Aged widower (4th claimant)
                                   DK = Aged widower (5th claimant)
                                   DL = Remarried widow (4th claimant)
                                   DM = Surviving divorced husband (2nd claimant)
                                   DN = Remarried widow (5th claimant)

1        BENE_IDENT_TB                       Beneficiary Identification Code (BIC) Table
         -------------                       -------------------------------------------

                                   DP = Remarried widower (2nd claimant)
                                   DQ = Remarried widower (3rd claimant)
                                   DR = Remarried widower (4th claimant)
                                   DS = Surviving divorced husband (3rd
                                        claimant)
                                   DT = Remarried widower (5th claimant)
                                   DV = Surviving divorced wife (3rd claimant)
                                   DW = Surviving divorced wife (4th claimant)
                                   DX = Surviving divorced husband (4th
                                        claimant)
                                   DY = Surviving divorced wife (5th claimant)
                                   DZ = Surviving divorced husband (5th
                                        claimant)
                                   E  = Mother (widow) (1st claimant)
                                   E1 = Surviving divorced mother (1st
                                        claimant)
                                   E2 = Mother (widow) (2nd claimant)
                                   E3 = Surviving divorced mother (2nd
                                        claimant)
                                   E4 = Father (widower) (1st claimant)
                                   E5 = Surviving divorced father (widower)
                                        (1st claimant)
                                   E6 = Father (widower) (2nd claimant)
                                   E7 = Mother (widow) (3rd claimant)
                                   E8 = Mother (widow) (4th claimant)
                                   E9 = Surviving divorced father (widower)
                                        (2nd claimant)
                                   EA = Mother (widow) (5th claimant)
                                   EB = Surviving divorced mother (3rd
                                        claimant)
                                   EC = Surviving divorced mother (4th
                                        claimant)
                                   ED = Surviving divorced mother (5th
                                        claimant
                                   EF = Father (widower) (3rd claimant)
                                   EG = Father (widower) (4th claimant)
                                   EH = Father (widower) (5th claimant)
                                   EJ = Surviving divorced father (3rd
                                        claimant)
                                   EK = Surviving divorced father (4th
                                        claimant)
                                   EM = Surviving divorced father (5th
                                        claimant)
                                   F1 = Father
                                   F2 = Mother
                                   F3 = Stepfather
                                   F4 = Stepmother
                                   F5 = Adopting father
                                   F6 = Adopting mother
                                   F7 = Second alleged father
                                   F8 = Second alleged mother
                                   J1 = Primary prouty entitled to HIB
                                        (less than 3 Q.C.) (general fund)
                                   J2 = Primary prouty entitled to HIB
                                        (over 2 Q.C.) (RSI trust fund)
                                   J3 = Primary prouty not entitled to HIB
                                        (less than 3 Q.C.) (general fund)
                                   J4 = Primary prouty not entitled to HIB
1        BENE_IDENT_TB                       Beneficiary Identification Code (BIC) Table
         -------------                       -------------------------------------------

                                        (over 2 Q.C.) (RSI trust fund)
                                   K1 = Prouty wife entitled to HIB (less than
                                        3 Q.C.) (general fund) (1st claimant)
                                   K2 = Prouty wife entitled to HIB (over 2
                                        Q.C.) (RSI trust fund) (1st claimant)
                                   K3 = Prouty wife not entitled to HIB (less
                                        than 3 Q.C.) (general fund) (1st
                                        claimant)
                                   K4 = Prouty wife not entitled to HIB (over
                                        2 Q.C.) (RSI trust fund) (1st
                                        claimant)
                                   K5 = Prouty wife entitled to HIB (less than
                                        3 Q.C.) (general fund) (2nd claimant)
                                   K6 = Prouty wife entitled to HIB (over 2
                                        Q.C.) (RSI trust fund) (2nd claimant)
                                   K7 = Prouty wife not entitled to HIB (less
                                        than 3 Q.C.) (general fund) (2nd
                                        claimant)
                                   K8 = Prouty wife not entitled to HIB (over
                                        2 Q.C.) (RSI trust fund) (2nd
                                        claimant)
                                   K9 = Prouty wife entitled to HIB (less than
                                        3 Q.C.) (general fund) (3rd claimant)
                                   KA = Prouty wife entitled to HIB (over 2
                                        Q.C.) (RSI trust fund) (3rd claimant)
                                   KB = Prouty wife not entitled to HIB (less
                                        than 3 Q.C.) (general fund) (3rd
                                        claimant)
                                   KC = Prouty wife not entitled to HIB (over
                                        2 Q.C.) (RSI trust fund) (3rd
                                        claimant)
                                   KD = Prouty wife entitled to HIB (less than
                                        3 Q.C.) (general fund) (4th claimant)
                                   KE = Prouty wife entitled to HIB (over 2 Q.C
                                        (4th claimant)
                                   KF = Prouty wife not entitled to HIB (less
                                        than 3 Q.C.)(4th claimant)
                                   KG = Prouty wife not entitled to HIB (over
                                        2 Q.C.)(4th claimant)
                                   KH = Prouty wife entitled to HIB (less than
                                        3 Q.C.)(5th claimant)
                                   KJ = Prouty wife entitled to HIB (over 2
                                        Q.C.) (5th claimant)
                                   KL = Prouty wife not entitled to HIB (less
                                        than 3 Q.C.)(5th claimant)
                                   KM = Prouty wife not entitled to HIB (over
                                        2 Q.C.) (5th claimant)
                                   M  = Uninsured-not qualified for deemed HIB
                                   M1 = Uninsured-qualified but refused HIB
                                   T  = Uninsured-entitled to HIB under deemed
                                        or renal provisions
                                   TA = MQGE (primary claimant)
                                   TB = MQGE aged spouse (first claimant)
                                   TC = MQGE disabled adult child (first claimant)
                                   TD = MQGE aged widow(er) (first claimant)
                                   TE = MQGE young widow(er) (first claimant)
                                   TF = MQGE parent (male)
                                   TG = MQGE aged spouse (second claimant)
1        BENE_IDENT_TB                       Beneficiary Identification Code (BIC) Table
         -------------                       -------------------------------------------

                                   TH = MQGE aged spouse (third claimant)
                                   TJ = MQGE aged spouse (fourth claimant)
                                   TK = MQGE aged spouse (fifth claimant)
                                   TL = MQGE aged widow(er) (second claimant)
                                   TM = MQGE aged widow(er) (third claimant)
                                   TN = MQGE aged widow(er) (fourth claimant)
                                   TP = MQGE aged widow(er) (fifth claimant)
                                   TQ = MQGE parent (female)
                                   TR = MQGE young widow(er) (second claimant)
                                   TS = MQGE young widow(er) (third claimant)
                                   TT = MQGE young widow(er) (fourth claimant)
                                   TU = MQGE young widow(er) (fifth claimant)
                                   TV = MQGE disabled widow(er) fifth claimant
                                   TW = MQGE disabled widow(er) first claimant
                                   TX = MQGE disabled widow(er) second claimant
                                   TY = MQGE disabled widow(er) third claimant
                                   TZ = MQGE disabled widow(er) fourth claimant
                                   T2-T9 = Disabled child (second to ninth
                                           claimant)
                                   W  = Disabled widow, age 50 or over (1st
                                        claimant)
                                   W1 = Disabled widower, age 50 or over (1st
                                        claimant)
                                   W2 = Disabled widow (2nd claimant)
                                   W3 = Disabled widower (2nd claimant)
                                   W4 = Disabled widow (3rd claimant)
                                   W5 = Disabled widower (3rd claimant)
                                   W6 = Disabled surviving divorced wife (1st
                                        claimant)
                                   W7 = Disabled surviving divorced wife (2nd
                                        claimant)
                                   W8 = Disabled surviving divorced wife (3rd
                                        claimant)
                                   W9 = Disabled widow (4th claimant)
                                   WB = Disabled widower (4th claimant)
                                   WC = Disabled surviving divorced wife (4th
                                        claimant)
                                   WF = Disabled widow (5th claimant)
                                   WG = Disabled widower (5th claimant)
                                   WJ = Disabled surviving divorced wife (5th
                                        claimant)
                                   WR = Disabled surviving divorced husband
                                        (1st claimant)
                                   WT = Disabled surviving divorced husband
                                        (2nd claimant)

                                   Railroad Retirement Board:

                                      NOTE:
                                      Employee:  a Medicare beneficiary who is
                                                 still working or a worker who
                                                 died before retirement
                                      Annuitant: a person who retired under the
                                                 railroad retirement act on or
                                                 after 03/01/37
                                      Pensioner: a person who retired prior to
                                                 03/01/37 and was included in the
                                                 railroad retirement act
1        BENE_IDENT_TB                       Beneficiary Identification Code (BIC) Table
         -------------                       -------------------------------------------

                                   10 = Retirement - employee or annuitant
                                   80 = RR pensioner (age or disability)
                                   14 = Spouse of RR employee or annuitant
                                        (husband or wife)
                                   84 = Spouse of RR pensioner
                                   43 = Child of RR employee
                                   13 = Child of RR annuitant
                                   17 = Disabled adult child of RR annuitant
                                   46 = Widow/widower of RR employee
                                   16 = Widow/widower of RR annuitant
                                   86 = Widow/widower of RR pensioner
                                   43 = Widow of employee with a child in her care
                                   13 = Widow of annuitant with a child in her care
                                   83 = Widow of pensioner with a child in her care
                                   45 = Parent of employee
                                   15 = Parent of annuitant
                                   85 = Parent of pensioner
                                   11 = Survivor joint annuitant
                                        (reduced benefits taken to insure benefits
                                        for surviving spouse)

1      BENE_PRMRY_PYR_TB                           Beneficiary Primary Payer Table
       -----------------                           -------------------------------

                                   A = Working aged bene/spouse with employer
                                       group health plan (EGHP)
                                   B = End stage renal disease (ESRD) beneficiary
                                       in the 18 month coordination period with
                                       an employer group health plan
                                   C = Conditional payment by Medicare; future
                                       reimbursement expected
                                   D = Automobile no-fault (eff. 4/97; Prior
                                       to 3/94, also included any liability
                                       insurance)
                                   E = Workers' compensation
                                   F = Public Health Service or other federal
                                       agency (other than Dept. of Veterans
                                       Affairs)
                                   G = Working disabled bene (under age 65
                                       with LGHP)
                                   H = Black Lung
                                   I = Dept. of Veterans Affairs
                                   J = Any liability insurance
                                       (eff. 3/94 - 3/97)
                                   L = Any liability insurance (eff. 4/97)
                                       (eff. 12/90 for carrier claims and 10/93
                                       for FI claims; obsoleted for all claim
                                       types 7/1/96)

                                   M = Override code:  EGHP services involved
                                       (eff. 12/90 for carrier claims and 10/93
                                       for FI claims; obsoleted for all claim
                                       types 7/1/96)

                                   N = Override code:  non-EGHP services involved
                                       (eff. 12/90 for carrier claims and 10/93
                                       for FI claims; obsoleted for all claim
                                       types 7/1/96)

                                   BLANK = Medicare is primary payer (not sure
                                           of effective date: in use 1/91, if
                                           not earlier)

                                   T = MSP cost avoided - IEQ contractor
                                       (eff. 7/96 carrier claims only)
                                   U = MSP cost avoided - HMO rate cell adjust-
                                       ment contractor (eff. 7/96 carrier claims
                                       only)
                                   V = MSP cost avoided - litigation settlement
                                       contractor (eff. 7/96 carrier claims
                                       only)

                                   X = MSP cost avoided override code (eff.
                                       12/90 for carrier claims and 10/93 for
                                       FI claims; obsoleted for all claim types
                                       7/1/96)

                                                ***Prior to 12/90***

                                   Y = Other secondary payer investigation
                                       shows Medicare as primary payer
                                   Z = Medicare is primary payer
1      BENE_PRMRY_PYR_TB                           Beneficiary Primary Payer Table
       -----------------                           -------------------------------

                                   NOTE:  Values C, M, N, Y, Z and BLANK
                                          indicate Medicare is primary payer.
                                          (values Z and Y were used prior to
                                          12/90.  BLANK was suppose to be
                                          effective after 12/90, but may have
                                          been used prior to that date.)


1           BETOS_TB                                         BETOS Table
            --------                                         -----------


                                   M1A = Office visits - new
                                   M1B = Office visits - established
                                   M2A = Hospital visit - initial
                                   M2B = Hospital visit - subsequent
                                   M2C = Hospital visit - critical care
                                   M3  = Emergency room visit
                                   M4A = Home visit
                                   M4B = Nursing home visit
                                   M5A = Specialist - pathology
                                   M5B = Specialist - psychiatry
                                   M5C = Specialist - opthamology
                                   M5D = Specialist - other
                                   M6  = Consultations
                                   P0  = Anesthesia
                                   P1A = Major procedure - breast
                                   P1B = Major procedure - colectomy
                                   P1C = Major procedure - cholecystectomy
                                   P1D = Major procedure - turp
                                   P1E = Major procedure - hysterctomy
                                   P1F = Major procedure - explor/decompr/excisdisc
                                   P1G = Major procedure - Other
                                   P2A = Major procedure, cardiovascular-CABG
                                   P2B = Major procedure, cardiovascular-Aneurysm repair
                                   P2C = Major Procedure, cardiovascular-Thromboendarterectomy
                                   P2D = Major procedure, cardiovascualr-Coronary angioplasty (PTCA)
                                   P2E = Major procedure, cardiovascular-Pacemaker insertion
                                   P2F = Major procedure, cardiovascular-Other
                                   P3A = Major procedure, orthopedic - Hip fracture repair
                                   P3B = Major procedure, orthopedic - Hip replacement
                                   P3C = Major procedure, orthopedic - Knee replacement
                                   P3D = Major procedure, orthopedic - other
                                   P4A = Eye procedure - corneal transplant
                                   P4B = Eye procedure - cataract removal/lens insertion
                                   P4C = Eye procedure - retinal detachment
                                   P4D = Eye procedure - treatment
                                   P4E = Eye procedure - other
                                   P5A = Ambulatory procedures - skin
                                   P5B = Ambulatory procedures - musculoskeletal
                                   P5C = Ambulatory procedures - inguinal hernia repair
                                   P5D = Ambulatory procedures - lithotripsy
                                   P5E = Ambulatory procedures - other
                                   P6A = Minor procedures - skin
                                   P6B = Minor procedures - musculoskeletal
                                   P6C = Minor procedures - other (Medicare fee schedule)
                                   P6D = Minor procedures - other (non-Medicare fee schedule)
                                   P7A = Oncology - radiation therapy
                                   P7B = Oncology - other
                                   P8A = Endoscopy - arthroscopy
                                   P8B = Endoscopy - upper gastrointestinal
                                   P8C = Endoscopy - sigmoidoscopy
                                   P8D = Endoscopy - colonoscopy
                                   P8E = Endoscopy - cystoscopy
                                   P8F = Endoscopy - bronchoscopy
                                   P8G = Endoscopy - laparoscopic cholecystectomy
                                   P8H = Endoscopy - laryngoscopy
                                   P8I = Endoscopy - other

1           BETOS_TB                                         BETOS Table
            --------                                         -----------

                                   P9A = Dialysis services (Medicare Fee Schedule)
                                   P9B = Dialysis services (Non-Medicare Fee Schedule)
                                   I1A = Standard imaging - chest
                                   I1B = Standard imaging - musculoskeletal
                                   I1C = Standard imaging - breast
                                   I1D = Standard imaging - contrast gastrointestinal
                                   I1E = Standard imaging - nuclear medicine
                                   I1F = Standard imaging - other
                                   I2A = Advanced imaging - CAT: head
                                   I2B = Advanced imaging - CAT: other
                                   I2C = Advanced imaging - MRI: brain
                                   I2D = Advanced imaging - MRI: other
                                   I3A = Echography - eye
                                   I3B = Echography - abdomen/pelvis
                                   I3C = Echography - heart
                                   I3D = Echography - carotid arteries
                                   I3E = Echography - prostate, transrectal
                                   I3F = Echography - other
                                   I4A = Imaging/procedure - heart including cardiac
                                                              catheter
                                   I4B = Imaging/procedure - other
                                   T1A = Lab tests - routine venipuncture (non Medicare
                                                     fee schedule)
                                   T1B = Lab tests - automated general profiles
                                   T1C = Lab tests - urinalysis
                                   T1D = Lab tests - blood counts
                                   T1E = Lab tests - glucose
                                   T1F = Lab tests - bacterial cultures
                                   T1G = Lab tests - other (Medicare fee schedule)
                                   T1H = Lab tests - other (non-Medicare fee schedule)
                                   T2A = Other tests - electrocardiograms
                                   T2B = Other tests - cardiovascular stress tests
                                   T2C = Other tests - EKG monitoring
                                   T2D = Other tests - other
                                   D1A = Medical/surgical supplies
                                   D1B = Hospital beds
                                   D1C = Oxygen and supplies
                                   D1D = Wheelchairs
                                   D1E = Other DME
                                   D1F = Orthotic devices
                                   D1G = Drugs administered through DME
                                   O1A = Ambulance
                                   O1B = Chiropractic
                                   O1C = Enteral and parenteral
                                   O1D = Chemotherapy
                                   O1E = Other drugs
                                   O1F = Vision, hearing and speech services
                                   O1G = Influenza immunization
                                   Y1  = Other - Medicare fee schedule
                                   Y2  = Other - non-Medicare fee schedule
                                   Z1  = Local codes
                                   Z2  = Undefined codes

1     CARR_CLM_PMT_DNL_TB                         Carrier Claim Payment Denial Table
      -------------------                         ----------------------------------


                                   0 = Denied
                                   1 = Physician/supplier
                                   2 = Beneficiary
                                   3 = Both physician/supplier and beneficiary
                                   4 = Hospital (hospital based physicians)
                                   5 = Both hospital and beneficiary
                                   6 = Group practice prepayment plan
                                   7 = Other entries (e.g. Employer, union)
                                   8 = Federally funded
                                   9 = PA service
                                   A = Beneficiary under limitation of
                                       liability
                                   B = Physician/supplier under limitation of
                                       liability
                                   D = Denied due to demonstration involvement
                                       (eff. 5/97)
                                   E = MSP cost avoided IRS/SSA/HCFA Data
                                       Match (eff. 7/3/00)
                                   F = MSP cost avoided HMO Rate Cell
                                       (eff. 7/3/00)
                                   G = MSP cost avoided Litigation Settlement
                                       (eff. 7/3/00)
                                   H = MSP cost avoided Employer Voluntary
                                       Reporting (eff. 7/3/00)
                                   J = MSP cost avoided Insurer Voluntary
                                       Reporting (eff. 7/3/00)
                                   K = MSP cost avoided Initial Enrollment
                                       Questionnaire (eff. 7/3/00)
                                   P = Physician ownership denial (eff 3/92)
                                   Q = MSP cost avoided - (Contractor #88888)
                                       voluntary agreement (eff. 1/98)
                                   T = MSP cost avoided - IEQ contractor
                                       (eff. 7/96) (obsolete 6/30/00)
                                   U = MSP cost avoided - HMO rate cell
                                       adjustment (eff. 7/96) (obsolete 6/30/00)
                                   V = MSP cost avoided - litigation
                                       settlement (eff. 7/96) (obsolete 6/30/00)
                                   X = MSP cost avoided - generic
                                   Y = MSP cost avoided - IRS/SSA data
                                       match project (obsolete 6/30/00)

1   CARR_LINE_PRVDR_TYPE_TB                        Carrier Line Provider Type Table
    -----------------------                        --------------------------------


                                   For Physician/Supplier (RIC O) Claims:

                                   0 = Clinics, groups, associations,
                                       partnerships, or other entities
                                   1 = Physicians or suppliers reporting as
                                       solo practitioners
                                   2 = Suppliers (other than sole proprietorship)
                                   3 = Institutional provider
                                   4 = Independent laboratories
                                   5 = Clinics (multiple specialties)
                                   6 = Groups (single specialty)
                                   7 = Other entities

                                   For DMERC (RIC M) Claims - PRIOR TO VERSION H:

                                   0 = Clinics, groups, associations,
                                       partnerships, or other entities
                                       for whom the carrier's own ID number
                                       has been assigned.
                                   1 = Physicians or suppliers billing as
                                       solo practitioners for whom SSN's are
                                       shown in the physician ID code field.
                                   2 = Physicians or suppliers billing as
                                       solo practitioners for whom the carrier's
                                       own physician ID code is shown.
                                   3 = Suppliers (other than sole proprietorship)
                                       for whom EI numbers are used in coding the
                                       ID field.
                                   4 = Suppliers (other than sole proprietorship)
                                       for whom the carrier's own code has been
                                       shown.
                                   5 = Institutional providers and
                                       independent laboratories for whom EI
                                       numbers are used in coding the ID field.
                                   6 = Institutional providers and
                                       independent laboratories for whom the
                                       carrier's own ID number is shown.
                                   7 = Clinics, groups, associations, or
                                       partnerships for whom EI numbers
                                       are used in coding the ID field.
                                   8 = Other entities for whom EI numbers
                                       are used in coding the ID field or
                                       proprietorship for whom EI numbers are
                                       used in coding the ID field.

1  CARR_LINE_RDCD_PHYSN_ASTNT_TB        Carrier Line Part B Reduced Physician Assistant Table
   -----------------------------        -----------------------------------------------------


                                   BLANK = Adjustment situation (where
                                           CLM_DISP_CD equal 3)
                                   0 = N/A
                                   1 = 65%
                                       A) Physician assistants assisting in
                                          surgery
                                       B) Nurse midwives
                                   2 = 75%
                                       A) Physician assistants performing
                                          services in a hospital (other than
                                          assisting surgery)
                                       B) Nurse practitioners and clinical
                                          nurse specialists performing
                                          services in rural areas
                                       C) Clinical social worker services
                                   3 = 85%
                                       A) Physician assistant services for
                                          other than assisting surgery
                                       B) Nurse practitioners services

1         CARR_NUM_TB                                    Carrier Number Table
          -----------                                    --------------------


                                   00510 = Alabama BS (eff. 1983)
                                   00511 = Georgia - Alabama BS (eff. 1998)
                                   00512 = Mississippi - Alabama BS (eff. 2000)
                                   00520 = Arkansas BS (eff. 1983)
                                   00521 = New Mexico - Arkansas BS (eff. 1998)
                                   00522 = Oklahoma - Arkansas BS (eff. 1998)
                                   00523 = Missouri - Arkansas BS (eff. 1999)
                                   00528 = Louisianna - Arkansas BS (eff. 1984)
                                   00542 = California BS (eff. 1983; term. 1996)
                                   00550 = Colorado BS (eff. 1983; term. 1994)
                                   00570 = Delaware - Pennsylvania BS (eff. 1983;
                                             term. 1997)
                                   00580 = District of Columbia - Pennsylvania BS
                                           (eff. 1983; term. 1997)
                                   00590 = Florida BS (eff. 1983)
                                   00591 = Connecticut - Florida BS (eff. 2000)
                                   00621 = Illinois BS - HCSC (eff. 1983; term. 1998)
                                   00623 = Michigan - Illinois Blue Shield (eff. 1995)
                                           (term. 1998)
                                   00630 = Indiana - Administar (eff. 1983)
                                   00635 = DMERC-B (Administar Federal, Inc.)
                                           (eff. 1993)
                                   00640 = Iowa - Wellmark, Inc. (eff. 1983; term. 1998)
                                   00645 = Nebraska - Iowa BS (eff. 1985; term. 1987)
                                   00650 = Kansas BS (eff. 1983)
                                   00655 = Nebraska - Kansas BS (eff. 1988)
                                   00660 = Kentucky - Administar (eff. 1983)
                                   00690 = Maryland BS (eff. 1983; term. 1994)
                                   00700 = Massachusetts BS (eff. 1983; term. 1997)
                                   00710 = Michigan BS (eff. 1983; term. 1994)
                                   00720 = Minnesota BS (eff. 1983; term. 1995)
                                   00740 = Missouri - BS Kansas City (eff. 1983)
                                   00751 = Montana BS (eff. 1983)
                                   00770 = New Hampshire/Vermont Physician Services
                                           (eff. 1983; term. 1984)
                                   00780 = New Hampshire/Vermont - Massachusetts BS
                                           (eff. 1985; term. 1997)
                                   00801 = New York - Western BS (eff. 1983)
                                   00803 = New York - Empire BS (eff. 1983)
                                   00805 = New Jersey - Empire BS (eff. 3/99)
                                   00811 = DMERC (A) - Western New York BS (eff. 2000)
                                   00820 = North Dakota - North Dakota BS (eff. 1983)
                                   00824 = Colorado - North Dakota BS (eff. 1995)
                                   00825 = Wyoming - North Dakota BS (eff. 1990)
                                   00826 = Iowa - North Dakota BS (eff. 1999)
                                   00831 = Alaska - North Dakota BS (eff. 1998)
                                   00832 = Arizona -  North Dakota BS (eff. 1998)
                                   00833 = Hawaii - North Dakota BS (eff. 1998)
                                   00834 = Nevada - North Dakota BS (eff. 1998)
                                   00835 = Oregon - North Dakota BS (eff. 1998)
                                   00836 = Washington - North Dakota BS (eff. 1998)
                                   00860 = New Jersey - Pennsylvania BS (eff. 1988;
                                           term. 1999)
                                   00865 = Pennsylvania BS (eff. 1983)
                                   00870 = Rhode Island BS (eff. 1983)
                                   00880 = South Carolina BS (eff. 1983)
                                   00882 = RRB - South Carolina PGBA (eff. 2000)
1         CARR_NUM_TB                                    Carrier Number Table
          -----------                                    --------------------

                                   00885 = DMERC C - Palmetto (eff. 1993)
                                   00900 = Texas BS (eff. 1983)
                                   00901 = Maryland - Texas BS (eff. 1995)
                                   00902 = Delaware - Texas BS (eff. 1998)
                                   00903 = District of Columbia - Texas BS (eff. 1998)
                                   00904 = Virginia - Texas BS (eff. 2000)
                                   00910 = Utah  BS (eff. 1983)
                                   00951 = Wisconsin - Wisconsin Phy Svc (eff. 1983)
                                   00952 = Illinois - Wisconsin Phy Svc (eff. 1999)
                                   00953 = Michigan - Wisconsin Phy Svc (eff. 1999)
                                   00954 = Minnesota - Wisconsin Phy Svc (eff. 2000)
                                   00973 = Triple-S, Inc. - Puerto Rico (eff. 1983)
                                   00974 = Triple-S, Inc. - Virgin Islands
                                   01020 = Alaska - AETNA (eff. 1983; term. 1997)
                                   01030 = Arizona - AETNA (eff. 1983; term. 1997)
                                   01040 = Georgia - AETNA (eff. 1988; term. 1997)
                                   01120 = Hawaii - AETNA (eff. 1983; term. 1997)
                                   01290 = Nevada - AETNA (eff. 1983; term. 1997)
                                   01360 = New Mexico - AETNA (eff. 1986; term. 1997)
                                   01370 = Oklahoma - AETNA (eff. 1983; term. 1997)
                                   01380 = Oregon - AETNA (eff. 1983; term. 1997
                                   01390 = Washington - AETNA (eff. 1994; term. 1997)
                                   02050 = California - TOLIC (eff. 1983)
                                           (term. 2000)
                                   03070 = Connecticut General Life Insurance Co.
                                           (eff. 1983; term. 1985)
                                   05130 = Idaho - Connecticut General (eff. 1983)
                                   05320 = New Mexico - Equitable Insurance
                                           (eff. 1983; term. 1985)
                                   05440 = Tennessee - Connecticut General (eff. 1983)
                                   05530 = Wyoming - Equitable Insurance (eff. 1983)
                                           (term. 1989)
                                   05535 = North Carolina - Connecticut General
                                           (eff. 1988)
                                   05655 = DMERC-D - Connecticut General (eff. 1993)
                                   10071 = Railroad Board Travelers (eff. 1983)
                                           (term. 2000)
                                   10230 = Connecticut - Metra Health (eff. 1986)
                                           (term. 2000)
                                   10240 = Minnesota - Metra Health (eff. 1983)
                                           (term. 2000)
                                   10250 = Mississippi - Metra Health (eff. 1983)
                                           (term. 2000)
                                   10490 = Virginia - Metra Health (eff. 1983)
                                           (term. 2000)
                                   10555 = Travelers Insurance Co. (eff. 1993)
                                           (term. 2000)
                                   11260 = Missouri - General American Life
                                           (eff. 1983; term. 1998)
                                   14330 = New York - GHI (eff. 1983)
                                   16360 = Ohio - Nationwide Insurance Co.
                                   16510 = West Virginia - Nationwide Insurance Co.
                                   21200 = Maine - BS of Massachusetts
                                   31140 = California - National Heritage Ins.
                                   31142 = Maine - National Heritage Ins.
                                   31143 = Massachusetts - National Heritage Ins.
                                   31144 = New Hampshire - National Heritage Ins.
                                   31145 = Vermont - National Heritage Ins.
1         CARR_NUM_TB                                    Carrier Number Table
          -----------                                    --------------------

                                   31146 = So. California - NHIC (eff. 2000)

1       CLM_BILL_TYPE_TB                                Claim Bill Type Table
        ----------------                                ---------------------

                                   11 = Hospital-inpatient (including Part A)
                                   12 = Hospital-inpatient or home health visits (Part B only)
                                   13 = Hospital-outpatient (HHA-A also) (under OPPS 13X
                                        must be used for ASC claims submitted for OPPS
                                        payment -- eff. 7/00)
                                   14 = Hospital-other (Part B)
                                   15 = Hospital-intermediate care - level I
                                   16 = Hospital-intermediate care - level II
                                   17 = Hospital-intermediate care - level III
                                   18 = Hospital-swing beds
                                   19 = Hospital-reserved for national assignment
                                   21 = SNF-inpatient (including Part A)
                                   22 = SNF-inpatient or home health visits (Part B only)
                                   23 = SNF-outpatient (HHA-A also)
                                   24 = SNF-other (Part B)
                                   25 = SNF-intermediate care - level I
                                   26 = SNF-intermediate care - level II
                                   27 = SNF-intermediate care - level III
                                   28 = SNF-swing beds
                                   29 = SNF-reserved for national assignment
                                   31 = HHA-inpatient (including Part A)
                                   32 = HHA-inpatient or home health visits (Part B only)
                                   33 = HHA-outpatient (HHA-A also)
                                   34 = HHA-other (Part B)
                                   35 = HHA-intermediate care - level I
                                   36 = HHA-intermediate care - level II
                                   37 = HHA-intermediate care - level III
                                   38 = HHA-swing beds
                                   39 = HHA-reserved for national assignment
                                   41 = Religious Nonmedical Health Care Institution (RNHCI)
                                        hospital-inpatient (including Part A) (all references
                                        to Christian Science (CS) is obsolete eff. 8/00 and
                                        replaced with RNHCI)
                                   42 = RNHCI hospital-inpatient or home health visits (Part B only)
                                   43 = RNHCI hospital-outpatient (HHA-A also)
                                   44 = RNHCI hospital-other (Part B)
                                   45 = RNHCI hospital-intermediate care - level I
                                   46 = RNHCI hospital-intermediate care - level II
                                   47 = RNHCI hospital-intermediate care - level III
                                   48 = RNHCI hospital-swing beds
                                   49 = RNHCI hospital-reserved for national assignment
                                   51 = CS extended care-inpatient (including Part A) OBSOLETE
                                        eff. 7/00 - implementation of Religious Nonmedical
                                        Health Care Institutions (RNHCI)
                                   52 = RNHCI extended care-inpatient or home health visits
                                        (Part B only) (eff. 7/00); prior to 7/00 Christian Science (CS)
                                   53 = RNHCI extended care-outpatient (HHA-A also) (eff. 7/00);
                                        prior to 7/00 referenced CS
                                   54 = RNHCI extended care-other (Part B)(eff. 7/00); prior
                                        to 7/00 referenced CS
                                   55 = RNHCI extended care-intermediate care - level I (eff. 7/00)
                                        prior to 7/00 referenced CS
                                   56 = RNHCI extended care-intermediate care - level II (eff. 7/00)
                                        prior to 7/00 referenced CS
                                   57 = RNHCI extended care-intermediate care - level III (eff. 7/00)
                                        prior to 7/00 referenced CS
                                   58 = RNHCI extended care-swing beds (eff. 7/00)
1       CLM_BILL_TYPE_TB                                Claim Bill Type Table
        ----------------                                ---------------------

                                        prior to 7/00 referenced CS
                                   59 = RNHCI extended care-reserved for national assignment
                                        (eff. 7/00); prior to 7/00 referenced CS
                                   61 = Intermediate care-inpatient (including Part A)
                                   62 = Intermediate care-inpatient or home health visits (Part B only)
                                   63 = Intermediate care-outpatient (HHA-A also)
                                   64 = Intermediate care-other (Part B)
                                   65 = Intermediate care-intermediate care - level I
                                   66 = Intermediate care-intermediate care - level II
                                   67 = Intermediate care-intermediate care - level III
                                   68 = Intermediate care-swing beds
                                   69 = Intermediate care-reserved for national assignment
                                   71 = Clinic-rural health
                                   72 = Clinic-hospital based or independent renal dialysis facility
                                   73 = Clinic-independent provider based FQHC (eff 10/91)
                                   74 = Clinic-ORF only (eff 4/97);
                                        ORF and CMHC (10/91 - 3/97)
                                   75 = Clinic-CORF
                                   76 = Clinic-CMHC (eff 4/97)
                                   77 = Clinic-reserved for national assignment
                                   78 = Clinic-reserved for national assignment
                                   79 = Clinic-other
                                   81 = Special facility or ASC surgery-hospice (non-hospital based)
                                   82 = Special facility or ASC surgery-hospice (hospital based)
                                   83 = Special facility or ASC surgery-ambulatory surgical center
                                        (Discontinued for Hospitals Subject to Outpatient PPS;
                                         hospitals must use 13X for ASC claims submitted for OPPS
                                         payment -- eff. 7/00)
                                   84 = Special facility or ASC surgery-freestanding birthing center
                                   85 = Special facility or ASC surgery-rural primary care hospital (eff
                                   86 = Special facility or ASC surgery-reserved for national use
                                   87 = Special facility or ASC surgery-reserved for national use
                                   88 = Special facility or ASC surgery-reserved for national use
                                   89 = Special facility or ASC surgery-other
                                   91 = Reserved-inpatient (including Part A)
                                   92 = Reserved-inpatient or home health visits (Part B only)
                                   93 = Reserved-outpatient (HHA-A also)
                                   94 = Reserved-other (Part B)
                                   95 = Reserved-intermediate care - level I
                                   96 = Reserved-intermediate care - level II
                                   97 = Reserved-intermediate care - level III
                                   98 = Reserved-swing beds
                                   99 = Reserved-reserved for national assignment

1         CLM_DISP_TB                                  Claim Disposition Table
          -----------                                  -----------------------


                                   01 = Debit accepted
                                   02 = Debit accepted (automatic adjustment)
                                        applicable through 4/4/93
                                   03 = Cancel accepted
                                   61 = *Conversion code: debit accepted
                                   62 = *Conversion code: debit accepted
                                         (automatic adjustment)
                                   63 = *Conversion code: cancel accepted

                                      *Used only during conversion period:
                                            1/1/91 - 2/21/91

1       CLM_FAC_TYPE_TB                               Claim Facility Type Table
        ---------------                               -------------------------


                                   1 = Hospital
                                   2 = Skilled nursing facility (SNF)
                                   3 = Home health agency (HHA)
                                   4 = Religious Nonmedical (Hospital)
                                       (eff. 8/1/00); prior to 8/00 referenced Christian
                                       Science (CS)
                                   5 = Religious Nonmedical (Extended Care)
                                       (eff. 8/1/00); prior to 8/00 referenced CS
                                   6 = Intermediate care
                                   7 = Clinic or hospital-based renal dialysis facility
                                   8 = Special facility or ASC surgery
                                   9 = Reserved

1         CLM_FREQ_TB                                   Claim Frequency Table
          -----------                                   ---------------------


                                   0 = Non-payment/zero claims
                                   1 = Admit thru discharge claim
                                   2 = Interim - first claim
                                   3 = Interim - continuing claim
                                   4 = Interim - last claim
                                   5 = Late charge(s) only claim
                                   6 = Adjustment of prior claim
                                   7 = Replacement of prior claim;
                                       eff 10/93, provider debit
                                   8 = Void/cancel prior claim.
                                       eff 10/93, provider cancel
                                   9 = Final claim -- used in an HH PPS
                                       episode to indicate the claim
                                       should be processed like debit/
                                       credit adjustment to RAP (initial
                                       claim) (eff. 10/00)
                                   A = Admission notice - used when hospice
                                       is submitting the HCFA-1450 as an
                                       admission notice - hospice NOE only
                                   B = Hospice termination/revocation notice
                                       - hospice NOE only  (eff 9/93)
                                   C = Hospice change of provider notice
                                       - hospice NOE only (eff 9/93)
                                   D = Hospice election void/cancel
                                       - hospice NOE only  (eff 9/93)
                                   E = Hospice change of ownership
                                       - hospice NOE only  (eff 1/97)
                                   F = Beneficiary initiated adjustment
                                       (eff 10/93)
                                   G = CWF generated adjustment (eff 10/93)
                                   H = HCFA generated adjustment (eff 10/93)
                                   I = Misc adjustment claim (other than PRO
                                       or provider) - used to identify a
                                       debit adjustment initiated by HCFA or
                                       an intermediary - eff 10/93, used to
                                       identify intermediary initiated
                                       adjustment only
                                   J = Other adjustment request (eff 10/93)
                                   K = OIG initiated adjustment (eff 10/93)
                                   M = MSP adjustment (eff 10/93)
                                   P = Adjustment required by peer review
                                       organization (PRO)
                                   X = Special adjustment processing - used
                                       for QA editing (eff 8/92)
                                   Z = Hospital Encounter Data alternate sub-
                                       mission (TOB '11Z') used for MCO enrollee
                                       hospital discharges 7/1/97-12/31/98; not
                                       stored in NCH.  Exception:  Problem in
                                       startup months may have resulted in this
                                       abbreviated UB-92 being erroneously
                                       stored in NCH.

1       CLM_HHA_RFRL_TB                            Claim Home Health Referral Table
        ---------------                            --------------------------------


                                   1 = Physician referral - The patient was
                                       admitted upon the recommendation of
                                       a personal physician.
                                   2 = Clinic referral - The patient was
                                       admitted upon the recommendation of
                                       this facility's clinic physician.
                                   3 = HMO referral - The patient was admitted
                                       upon the recommendation of an health
                                       maintenance organization (HMO)
                                       physician.
                                   4 = Transfer from hospital - The patient
                                       was admitted as an inpatient transfer
                                       from an acute care facility.
                                   5 = Transfer from a skilled nursing
                                       facility (SNF) - The patient was
                                       admitted as an inpatient transfer
                                       from a SNF.
                                   6 = Transfer from another health care
                                       facility - The patient was admitted
                                       as a transfer from a health care
                                       facility other than an acute care
                                       facility or SNF.
                                   7 = Emergency room - The patient was
                                       admitted upon the recommendation of
                                       this facility's emergency room
                                       physician.
                                   8 = Court/law enforcement - The patient was
                                       admitted upon the direction of a
                                       court of law or upon the request of
                                       a law enforcement agency's
                                       representative.
                                   9 = Information not available -  The means
                                       by which the patient was admitted is
                                       not known.
                                   A = Transfer from a Critical Access Hospital -
                                       patient was admitted/referred to this
                                       facility as a transfer from a Critical
                                       Access Hospital.
                                   B = Transfer from another HHA - Beneficiaries
                                       are permitted to transfer from one HHA
                                       to another unrelated HHA under HH PPS.
                                       (eff. 10/00)
                                   C = Readmission to same HHA - If a beneficiary
                                       is discharged from an HHA and then re-
                                       admitted within the original 60-day
                                       episode, the original episode must be
                                       closed early and a new once created.
                                       NOTE: the use of this code will permit
                                       the agency to send a new RAP allowing
                                       all claims to  be accepted by Medicare.
                                       (eff. 10/00)

1         CLM_HIPPS_TB                    Claim SNF & HHA Health Insurance        PPS Table
          ------------                    -------------------------------------------------


                                   *******************  SNF PPS HIPPS **************************
                                   ***************1st 3 positions (RUGS-III group)**************
                                   AAA = Default: No assessment

                                   BA1,BA2,BB1,BB2 = Behavior only problems (e.g.,
                                                     physical/verbal abuse)

                                   CA1,CA2,CB1,CB2 = Clinically-complex conditions
                                   CC1,CC2           (e.g., chemo, dialysis)

                                   IA1,IA2,IB1,IB2 = Impaired cognition (e.g., im-
                                                     paired cognition (e.g., short-
                                                     term memory)

                                   PA1,PA2,PB1,PB2 = Reduced physical functions
                                   PC1,PC2,PD1,PD2
                                   PE1,PE2

                                   RHA,RHB,RHC,RLA = Low/medium/high rehabilitation
                                   RLB,RMA,RMB,RMC

                                   RUA,RUB,RUC,RVA = Very high/ultra high rehabilita-
                                   RVB,RVC           tion: highest level

                                   SE1,SE2,SE3     = Extensive services; e.g.; IV feed
                                                     trach care

                                   SSA,SSB,SSC     = Special care; e.g.; coma, burns

                                   ***********Positions 4 & 5 represent HIPPS modifier/********
                                   *************** assessment type indicator ******************

                                   00 = No assessment completed
                                   01 = Medicare 5-day full assessment/not an initial
                                        admission assessment
                                   02 = Medicare 30-day full assessment
                                   03 = Medicare 60-day full assessment
                                   04 = Medicare 90-day full assessment
                                   05 = Medicare Readmission/Return required assessment
                                        (eff. 10/2000)
                                   07 = Medicare 14-day full or comprehensive assessment/
                                        not an initial admission assessment
                                   08 = Off-cycle Other Medicare Required Assessment (OMRA)
                                   11 = Admission assessment AND Medicare 5-day (or readmission/
                                        return) assessment
                                   17 = Medicare 14-day required assessment AND initial
                                        admission assessment (eff. 10/2000)
                                   18 = OMRA replacing Medicare 5-day required assessment
                                        (eff. 10/2000)
                                   28 = OMRA replacing Medicare 30-day required assessment
                                        (eff. 10/2000)
                                   30 = Off-cycle significant change assessment (outside
                                        assessment window) (eff. 10/2000)
                                   31 = Significant change assessment replaces Medicare
                                        5-day assessment (eff. 10/2000)
                                   32 = Significant change assessment replaces Medicare
                                        30-day assessment
1         CLM_HIPPS_TB                    Claim SNF & HHA Health Insurance        PPS Table
          ------------                    -------------------------------------------------

                                   33 = Significant change assessment replaces Medicare
                                        6--day assessment
                                   34 = Significant change assessment replaces Medicare
                                        90-day assessment
                                   35 = Significant change assessment replaces a Medicare
                                        readmission/return assessment
                                   37 = Significant change assessment replaces Medicare
                                        14-day assessment
                                   38 = OMRA replacing Medicare 60-day required
                                        assessment
                                   40 = Off-cycle significant correction assessment of a
                                        prior assessment (outside assessment window)
                                        (eff. 10/2000)
                                   41 = Significant correction of prior full assessment
                                        replaces a Medicare 5-day assessment
                                   42 = Significant correction of prior full assessment
                                        replaces a Medicare 30-day assessment
                                   43 = Significant correction of prior full assessment
                                        replaces a Medicare 60-day assessment
                                   44 = Significant correction of prior full assessment
                                        replaces a Medicare 90-day assessment
                                   45 = Significant correction of a prior assessment
                                        replaces a readmission/return assessment
                                        (eff. 10/2000)
                                   47 = Significant correction of prior full assessment
                                        replaces a Medicare 14-day required assessment
                                   48 = OMRA replacing Medicare 90-day required assessment
                                   54 = Quarterly review assessment - Medicare 90-day
                                        full assessment
                                   78 = OMRA replacing a Medicare 14-day assessment
                                        (eff. 10/2000)

                                   ***************************************************************
                                   ***************************************************************


                                   *************Claim Home Health PPS HIPPS Table****************
                                   ************************* KEY ********************************
                                   Position 1 = 'H'
                                   Position 2 = Clinical (A, B, C, D)
                                   Position 3 = Functional (E, F, G, H, I)
                                   Position 4 = Service (J, K, K, M)
                                   Position 5 = identifies which elements of the code were
                                                computed or derived:
                                                1 = 2nd, 3rd, 4th positions computed
                                                2 = 2nd position derived
                                                3 = 3rd position derived
                                                4 = 4th position derived
                                                5 = 2nd & 3rd positions derived
                                                6 = 3rd & 4th positions derived
                                                7 = 2nd & 4th positions derived
                                                8 = 2nd, 3rd, 4th positions derived
                                   ***************************************************************

                                   **HHRG = C0F0S0/Clinical = Min, Functional = Min, Service = Min**
                                   HAEJ1
                                   HAEJ2
                                   HAEJ3
1         CLM_HIPPS_TB                    Claim SNF & HHA Health Insurance        PPS Table
          ------------                    -------------------------------------------------

                                   HAEJ4
                                   HAEJ5
                                   HAEJ6
                                   HAEJ7
                                   HAEJ8
                                   **HHRG = C0F0S1/Clinical = Min, Functional = Min, Service = Low**
                                   HAEK1
                                   HAEK2
                                   HAEK3
                                   HAEK4
                                   HAEK5
                                   HAEK6
                                   HAEK7
                                   HAEK8
                                   **HHRG = C0F0S2/Clinical = Min, Functional = Min, Service = Mod**
                                   HAEL1
                                   HAEL2
                                   HAEL3
                                   HAEL4
                                   HAEL5
                                   HAEL6
                                   HAEL7
                                   HAEL8
                                   **HHRG = C0F0S3/Clinical = Min, Functional = Min, Service = High**
                                   HAEM1
                                   HAEM2
                                   HAEM3
                                   HAEM4
                                   HAEM5
                                   HAEM6
                                   HAEM7
                                   HAEM8
                                   **HHRG = C0F1S0/Clinical = Min, Functional = Low, Service = Min**
                                   HAFJ1
                                   HAFJ2
                                   HAFJ3
                                   HAFJ4
                                   HAFJ5
                                   HAFJ6
                                   HAFJ7
                                   HAFJ8
                                   **HHRG = C0F1S1/Clinical = Min, Functional = Low, Service = Low**
                                   HAFK1
                                   HAFK2
                                   HAFK3
                                   HAFK4
                                   HAFK5
                                   HAFK6
                                   HAFK7
                                   HAFK8
                                   **HHRG = C0F1S2/Clinical = Min, Functional = Low, Service = Mod**
                                   HAFL1
                                   HAFL2
                                   HAFL3
                                   HAFL4
                                   HAFL5
                                   HAFL6
                                   HAFL7
1         CLM_HIPPS_TB                    Claim SNF & HHA Health Insurance        PPS Table
          ------------                    -------------------------------------------------

                                   HAFL8
                                   **HHRG = C0F1S3/Clinical = Min, Functional = Low, Service = High**
                                   HAFM1
                                   HAFM2
                                   HAFM3
                                   HAFM4
                                   HAFM5
                                   HAFM6
                                   HAFM7
                                   HAFM8
                                   **HHRG = C0F2S0/Clinical = Min, Functional = Mod, Service = Min**
                                   HAGJ1
                                   HAGJ2
                                   HAGJ3
                                   HAGJ4
                                   HAGJ5
                                   HAGJ6
                                   HAGJ7
                                   HAGJ8
                                   **HHRG = C0F2S1/Clinical = Min, Functional = Mod, Service = Low**
                                   HAGK1
                                   HAGK2
                                   HAGK3
                                   HAGK4
                                   HAGK5
                                   HAGK6
                                   HAGK7
                                   HAGK8
                                   **HHRG = C0F2S2/Clinical = Min, Functional = Mod, Service = Mod**
                                   HAGL1
                                   HAGL2
                                   HAGL3
                                   HAGL4
                                   HAGL5
                                   HAGL6
                                   HAGL7
                                   HAGL8
                                   **HHRG = C0F2S3/Clinical = Min, Functional = Mod, Service = High**
                                   HAGM1
                                   HAGM2
                                   HAGM3
                                   HAGM4
                                   HAGM5
                                   HAGM6
                                   HAGM7
                                   HAGM8
                                   **HHRG = C0F3S0/Clinical = Min, Functional = High, Service = Min**
                                   HAHJ1
                                   HAHJ2
                                   HAHJ3
                                   HAHJ4
                                   HAHJ5
                                   HAHJ6
                                   HAHJ7
                                   HAHJ8
                                   **HHRG = C0F3S1/Clinical = Min, Functional = High, Service = Low**
                                   HAHK1
                                   HAHK2
1         CLM_HIPPS_TB                    Claim SNF & HHA Health Insurance        PPS Table
          ------------                    -------------------------------------------------

                                   HAHK3
                                   HAHK4
                                   HAHK5
                                   HAHK6
                                   HAHK7
                                   HAHK8
                                   **HHRG = C0F3S2/Clinical = Min, Functional = High, Service = Mod**
                                   HAHL1
                                   HAHL2
                                   HAHL3
                                   HAHL4
                                   HAHL5
                                   HAHL6
                                   HAHL7
                                   HAHL8
                                   **HHRG = C0F3S3/Clinical = Min, Functional = High, Service = High**
                                   HAHM1
                                   HAHM2
                                   HAHM3
                                   HAHM4
                                   HAHM5
                                   HAHM6
                                   HAHM7
                                   HAHM8
                                   **HHRG = C0F4S0/Clinical = Min, Functional = Max, Service = Min**
                                   HAIJ1
                                   HAIJ2
                                   HAIJ3
                                   HAIJ4
                                   HAIJ5
                                   HAIJ6
                                   HAIJ7
                                   HAIJ8
                                   **HHRG = C0F4S1/Clinical = Min, Functional = Max, Service = Low**
                                   HAIK1
                                   HAIK2
                                   HAIK3
                                   HAIK4
                                   HAIK5
                                   HAIK6
                                   HAIK7
                                   HAIK8
                                   **HHRG = C0F4S2/Clinical = Min, Functional = Max, Service = Mod**
                                   HAIL1
                                   HAIL2
                                   HAIL3
                                   HAIL4
                                   HAIL5
                                   HAIL6
                                   HAIL7
                                   HAIL8
                                   **HHRG = C0F4S3/Clinical = Min, Functional = Max, Service = High**
                                   HAIM1
                                   HAIM2
                                   HAIM3
                                   HAIM4
                                   HAIM5
                                   HAIM6
1         CLM_HIPPS_TB                    Claim SNF & HHA Health Insurance        PPS Table
          ------------                    -------------------------------------------------

                                   HAIM7
                                   HAIM8
                                   **HHRG = C1F0S0/Clinical = Low, Functional = Min, Service = Min**
                                   HBEJ1
                                   HBEJ2
                                   HBEJ3
                                   HBEJ4
                                   HBEJ5
                                   HBEJ6
                                   HBEJ7
                                   HBEJ8
                                   **HHRG = C1F0S1/Clinical = Low, Functional = Min, Service = Low**
                                   HBEK1
                                   HBEK2
                                   HBEK3
                                   HBEK4
                                   HBEK5
                                   HBEK6
                                   HBEK7
                                   HBEK8
                                   **HHRG = C1F0S2/Clinical = Low, Functional = Min, Service = Mod**
                                   HBEL1
                                   HBEL2
                                   HBEL3
                                   HBEL4
                                   HBEL5
                                   HBEL6
                                   HBEL7
                                   HBEL8
                                   **HHRG = C1F0S3/Clinical = Low, Functional = Min, Service = High**
                                   HBEM1
                                   HBEM2
                                   HBEM3
                                   HBEM4
                                   HBEM5
                                   HBEM6
                                   HBEM7
                                   HBEM8
                                   **HHRG = C1F1S0/Clinical = Low, Functional = Low, Service = Min**
                                   HBFJ1
                                   HBFJ2
                                   HBFJ3
                                   HBFJ4
                                   HBFJ5
                                   HBFJ6
                                   HBFJ7
                                   HBFJ8
                                   **HHRG = C1F1S1/Clinical = Low, Functional = Low, Service = Low**
                                   HBFK1
                                   HBFK2
                                   HBFK3
                                   HBFK4
                                   HBFK5
                                   HBFK6
                                   HBFK7
                                   HBFK8
                                   **HHRG = C1F1S2/Clinical = Low, Functional = Low, Service = Mod**
                                   HBFL1
1         CLM_HIPPS_TB                    Claim SNF & HHA Health Insurance        PPS Table
          ------------                    -------------------------------------------------

                                   HBFL2
                                   HBFL3
                                   HBFL4
                                   HBFL5
                                   HBFL6
                                   HBFL7
                                   HBFL8
                                   **HHRG = C1F1S3/Clinical = Low, Functional = Low, Service = High**
                                   HBFM1
                                   HBFM2
                                   HBFM3
                                   HBFM4
                                   HBFM5
                                   HBFM6
                                   HBFM7
                                   HBFM8
                                   **HHRG = C1F2S0/Clinical = Low, Functional = Mod, Service = Min**
                                   HBGJ1
                                   HBGJ2
                                   HBGJ3
                                   HBGJ4
                                   HBGJ5
                                   HBGJ6
                                   HBGJ7
                                   HBGJ8
                                   **HHRG = C1F2S1/Clinical = Low, Functional = Mod, Service = Low**
                                   HBGK1
                                   HBGK2
                                   HBGK3
                                   HBGK4
                                   HBGK5
                                   HBGK6
                                   HBGK7
                                   HBGK8
                                   **HHRG = C1F2S2/Clinical = Low, Functional = Mod, Service = Mod**
                                   HBGL1
                                   HBGL2
                                   HBGL3
                                   HBGL4
                                   HBGL5
                                   HBGL6
                                   HBGL7
                                   HBGL8
                                   **HHRG = C1F2S3/Clinical = Low, Functional = Mod, Service = High**
                                   HBGM1
                                   HBGM2
                                   HBGM3
                                   HBGM4
                                   HBGM5
                                   HBGM6
                                   HBGM7
                                   HBGM8
                                   **HHRG = C1F3S0/Clinical = Low, Functional = High, Service = Min**
                                   HBHJ1
                                   HBHJ2
                                   HBHJ3
                                   HBHJ4
                                   HBHJ5
1         CLM_HIPPS_TB                    Claim SNF & HHA Health Insurance        PPS Table
          ------------                    -------------------------------------------------

                                   HBHJ6
                                   HBHJ7
                                   HBHJ8
                                   **HHRG = C1F3S1/Clinical = Low, Functional = High, Service = Low**
                                   HBHK1
                                   HBHK2
                                   HBHK3
                                   HBHK4
                                   HBHK5
                                   HBHK6
                                   HBHK7
                                   HBHK8
                                   **HHRG = C1F3S2/Clinical = Low, Functional = High, Service = Mod**
                                   HBHL1
                                   HBHL2
                                   HBHL3
                                   HBHL4
                                   HBHL5
                                   HBHL6
                                   HBHL7
                                   HBHL8
                                   **HHRG = C1F3S3/Clinical = Low, Functional = High, Service = High**
                                   HBHM1
                                   HBHM2
                                   HBHM3
                                   HBHM4
                                   HBHM5
                                   HBHM6
                                   HBHM7
                                   HBHM8
                                   **HHRG = C1F4S0/Clinical = Low, Functional = Max, Service = Min**
                                   HBIJ1
                                   HBIJ2
                                   HBIJ3
                                   HBIJ4
                                   HBIJ5
                                   HBIJ6
                                   HBIJ7
                                   HBIJ8
                                   **HHRG = C1F4S1/Clinical = Low, Functional = Max, Service = Low**
                                   HBIK1
                                   HBIK2
                                   HBIK3
                                   HBIK4
                                   HBIK5
                                   HBIK6
                                   HBIK7
                                   HBIK8
                                   **HHRG = C1F4S2/Clinical = Low, Functional = Max, Service = Mod**
                                   HBIL1
                                   HBIL2
                                   HBIL3
                                   HBIL4
                                   HBIL5
                                   HBIL6
                                   HBIL7
                                   HBIL8
                                   **HHRG = C1F4S3/Clinical = Low, Functional = Max, Service = High**
1         CLM_HIPPS_TB                    Claim SNF & HHA Health Insurance        PPS Table
          ------------                    -------------------------------------------------

                                   HBIM1
                                   HBIM2
                                   HBIM3
                                   HBIM4
                                   HBIM5
                                   HBIM6
                                   HBIM7
                                   HBIM8
                                   **HHRG = C2F0S0/Clinical = Mod, Functional = Min, Service = Min**
                                   HCEJ1
                                   HCEJ2
                                   HCEJ3
                                   HCEJ4
                                   HCEJ5
                                   HCEJ6
                                   HCEJ7
                                   HCEJ8
                                   **HHRG = C2F0S1/Clinical = Mod, Functional = Min, Service = Low**
                                   HCEK1
                                   HCEK2
                                   HCEK3
                                   HCEK4
                                   HCEK5
                                   HCEK6
                                   HCEK7
                                   HCEK8
                                   **HHRG = C2F0S2/Clinical = Mod, Functional = Min, Service = Mod**
                                   HCEL1
                                   HCEL2
                                   HCEL3
                                   HCEL4
                                   HCEL5
                                   HCEL6
                                   HCEL7
                                   HCEL8
                                   **HHRG = C2F0S3/Clinical = Mod, Functional = Min, Service = High**
                                   HCEM1
                                   HCEM2
                                   HCEM3
                                   HCEM4
                                   HCEM5
                                   HCEM6
                                   HCEM7
                                   HCEM8
                                   **HHRG = C2F1S0/Clinical = Mod, Functional = Low, Service = Min**
                                   HCFJ1
                                   HCFJ2
                                   HCFJ3
                                   HCFJ4
                                   HCFJ5
                                   HCFJ6
                                   HCFJ7
                                   HCFJ8
                                   **HHRG = C2F1S2/Clinical = Mod, Functional = Low, Service = Mod**
                                   HCFL1
                                   HCFL2
                                   HCFL3
                                   HCFL4
1         CLM_HIPPS_TB                    Claim SNF & HHA Health Insurance        PPS Table
          ------------                    -------------------------------------------------

                                   HCFL5
                                   HCFL6
                                   HCFL7
                                   HCFL8
                                   **HHRG = C2F1S3/Clinical = Mod, Functional = Low, Service = High**
                                   HCFM1
                                   HCFM2
                                   HCFM3
                                   HCFM4
                                   HCFM5
                                   HCFM6
                                   HCFM7
                                   HCFM8
                                   **HHRG = C2F2S0/Clinical = Mod, Functional = Mod, Service = Min**
                                   HCGJ1
                                   HCGJ2
                                   HCGJ3
                                   HCGJ4
                                   HCGJ5
                                   HCGJ6
                                   HCGJ7
                                   HCGJ8
                                   **HHRG = C2F2S1/Clinical = Mod, Functional = Mod, Service = Low**
                                   HCGK1
                                   HCGK2
                                   HCGK3
                                   HCGK4
                                   HCGK5
                                   HCGK6
                                   HCGK7
                                   HCGK8
                                   **HHRG = C2F2S2/Clinical = Mod, Functional = Mod, Service = Mod**
                                   HCGL1
                                   HCGL2
                                   HCGL3
                                   HCGL4
                                   HCGL5
                                   HCGL6
                                   HCGL7
                                   HCGL8
                                   **HHRG = C2F2S3/Clinical = Mod, Functional = Mod, Service = High**
                                   HCGM1
                                   HCGM2
                                   HCGM3
                                   HCGM4
                                   HCGM5
                                   HCGM6
                                   HCGM7
                                   HCGM8
                                   **HHRG = C2F3S0/Clinical = Mod, Functional = High, Service = Min**
                                   HCHJ1
                                   HCHJ2
                                   HCHJ3
                                   HCHJ4
                                   HCHJ5
                                   HCHJ6
                                   HCHJ7
                                   HCHJ8
1         CLM_HIPPS_TB                    Claim SNF & HHA Health Insurance        PPS Table
          ------------                    -------------------------------------------------

                                   **HHRG = C2F3S1/Clinical = Mod, Functional = High, Service = Low**
                                   HCHK1
                                   HCHK2
                                   HCHK3
                                   HCHK4
                                   HCHK5
                                   HCHK6
                                   HCHK7
                                   HCHK8
                                   **HHRG = C2F3S2/Clinical = Mod, Functional = High, Service = Mod**
                                   HCHL1
                                   HCHL2
                                   HCHL3
                                   HCHL4
                                   HCHL5
                                   HCHL6
                                   HCHL7
                                   HCHL8
                                   **HHRG = C2F3S3/Clinical = Mod, Functional = High, Service = High**
                                   HCHM1
                                   HCHM2
                                   HCHM3
                                   HCHM4
                                   HCHM5
                                   HCHM6
                                   HCHM7
                                   HCHM8
                                   **HHRG = C2F4S0/Clinical = Mod, Functional = Max, Service = Min**
                                   HCIJ1
                                   HCIJ2
                                   HCIJ3
                                   HCIJ4
                                   HCIJ5
                                   HCIJ6
                                   HCIJ7
                                   HCIJ8
                                   **HHRG = C2F4S1/Clinical = Mod, Functional = Max, Service = Low**
                                   HCIK1
                                   HCIK2
                                   HCIK3
                                   HCIK4
                                   HCIK5
                                   HCIK6
                                   HCIK7
                                   HCIK8
                                   **HHRG = C2F4S2/Clinical = Mod, Functional = Max, Service = Mod**
                                   HCIL1
                                   HCIL2
                                   HCIL3
                                   HCIL4
                                   HCIL5
                                   HCIL6
                                   HCIL7
                                   HCIL8
                                   **HHRG = C2F4S3/Clinical = Mod, Functional = Max, Service = High**
                                   HCIM1
                                   HCIM2
                                   HCIM3
1         CLM_HIPPS_TB                    Claim SNF & HHA Health Insurance        PPS Table
          ------------                    -------------------------------------------------

                                   HCIM4
                                   HCIM5
                                   HCIM6
                                   HCIM7
                                   HCIM8
                                   **HHRG = C3F0S0/Clinical = High, Functional = Min, Service = Min**
                                   HDEJ1
                                   HDEJ2
                                   HDEJ3
                                   HDEJ4
                                   HDEJ5
                                   HDEJ6
                                   HDEJ7
                                   HDEJ8
                                   **HHRG = C3F0S1/Clinical = High, Functional = Min, Service = Low**
                                   HDEK1
                                   HDEK2
                                   HDEK3
                                   HDEK4
                                   HDEK5
                                   HDEK6
                                   HDEK7
                                   HDEK8
                                   **HHRG = C3F0S2/Clinical = High, Functional = Min, Service = Mod**
                                   HDEL1
                                   HDEL2
                                   HDEL3
                                   HDEL4
                                   HDEL5
                                   HDEL6
                                   HDEL7
                                   HDEL8
                                   **HHRG = C3F0S3/Clinical = High, Functional = Min, Service = High**
                                   HDEM1
                                   HDEM2
                                   HDEM3
                                   HDEM4
                                   HDEM5
                                   HDEM6
                                   HDEM7
                                   HDEM8
                                   **HHRG = C3F1S0/Clinical = High, Functional = Low, Service = Min**
                                   HDFJ1
                                   HDFJ2
                                   HDFJ3
                                   HDFJ4
                                   HDFJ5
                                   HDFJ6
                                   HDFJ7
                                   HDFJ8
                                   **HHRG = C3F1S1/Clinical = High, Functional = Low, Service = Low**
                                   HDFK1
                                   HDFK2
                                   HDFK3
                                   HDFK4
                                   HDFK5
                                   HDFK6
                                   HDFK7
1         CLM_HIPPS_TB                    Claim SNF & HHA Health Insurance        PPS Table
          ------------                    -------------------------------------------------

                                   HDFK8
                                   **HHRG = C3F1S2/Clinical = High, Functional = Low, Service = Mod**
                                   HDFL1
                                   HDFL2
                                   HDFL3
                                   HDFL4
                                   HDFL5
                                   HDFL6
                                   HDFL7
                                   HDFL8
                                   **HHRG = C3F1S3/Clinical = High, Functional = Low, Service = High**
                                   HDFM1
                                   HDFM2
                                   HDFM3
                                   HDFM4
                                   HDFM5
                                   HDFM6
                                   HDFM7
                                   HDFM8
                                   **HHRG = C3F2S0/Clinical = High, Functional = Mod, Service = Min**
                                   HDGJ1
                                   HDGJ2
                                   HDGJ3
                                   HDGJ4
                                   HDGJ5
                                   HDGJ6
                                   HDGJ7
                                   HDGJ8
                                   **HHRG = C3F2S1/Clinical = High, Functional = Mod, Service = Low**
                                   HDGK1
                                   HDGK2
                                   HDGK3
                                   HDGK4
                                   HDGK5
                                   HDGK6
                                   HDGK7
                                   HDGK8
                                   **HHRG = C3F2S2/Clinical = High, Functional = Mod, Service = Mod**
                                   HDGL1
                                   HDGL2
                                   HDGL3
                                   HDGL4
                                   HDGL5
                                   HDGL6
                                   HDGL7
                                   HDGL8
                                   **HHRG = C3F2S3/Clinical = High, Functional = Mod, Service = High**
                                   HDGM1
                                   HDGM2
                                   HDGM3
                                   HDGM4
                                   HDGM5
                                   HDGM6
                                   HDGM7
                                   HDGM8
                                   **HHRG = C3F3S0/Clinical = High, Functional = High, Service = Min**
                                   HDHJ1
                                   HDHJ2
1         CLM_HIPPS_TB                    Claim SNF & HHA Health Insurance        PPS Table
          ------------                    -------------------------------------------------

                                   HDHJ3
                                   HDHJ4
                                   HDHJ5
                                   HDHJ6
                                   HDHJ7
                                   HDHJ8
                                   **HHRG = C3F3S1/Clinical = High, Functional = High, Service = Low**
                                   HDHK1
                                   HDHK2
                                   HDHK3
                                   HDHK4
                                   HDHK5
                                   HDHK6
                                   HDHK7
                                   HDHK8
                                   **HHRG = C3F3S2/Clinical = High, Functional = High, Service = Mod**
                                   HDHL1
                                   HDHL2
                                   HDHL3
                                   HDHL4
                                   HDHL5
                                   HDHL6
                                   HDHL7
                                   HDHL8
                                   **HHRG = C3F3S3/Clinical = High, Functional = High, Service = High**
                                   HDHM1
                                   HDHM2
                                   HDHM3
                                   HDHM4
                                   HDHM5
                                   HDHM6
                                   HDHM7
                                   HDHM8
                                   **HHRG = C3F4S0/Clinical = High, Functional = Max, Service = Min**
                                   HDIJ1
                                   HDIJ2
                                   HDIJ3
                                   HDIJ4
                                   HDIJ5
                                   HDIJ6
                                   HDIJ7
                                   HDIJ8
                                   **HHRG = C3F4S1/Clinical = High, Functional = Max, Service = Low**
                                   HDIK1
                                   HDIK2
                                   HDIK3
                                   HDIK4
                                   HDIK5
                                   HDIK6
                                   HDIK7
                                   HDIK8
                                   **HHRG = C3F4S2/Clinical = High, Functional = Max, Service = Mod**
                                   HDIL1
                                   HDIL2
                                   HDIL3
                                   HDIL4
                                   HDIL5
                                   HDIL6
1         CLM_HIPPS_TB                    Claim SNF & HHA Health Insurance        PPS Table
          ------------                    -------------------------------------------------

                                   HDIL7
                                   HDIL8
                                   **HHRG = C3F4S3/Clinical = High, Functional = Max, Service = High**
                                   HDIM1
                                   HDIM2
                                   HDIM3
                                   HDIM4
                                   HDIM5
                                   HDIM6
                                   HDIM7
                                   HDIM8

1     CLM_IP_ADMSN_TYPE_TB                       Claim Inpatient Admission Type Table
      --------------------                       ------------------------------------


                                   0 = Blank
                                   1 = Emergency - The patient required
                                       immediate medical intervention as a
                                       result of severe, life threatening, or
                                       potentially disabling conditions.
                                       Generally, the patient was admitted
                                       through the emergency room.
                                   2 = Urgent - The patient required immediate
                                       attention for the care and treatment
                                       of a physical or mental disorder.
                                       Generally, the patient was admitted to
                                       the first available and suitable
                                       accommodation.
                                   3 = Elective - The patient's condition
                                       permitted adequate time to schedule the
                                       availability of suitable accommodations.
                                   4 = Newborn - Necessitates the use of
                                       special source of admission codes.

                                   5 THRU 8 =  Reserved.
                                   9 =  Unknown - Information not available.

1     CLM_MDCR_NPMT_RSN_TB                     Claim Medicare Non-Payment Reason Table
      --------------------                     ---------------------------------------


                                   A = Covered worker's compensation (Obsolete)
                                   B = Benefit exhausted
                                   C = Custodial care - noncovered care
                                       (includes all 'beneficiary at fault'
                                       waiver cases) (Obsolete)
                                   E = HMO out-of-plan services not emergency
                                       or urgently needed (Obsolete)
                                   E = MSP cost avoided - IRS/SSA/HCFA Data
                                       Match (eff. 7/00)
                                   F = MSP cost avoid HMO Rate Cell (eff. 7/00)
                                   G = MSP cost avoided Litigation Settlement
                                       (eff. 7/00)
                                   H = MSP cost avoided Employer Voluntary
                                       Reporting (eff. 7/00)
                                   J = MSP cost avoid Insurer Voluntary
                                       Reporting (eff. 7/00)
                                   K = MSP cost avoid Initial Enrollment
                                       Questionnaire (eff. 7/00)
                                   N = All other reasons for nonpayment
                                   P = Payment requested
                                   Q = MSP cost avoided Voluntary Agreement
                                       (eff. 7/00)
                                   R = Benefits refused, or evidence not
                                       submitted
                                   T = MSP cost avoided - IEQ contractor
                                       (eff. 9/76) (obsolete 6/30/00)
                                   U = MSP cost avoided - HMO rate cell
                                       adjustment (eff. 9/76) (Obsolete 6/30/00)
                                   V = MSP cost avoided - litigation
                                       settlement (eff. 9/76) (Obsolete 6/30/00)
                                   W = Worker's compensation (Obsolete)
                                   X = MSP cost avoided - generic
                                   Y = MSP cost avoided - IRS/SSA data
                                       match project (obsolete 6/30/00)
                                   Z = Zero reimbursement RAPs -- zero reimbursement
                                       made due to medical review intervention or
                                       where provider specific zero payment has been
                                       determined. (effective with HHPPS - 10/00)

1      CLM_OCRNC_SPAN_TB                             Claim Occurrence Span Table
       -----------------                             ---------------------------

                                   70 = Eff 10/93, payer use only, the
                                        nonutilization from/thru dates
                                        for PPS-inlier stay where bene had
                                        exhausted all full/coinsurance days, but
                                        covered on cost report.
                                        SNF qualifying hospital stay from/thru dates
                                   71 = Hospital prior stay dates - the from/
                                        thru dates of any hospital stay that
                                        ended within 60 days of this hospital
                                        or SNF admission.
                                   72 = First/last visit - the dates of the
                                        first and last visits occurring in this
                                        billing period if the dates are different
                                        from those in the statement covers period.
                                   73 = Benefit eligibility period - the
                                        inclusive dates during which CHAMPUS
                                        medical benefits are available to a
                                        sponsor's bene as shown on the
                                        bene's ID card.
                                   74 = Non-covered level of care - The from/
                                        thru dates of a period at a noncovered
                                        level of care in an otherwise
                                        covered stay, excluding any period
                                        reported with occurrence span code 76,
                                        77, or 79.
                                   75 = The from/thru dates of SNF level of care
                                        during IP hospital stay.  Shows PRO approval
                                        of patient remaining in hospital
                                        because SNF bed not available.
                                        not applicable to swing bed
                                        cases. PPS hospitals use in day
                                        outlier cases only.
                                   76 = Patient liability - From/thru
                                        dates of period of noncovered care
                                        for which hospital may charge
                                        bene. The FI or PRO must have
                                        approved such charges in advance.
                                        patient must be notified in writing
                                        3 days prior to noncovered period
                                   77 = Provider liability - The from/thru
                                        dates of period of noncovered care
                                        for which the provider is liable.
                                        Eff 3/92, applies to provider liability
                                        where bene is charged with utilization
                                        and is liable for deductible/coinsurance
                                   78 = SNF prior stay dates - The from/
                                        thru dates of any SNF stay that
                                        ended within 60 days of this hospital
                                        or SNF admission.
                                   79 = (Payer code) -
                                        Eff 3/92, from/thru dates of
                                        period of noncovered care where
                                        bene is not charged with utilization,
                                        deductible, or coinsurance.
                                        and provider is liable.
                                        Eff 9/93, noncovered period of care
                                        due to lack of medical necessity.
1      CLM_OCRNC_SPAN_TB                             Claim Occurrence Span Table
       -----------------                             ---------------------------

                                   80 - 99 = Reserved for state assignment
                                   M0 = PRO/UR approved stay dates - Eff 10/93,
                                        the first and last days that were
                                        approved where not all of the stay was
                                        approved.

1        CLM_PPS_IND_TB                               Claim PPS Indicator Table
         --------------                               -------------------------


                                   ***Effective NCH weekly process date 10/3/97 - 5/29/98***

                                   0 = not PPS bill (claim contains no PPS indicator)
                                   2 = PPS bill ( claim contains PPS indicator)

                                   ***Effective NCH weekly process date 6/5/98***

                                   0 = not applicable (claim contains neither PPS
                                       nor deemed insured MQGE status indicators)
                                   1 = Deemed insured MQGE (claim contains deemed
                                       insured MQGE indicator but not PPS indicator)
                                   2 = PPS bill ( claim contains PPS indicator but no
                                       deemed insured MQGE status indicator)
                                   3 = Both PPS and deemed insured MQGE (contains both
                                       PPS and deemed insured MQGE indicators)

1       CLM_RLT_COND_TB                             Claim Related Condition Table
        ---------------                             -----------------------------

                                   01 = Military service related - Medical
                                        condition incurred during military
                                        service.
                                   02 = Employment related - Patient alleged
                                        that the medical condition causing this
                                        episode of care was due to environment/
                                        events resulting from employment.
                                   03 = Patient covered by insurance not
                                        reflected here - Indicates that patient
                                        or patient representative has stated
                                        that coverage may exist beyond that
                                        reflected on this bill.
                                   04 = Health Maintenance Organization (HMO)
                                        enrollee - Medicare beneficiary is
                                        enrolled in an HMO.  Eff 9/93, hospital
                                        must also expect to receive payment
                                        from HMO.
                                   05 = Lien has been filed - Provider has
                                        filed legal claim for recovery of funds
                                        potentially due a patient as a result
                                        of legal action initiated by or on
                                        behalf of the patient.
                                   06 = ESRD patient in 1st 18 months of entitlement
                                        covered by employer group health insurance -
                                        indicates Medicare may be secondary
                                        insurer.  Eff 3/1/96, ESRD patient in 1st
                                        30 months of entitlement covered by employer
                                        group health insurance.
                                   07 = Treatment of nonterminal condition for
                                        hospice patient - The patient is a
                                        hospice enrollee, but the provider is
                                        not treating a terminal condition and
                                        is requesting Medicare reimbursement.
                                   08 = Beneficiary would not provide information
                                        concerning other insurance coverage.
                                   09 = Neither patient nor spouse is employed
                                        - Code indicates that in response to
                                        development questions, the patient and
                                        spouse have denied employment.
                                   10 = Patient and/or spouse is employed but
                                        no EGHP coverage exists or (eff 9/93)
                                        other employer sponsored/provided
                                        health insurance covering patient.
                                   11 = The disabled beneficiary and/or family
                                        member has no group coverage from a LGHP
                                        or (eff 9/93) other employer
                                        sponsored/provided health insurance
                                        covering patient.
                                   12 = Payer code - Reserved for internal
                                        use only by third party payers.  HCFA
                                        will assign as needed.  Providers will
                                        not report them.
                                   13 = Payer code - Reserved for internal
                                        use only by third party payers.  HCFA
                                        will assign as needed.  Providers will
                                        not report them.
                                   14 = Payer code - Reserved for internal
1       CLM_RLT_COND_TB                             Claim Related Condition Table
        ---------------                             -----------------------------

                                        use only by third party payers.  HCFA
                                        will assign as needed.  Providers will
                                        not report them.
                                   15 = Clean claim (eff 10/92)
                                   16 = SNF transition exemption - An
                                        exemption from the post-hospital
                                        requirement applies for this SNF stay
                                        or the qualifying stay dates are more
                                        than 30 days prior to the admission date
                                   17 = Patient is over 100 years old - Code
                                        indicates that the patient was over
                                        100 years old at the date of admission.
                                   18 = Maiden name retained - A dependent
                                        spouse entitled to benefits who does
                                        not use her husband's last name.
                                   19 = Child retains mother's name - A
                                        patient who is a dependent child
                                        entitled to CHAMPVA benefits that does
                                        not have father's last name.
                                   20 = Bene requested billing - Provider
                                        realizes the services on this bill are at a
                                        noncovered level of care or otherwise excluded
                                        from coverage, but the bene has requested
                                        formal determination
                                   21 = Billing for denial notice - The SNF or HHA
                                        realizes services are at a noncovered level of
                                        care or excluded, but requests a Medicare denial
                                        in order to bill medicaid or other insurer
                                   22 = Patient on multiple drug regimen - A
                                        patient who is receiving multiple
                                        intravenous drugs while on home IV
                                        therapy
                                   23 = Homecaregiver available - The patient
                                        has a caregiver available to assist him
                                        or her during self-administration of an
                                        intravenous drug
                                   24 = Home IV patient also receiving HHA
                                        services - the patient is under care
                                        of HHA while receiving home IV drug
                                        therapy services
                                   25 = Reserved for national assignment
                                   26 = VA eligible patient chooses to
                                        receive services in Medicare certified
                                        facility rather than a VA facility
                                        (eff 3/92)
                                   27 = Patient referred to a sole community
                                        hospital for a diagnostic laboratory
                                        test - (sole community hospital only).
                                        (eff 9/93)
                                   28 = Patient and/or spouse's EGHP is
                                        secondary to Medicare -
                                        Qualifying EGHP for employers who have
                                        fewer than 20 employees. (eff 9/93)
                                   29 = Disabled beneficiary and/or family
                                        member's LGHP is secondary to
                                        Medicare - Qualifying LGHP for
                                        employer having fewer than 100 full and
                                        part-time employees
1       CLM_RLT_COND_TB                             Claim Related Condition Table
        ---------------                             -----------------------------

                                   31 = Patient is student (full time - day) -
                                        Patient declares that he or she is
                                        enrolled as a full time day student.
                                   32 = Patient is student (cooperative/work
                                        study program)
                                   33 = Patient is student (full time - night)
                                        - Patient declares that he or she is
                                        enrolled as a full time night student.
                                   34 = Patient is student (part time) -
                                        Patient declares that he or she is
                                        enrolled as a part time student.
                                   36 = General care patient in a special
                                        unit - Patient is temporarily placed in
                                        special care unit bed because no
                                        general care beds were available.
                                   37 = Ward accommodation is patient's
                                        request - Patient is assigned to ward
                                        accommodations at patient's request.
                                   38 = Semi-private room not available -
                                        Indicates that either private or ward
                                        accommodations were assigned because
                                        semi-private accomodations were not
                                        available.
                                   39 = Private room medically necessary -
                                        Patient needed a private room for
                                        medical reasons.
                                   40 = Same day transfer - Patient
                                        transferred to another facility
                                        before midnight of the day of admission.
                                   41 = Partial hospitalization - Eff 3/92,
                                        indicates claim is for partial
                                        hospitalization services.  For OP
                                        services, this includes a variety
                                        of psych programs.
                                   42 = Reserved for national assignment.
                                   43 = Reserved for national assignment.
                                   44 = Reserved for national assignment.
                                   45 = Reserved for national assignment.
                                   46 = Nonavailability statement on file for
                                        CHAMPUS claim for nonemergency IP care
                                        for CHAMPUS bene residing within the
                                        catchment area (usually a 40 mile
                                        radius) of a uniform services hospital.
                                   47 = Reserved for CHAMPUS.
                                   48 = Reserved for national assignment.
                                   49 = Reserved for national assignment.
                                   50 = Reserved for national assignment.
                                   51 = Reserved for national assignment.
                                   52 = Reserved for national assignment.
                                   53 = Reserved for national assignment.
                                   54 = Reserved for national assignment.
                                   55 = SNF bed not available - The patient's
                                        SNF admission was delayed more than 30
                                        days after hospital discharge because
                                        a SNF bed was not available.
                                   56 = Medical appropriateness - Patient's
                                        SNF admission was delayed more than 30
                                        days after hospital discharge because
1       CLM_RLT_COND_TB                             Claim Related Condition Table
        ---------------                             -----------------------------

                                        physical condition made it inappropriate
                                        to begin active care within that period
                                   57 = SNF readmission - Patient previously
                                        received Medicare covered SNF care
                                        within 30 days of the current SNF
                                        admission.
                                   58 = Payment of SNF claims for beneficiaries
                                        disenrolling from terminating M+C plans
                                        plans who have not met the 3-day hospital
                                        stay requirement (eff. 10/1/00)
                                   59 = Reserved for national assignment.
                                   60 = Operating cost day outlier - PRICER
                                        indicates this bill is length of stay
                                        outlier (PPS)
                                   61 = Operating cost cost outlier - PRICER
                                        indicates this bill is a cost outlier
                                        (PPS)
                                   62 = PIP bill - This bill is a periodic
                                        interim payment bill.
                                   63 = PRO denial received before batch
                                        clearance report - The HCSSACL receipt date
                                        is used on PRO adjustment if the PRO's
                                        notification is before orig bill's acceptance
                                        report. (Payer only code eff 9/93)
                                   64 = Other than clean claim - The claim is
                                        not a 'clean claim'
                                   65 = Non-PPS code - The bill is not a
                                        prospective payment system bill.
                                   66 = Outlier not claimed - Bill may meet
                                        the criteria for cost outlier, but the
                                        hospital did not claim the cost outlier
                                        (PPS)
                                   67 = Beneficiary elects not to use LTR days
                                   68 = Beneficiary elects to use LTR days
                                   69 = Operating IME Payment Only - providers
                                        request for IME payment for each discharge
                                        of MCO enrollee, beginning 1/1/98, from
                                        teaching hospitals (facilities with approved
                                        medical residency training program); not
                                        stored in NCH.  Exception:  problem in
                                        startup year may have resulted in this
                                        special IME payment request being erroneously
                                        stored in NCH.  If present, disregard claim
                                        as condition code '69' is not valid NCH
                                        claim.
                                   70 = Self-administered EPO - Billing is
                                        for a home dialysis patient who self
                                        administers EPO.
                                   71 = Full care in unit - Billing is for a
                                        patient who received staff assisted
                                        dialysis services in a hospital or
                                        renal dialysis facility.
                                   72 = Self care in unit - Billing is for a
                                        patient who managed his own dialysis
                                        services without staff assistance in a
                                        hospital or renal dialysis facility.
                                   73 = Self care training - Billing is for
                                        special dialysis services where the
1       CLM_RLT_COND_TB                             Claim Related Condition Table
        ---------------                             -----------------------------

                                        patient and helper (if necessary) were
                                        learning to perform dialysis.
                                   74 = Home - Billing is for a patient who
                                        received dialysis services at home.
                                   75 = Home 100% reimbursement -
                                        (not to be used for services after 4/15/90)
                                        The billing is for home dialsis patient using
                                        a dialysis machine that was purchased
                                        under the 100% program.
                                   76 = Back-up facility - Billing is for a
                                        patient who received dialysis services
                                        in a back-up facility.
                                   77 = Provider accepts or is obligated/
                                        required due to contractual agreement
                                        or law to accept payment by a primary
                                        payer as payment in full - Medicare
                                        pays nothing.
                                   78 = New coverage not implemented by HMO -
                                        eff 3/92, indicates newly covered
                                        service under Medicare for which HMO
                                        does not pay.
                                   79 = CORF services provided off site -
                                        Code indicates that physical therapy,
                                        occupational therapy, or speech path-
                                        ology services were provided off site.
                                   80 - 99 = Reserved for state assignment.
                                   A0 = CHAMPUS external partnership program
                                        special program indicator code. (eff 10/93)
                                   A1 = EPSDT/CHAP - Early and periodic
                                        screening diagnosis and treatment
                                        special program indicator code. (eff 10/93)
                                   A2 = Physically handicapped children's
                                        program - Services provided receive
                                        special funding through Title 8 of
                                        the Social Security Act or the CHAMPUS
                                        program for the handicapped. (eff 10/93)
                                   A3 = Special federal funding - Designed for
                                        uniform use by state uniform billing
                                        committees.
                                        Special program indicator code (eff 10/93)
                                   A4 = Family planning - Designed for
                                        uniform use by state uniform billing
                                        committees.
                                        Special program indicator code (eff 10/93)
                                   A5 = Disability - Designed for uniform
                                        use by state uniform billing
                                        committees.
                                        Special program indicator code (eff 10/93)
                                   A6 = PPV/Medicare - Identifies that
                                        pneumococcal pneumonia 100% payment
                                        vaccine (PPV) services should be
                                        reimbursed under a special Medicare
                                        program provision.
                                        Special program indicator code (eff 10/93)
                                   A7 = Induced abortion to avoid danger to
                                        woman's life.
                                        Special program indicator code (eff 10/93)
                                   A8 = Induced abortion - Victim of rape/
1       CLM_RLT_COND_TB                             Claim Related Condition Table
        ---------------                             -----------------------------

                                        incest.
                                        Special program indicator code (eff 10/93)
                                   A9 = Second opinion surgery - Services
                                        requested to support second opinion
                                        on surgery.  Part B deductible and
                                        coinsurance do not apply.
                                        Special program indicator code (eff 10/93)
                                   B0 = Special program indicator
                                        Reserved for national assignment.
                                   B1 = Special program indicator
                                        Reserved for national assignment.
                                   B2 = Special program indicator
                                        Reserved for national assignment.
                                   B3 = Special program indicator
                                        Reserved for national assignment.
                                   B4 = Special program indicator
                                        Reserved for national assignment.
                                   B5 = Special program indicator
                                        Reserved for national assignment.
                                   B6 = Special program indicator
                                        Reserved for national assignment.
                                   B7 = Special program indicator
                                        Reserved for national assignment.
                                   B8 = Special program indicator
                                        Reserved for national assignment.
                                   B9 = Special program indicator
                                        Reserved for national assignment.
                                   C0 = Reserved for national assignment.
                                   C1 = Approved as billed - The services
                                        provided for this billing period have
                                        been reviewed by the PRO/UR or
                                        intermediary and are fully approved
                                        including any day or cost outlier. (eff 10/93)
                                   C2 = Automatic approval as billed based on
                                        focused review.  (No longer used for
                                        Medicare)
                                        PRO approval indicator services (eff 10/93)
                                   C3 = Partial approval - The services
                                        provided for this billing period have
                                        been reviewed by the PRO/UR or
                                        intermediary and some portion has been
                                        denied (days or services). (eff 10/93)
                                   C4 = Admission/services denied - Indicates
                                        that all of the services were denied
                                        by the PRO/UR.
                                        PRO approval indicator services (eff 10/93)
                                   C5 = Postpayment review applicable - PRO/UR
                                        review to take place after payment.
                                        PRO approval indicator services (eff 10/93)
                                   C6 = Admission preauthorization - The
                                        PRO/UR authorized this admission/
                                        service but has not reviewed the
                                        services provided.
                                        PRO approval indicator services (eff 10/93)
                                   C7 = Extended authorization - the PRO has
                                        authorized these services for an
                                        extended length of time but has not
                                        reviewed the services provided.
1       CLM_RLT_COND_TB                             Claim Related Condition Table
        ---------------                             -----------------------------

                                        PRO approval indicator services (eff 10/93)
                                   C8 = Reserved for national assignment.
                                        PRO approval indicator services (eff 10/93)
                                   C9 = Reserved for national assignment.
                                        PRO approval indicator services (eff 10/93)
                                   D0 = Changes to service dates.
                                        Change condition (eff 10/93)
                                   D1 = Changes in charges.
                                        Change condition (eff 10/93)
                                   D2 = Changes in revenue codes/HCPCS.
                                        Change condition (eff 10/93)
                                   D3 = Second or subsequent interim
                                        PPS bill.
                                        Change condition (eff 10/93)
                                   D4 = Change in grouper input (diagnosis
                                        and/or procedures are changed resulting
                                        in a different DRG).
                                        Change condition (eff 10/93)
                                   D5 = Cancel only to correct a beneficiary
                                        claim account number or provider
                                        identification number.
                                        change condition (eff 10/93)
                                   D6 = Cancel only to repay a duplicate
                                        payment or OIG overpayment (includes
                                        cancellation of an OP bill containing
                                        services required to be included on the
                                        IP bill). Change condition eff 10/93.
                                   D7 = Change to make Medicare the secondary
                                        payer.
                                        Change condition (eff 10/93)
                                   D8 = Change to make Medicare the primary
                                        payer.
                                        Change condition (eff 10/93)
                                   D9 = Any other change.
                                        Change condition (eff 10/93)
                                   E0 = Change in patient status.
                                        Change condition (eff 10/93)
                                   EY = National Emphysema Treatment Trial (NETT)
                                        or Lung Volume Reduction Surgery (LVRS)
                                        clinical study (eff. 11/97)
                                   G0 = Multiple medical visits occur on the same
                                        day in the same revenue center but visits
                                        are distinct and constitute independent
                                        visits (allows for payment under outpatient
                                        PPS -- eff. 7/3/00).
                                   M0 = All inclusive rate for outpatient services.
                                        (payer only code)
                                   M1 = Roster billed influenza virus vaccine.
                                        (payer only code)
                                        Eff 10/96, also includes pneumoccocal
                                        pneumonia vaccine (PPV)
                                   M2 = HH override code - home health total
                                        reimbursement exceeds the $150,000 cap
                                        or the number of total visits exceeds the
                                        150 limitation. (eff 4/3/95)
                                        (payer only code)
                                   W0 = United Mine Workers of America (UMWA)
                                        SNF demonstration indicator (eff 1/97);
1       CLM_RLT_COND_TB                             Claim Related Condition Table
        ---------------                             -----------------------------

                                        but no claims transmitted until 2/98)

1       CLM_RLT_OCRNC_TB                            Claim Related Occurrence Table
        ----------------                            ------------------------------


                                   01 = Auto accident - The date of an auto
                                        accident.
                                   02 = No-fault insurance involved, including
                                        auto accident/other - The date of an
                                        accident where the state has applicable
                                        no-fault liability laws, (i.e., legal
                                        basis for settlement without admission
                                        or proof of guilt).
                                   03 = Accident/tort liability - The date of
                                        an accident resulting from a third
                                        party's action that may involve a civil
                                        court process in an attempt to require
                                        payment by the third party, other than
                                        no-fault liability.
                                   04 = Accident/employment related - The
                                        date of an accident relating to the
                                        patient's employment.
                                   05 = Other accident - The date of an accident
                                        not described by the codes 01 thru 04.
                                   06 = Crime victim - Code indicating the
                                        date on which a medical condition
                                        resulted from alleged criminal action
                                        committed by one or more parties.
                                   07 = Reserved for national assignment.
                                   08 = Reserved for national assignment.
                                   11 = Onset of symptoms/illness - The date
                                        the patient first became aware of
                                        symptoms/illness.
                                   12 = Date of onset for a chronically
                                        dependent individual - Code indicates
                                        the date the patient/bene became
                                        a chronically dependent individual.
                                   13 = Reserved for national assignment.
                                   14 = Reserved for national assignment.
                                   15 = Reserved for national assignment.
                                   16 = Reserved for national assignment.
                                   17 = Date outpatient occupational therapy
                                        plan established or last reviewed -
                                        Code indicating the date an occupational
                                        therapy plan was established or
                                        last reviewed (eff 3/93)
                                   18 = Date of retirement (patient/bene)
                                        - Code indicates the date of retirement
                                        for the patient/bene.
                                   19 = Date of retirement spouse -
                                        Code indicates the date of retirement
                                        for the patient's spouse.
                                   20 = Guarantee of payment began - The date
                                        on which the provider began claiming
                                        Medicare payment under the guarantee
                                        of payment provision.
                                   21 = UR notice received - Code indicating
                                        the date of receipt by the hospital
                                        of the UR committee's finding that the
                                        admission or future stay was not
                                        medically necessary.
                                   22 = Active care ended - The date on which
1       CLM_RLT_OCRNC_TB                            Claim Related Occurrence Table
        ----------------                            ------------------------------

                                        a covered level of care ended in a SNF
                                        or general hospital, or date active care
                                        ended in a psychiatric or tuberculosis
                                        hospital.  (For use by intermediary only)
                                   23 = Reserved for national assignment
                                        (eff 10/93).
                                        Benefits exhausted - The last date
                                        for which benefits can be paid.
                                        (term 9/30/93; replaced by code A3)
                                   24 = Date insurance denied - The date the
                                        insurer's denial of coverage was
                                        received by a higher priority payer.
                                   25 = Date benefits terminated by primary
                                        payer - The date on which coverage
                                        (including worker's compensation benefits
                                        or no-fault coverage) is no longer
                                        available to the patient.
                                   26 = Date skilled nursing facility (SNF)
                                        bed available - The date on which a SNF
                                        bed became available to a hospital
                                        inpatient who required only SNF level of
                                        care.
                                   27 = Date home health plan established or
                                        last reviewed - Code indicating the
                                        date a home health plan of treatment
                                        was established or last reviewed.
                                        not used by hospital unless owner of facility
                                   28 = Date comprehensive outpatient rehabi-
                                        litation plan established or last re-
                                        viewed - Code indicating the date a
                                        comprehensive outpatient rehabilitation
                                        plan was established or last reviewed.
                                        not used by hospital unless owner of facility
                                   29 = Date OPT plan established or last
                                        reviewed - the date a plan of treatment
                                        was established for outpatient physical
                                        therapy.
                                        Not used by hospital unless owner of facility
                                   30 = Date speech pathology plan treatment
                                        established or last reviewed - The date
                                        a speech pathology plan of treatment
                                        was established or last reviewed.
                                        Not used by hospital unless owner of facility
                                   31 = Date bene notified of intent
                                        to bill (accommodations) - The date of
                                        the notice provided to the patient by
                                        the hospital stating that he no longer
                                        required a covered level of IP care.
                                   32 = Date bene notified of intent
                                        to bill (procedures or treatment) - The
                                        date of the notice provided to the patient
                                        by the hospital stating requested care
                                        (diagnostic procedures or treatments) is
                                        not considered reasonable or necessary.
                                   33 = First day of the Medicare coordination
                                        period for ESRD bene - During
                                        which Medicare benefits are secondary
                                        to benefits payable under an EGHP.
1       CLM_RLT_OCRNC_TB                            Claim Related Occurrence Table
        ----------------                            ------------------------------

                                        Required only for ESRD beneficiaries.
                                   34 = Date of election of extended care
                                        facilities - The date the guest elected
                                        to receive extended care services (used
                                        by Christian Science Sanatoria only).
                                   35 = Date treatment started for physical
                                        therapy - Code indicates the date
                                        services were initiated by the billing
                                        provider for physical therapy.
                                   36 = Date of discharge for the IP
                                        hospital stay when patient
                                        received a transplant procedure
                                        - Hospital is billing for
                                        immunosuppressive drugs.
                                   37 = The date of discharge
                                        for the IP hospital stay when
                                        patient received a noncovered
                                        transplant procedure - Hospital
                                        is billing for immunosuppresive drugs.
                                   38 = Date treatment started for home IV
                                        therapy - Date the patient was first
                                        treated in his home for IV therapy.
                                   39 = Date discharged on a continuous
                                        course of IV therapy - Date the patient
                                        was discharged from the hospital on a
                                        continuous course of IV therapy.
                                   40 = Scheduled date of admission - The
                                        date on which a patient will be admitted
                                        as an inpatient to the hospital.
                                        (This code may only be used on an
                                        outpatient claim.)
                                   41 = The date on which the first
                                        outpatient diagnostic test was
                                        performed as part of a pre-admission
                                        testing (PAT) program.  This code may
                                        only be used if a date of admission
                                        was scheduled prior to the administration
                                        of the test(s).
                                   42 = Date of discharge/termination of hospice
                                        care - for the final bill for hospice
                                        care.  Eff 5/93, definition revised to
                                        apply only to date patient revoked
                                        hospice election.
                                   43 = Reserved for national assignment.
                                   44 = Date treatment started for occupational
                                        therapy - Code indicates the date
                                        services were initiated by the billing
                                        provider for occupational therapy.
                                   45 = Date treatment started for speech
                                        therapy - Code indicates the date
                                        services were initiated by the billing
                                        provider for speech therapy.
                                   46 = Date treatment started for cardiac
                                        rehabilitation - Code indicates the
                                        date services were initiated by the
                                        billing provider for cardiac
                                        rehabilitation.
                                   47 = Noncovered Outlier Stay Began- code
1       CLM_RLT_OCRNC_TB                            Claim Related Occurrence Table
        ----------------                            ------------------------------

                                        indicates the date that cost outlier
                                        status began and no Medicare payment
                                        will be made because all benefits have
                                        been exhausted during the inlier stay or
                                        the beneficiary does not elect to use life
                                        time reserve days (to be implemented in
                                        1999).
                                   48 = Payer code - Code reserved for
                                        internal use only by third party
                                        payers.  HCFA assigns as needed for
                                        your use.  Providers will not report it.
                                   49 = Payer code - Code reserved for
                                        internal use only by third party
                                        payers.  HCFA assigns as needed for
                                        your use.  Providers will not report it.
                                   50 - 69 = Reserved for state assignment
                                   A1 = Birthdate, Insured A - The birthdate of
                                        the individual in whose name the insurance
                                        is carried. (Eff 10/93)
                                   A2 = Effective date, Insured A policy - A
                                        code indicating the first date insurance
                                        is in force. (eff 10/93)
                                   A3 = Benefits exhausted - Code indicating
                                        the last date for which benefits are
                                        available and after which no payment
                                        can be made to payer A.  (eff 10/93)
                                   B1 = Birthdate, Insured B - The birthdate of
                                        the individual in whose name the insurance
                                        is carried. (eff 10/93)
                                   B2 = Effective date, Insured B policy - A
                                        code indicating the first date insurance
                                        is in force. (eff 10/93)
                                   B3 = Benefits exhausted - code indicating
                                        the last date for which benefits are
                                        available and after which no payment
                                        can be made to payer B.  (eff 10/93)
                                   C1 = Birthdate, Insured C - The birthdate of
                                        the individual in whose name the insurance
                                        is carried. (eff 10/93)
                                   C2 = Effective date, Insured C policy - A
                                        code indicating the first date insurance
                                        is in force. (eff 10/93)
                                   C3 = Benefits exhausted - Code indicating
                                        the last date for which benefits are
                                        available and after which no payment
                                        can be made to payer C.  (eff 10/93)
1     CLM_SRC_IP_ADMSN_TB                     Claim Source Of Inpatient Admission Table
      -------------------                     -----------------------------------------


                                          **For Inpatient/SNF Claims:**


                                   0 = ANOMALY: invalid value, if present,
                                       translate to '9'
                                   1 = Physician referral - The patient was
                                       admitted upon the recommendation of
                                       a personal physician.
                                   2 = Clinic referral - The patient was
                                       admitted upon the recommendation of
                                       this facility's clinic physician.
                                   3 = HMO referral - The patient was admitted
                                       upon the recommendation of an health
                                       maintenance organization (HMO)
                                       physician.
                                   4 = Transfer from hospital - The patient
                                       was admitted as an inpatient transfer
                                       from an acute care facility.
                                   5 = Transfer from a skilled nursing
                                       facility (SNF) - The patient was
                                       admitted as an inpatient transfer
                                       from a SNF.
                                   6 = Transfer from another health care
                                       facility - The patient was admitted
                                       as a transfer from a health care
                                       facility other than an acute care
                                       facility or SNF.
                                   7 = Emergency room - The patient was
                                       admitted upon the recommendation of
                                       this facility's emergency room
                                       physician.
                                   8 = Court/law enforcement - The patient was
                                       admitted upon the direction of a
                                       court of law or upon the request of
                                       a law enforcement agency's
                                       representative.
                                   9 = Information not available -  The means
                                       by which the patient was admitted is
                                       not known.
                                   A = Transfer from a Critical Access Hospital -
                                       patient was admitted/referred to this
                                       facility as a transfer from a Critical
                                       Access Hospital.
                                     ---------------------------------------
                                        **For Newborn Type of Admission**

                                   1 = Normal delivery - A baby delivered with
                                       out complications.
                                   2 = Premature delivery - A baby delivered
                                       with time and/or weight factors
                                       qualifying it for premature status.
                                   3 = Sick baby - A baby delivered with
                                       medical complications, other than those
                                       relating to premature status.
                                   4 = Extramural birth - A baby delivered in
                                       a nonsterile environment.
                                   5-8 = Reserved for national assignment.
1     CLM_SRC_IP_ADMSN_TB                     Claim Source Of Inpatient Admission Table
      -------------------                     -----------------------------------------

                                   9 = Information not available.

1   CLM_SRVC_CLSFCTN_TYPE_TB                   Claim Service Classification Type Table
    ------------------------                   ---------------------------------------


                                      For facility type code 1 thru 6, and 9

                                   1 = Inpatient (including Part A)
                                   2 = Hospital based or Inpatient (Part B only)
                                       or home health visits under Part B
                                   3 = Outpatient (HHA-A also)
                                   4 = Other (Part B)
                                   5 = Intermediate care - level I
                                   6 = Intermediate care - level II
                                   7 = Subacute Inpatient
                                       (formerly Intermediate care - level III)
                                   8 = Swing beds (used to indicate billing for
                                       SNF level of care in a hospital with an
                                       approved swing bed agreement)
                                   9 = Reserved for national assignment

                                     For facility type code 7

                                   1 = Rural health
                                   2 = Hospital based or independent renal
                                       dialysis facility
                                   3 = Free-standing provider based federally
                                       qualified health center (eff 10/91)
                                   4 = Other Rehabilitation Facility (ORF) and
                                       Community Mental Health Center (CMHC)
                                       (eff 10/91 - 3/97); ORF only (eff. 4/97)
                                   5 = Comprehensive Rehabilitation Center
                                         (CORF)
                                   6 = Community Mental Health Center (CMHC) (eff 4/97)
                                   7-8 = Reserved for national assignment
                                   9 = Other

                                     For facility type code 8

                                   1 = Hospice (non-hospital based)
                                   2 = Hospice (hospital based)
                                   3 = Ambulatory surgical center in hospital
                                       outpatient department
                                   4 = Freestanding birthing center
                                   5 = Critical Access Hospital (eff. 10/99)
                                       formerly Rural primary care hospital
                                       (eff. 10/94)
                                   6-8 = Reserved for national use
                                   9 = Other

1         CLM_TRANS_TB                                 Claim Transaction Table
          ------------                                 -----------------------


                                   0 = Religious NonMedical Health Care Institutions (RNHCI)
                                       bill (prior to 8/00, Christian Science bill), SNF bill,
                                       or state buy-in
                                   1 = Psychiatric hospital facility bill or dummy psychiatric
                                   2 = Tuberculosis hospital facility bill
                                   3 = General care hospital facility bill or dummy LRD
                                   4 = Regular SNF bill
                                   5 = Home health agency bill (HHA)
                                   6 = Outpatient hospital bill
                                   C = CORF bill - type of OP bill in the HHA bill format
                                       (obsoleted 7/98)
                                   H = Hospice bill

1          CLM_VAL_TB                                     Claim Value Table
           ----------                                     -----------------

                                   04 = Inpatient professional component
                                        charges which are combined billed -
                                        For use only by some all inclusive
                                        rate hospitals. (Eff 9/93)
                                   05 = Professional component included in
                                        charges and also billed separately to
                                        carrier - For use on Medicare and
                                        Medicaid bills if the state requests
                                        this information.
                                   06 = Medicare blood deductible - Total
                                        cash blood deductible (Part A blood
                                        deductible).
                                   07 = Medicare cash deductible (term 9/30/93)
                                        reserved for national assignment.
                                        (eff 10/93)
                                   08 = Medicare Part A lifetime reserve amount
                                        in first calendar year - Lifetime reserve
                                        amount charged in the year of admission.
                                        (not stored in NCH until 2/93)
                                   09 = Medicare Part A coinsurance amount in
                                        the first calendar year - Coinsurance
                                        amount charged in the year of admission.
                                        (not stored in NCH until 2/93)
                                   10 = Medicare Part A lifetime reserve amount
                                        in the second calendar year - Lifetime
                                        reserve amount charged in the year of
                                        discharge where the bill spans two
                                        calendar years.
                                        (not stored in NCH until 2/93)
                                   11 = Medicare Part A coinsurance amount in
                                        the second calendar year - Coinsurance
                                        amount charged in the year of discharge
                                        where the bill spans two calendar years
                                        (not stored in NCH until 2/93)
                                   12 = Amount is that portion of
                                        higher priority EGHP insurance payment
                                        made on behalf of aged bene
                                        provider applied to Medicare
                                        covered services on this bill.
                                        Six zeroes indicate provider
                                        claimed conditional Medicare payment.
                                   13 = Amount is that portion of higher
                                        priority EGHP insurance payment made on
                                        behalf of ESRD bene provider
                                        applied to Medicare covered services
                                        on this bill. Six zeroes indicate
                                        the provider claimed conditional
                                        Medicare payment.
                                   14 = That portion of payment from higher
                                        priority no fault auto/other
                                        liability insurance made on behalf of bene
                                        provider applied to Medicare covered
                                        services on this bill. Six zeroes indicate
                                        provider claimed conditional payment
                                   15 = That portion of a payment from a
                                        higher priority WC plan made on behalf
                                        of a bene that the provider applied to
1          CLM_VAL_TB                                     Claim Value Table
           ----------                                     -----------------

                                        Medicare covered services on this bill. Six
                                        zeroes indicate the provider claimed
                                        conditional Medicare payment.
                                   16 = That portion of a payment from
                                        higher priority PHS or other federal
                                        agency made on behalf of a
                                        bene the provider applied
                                        to Medicare covered services on this
                                        bill. Six zeroes indicate
                                        provider claimed conditional Medicare
                                        payment.
                                   17 = Operating Outlier amount - Providers do
                                        not report this.  For payer internal use
                                        only.  Indicates the amount of day or
                                        cost outlier payment to be made.
                                        (Do not include any PPS capital outlier
                                        payment in this entry).
                                   18 = Operating Disproportionate share amount -
                                        Providers do not report this.  For
                                        payer internal use only.  Indicates the
                                        disproportionate share amount applicable
                                        to the bill.  Use the amount provided by
                                        the disproportionate share field in PRICER.
                                        (Do not include any PPS capital DSH adjust-
                                        ment in this entry).
                                   19 = Operating Indirect medical education amount -
                                        Providers do not report this.  For
                                        payer internal use only.  Indicates the
                                        indirect medical education amount applicable
                                        to the bill.  (Do not include PPS capital
                                        IME adjustment in this entry).
                                   20 = Total payment sent provider for capital
                                        under PPS, including HSP, FSP, outlier,
                                        old capital, DSH adjustment, IME
                                        adjustment, and any exception amount.
                                        (used 10/1/91 - 3/1/92 for provider
                                        reporting.  Payer only code eff 9/93.)
                                   21 = Catastrophic - Medicaid - Eligibility
                                        requirements to be determined at state
                                        level.  (Medicaid specific/deleted 9/93)
                                   22 = Surplus - Medicaid - Eligibility
                                        requirements to be determined at state
                                        level. (Medicaid specific/deleted 9/93)
                                   23 = Recurring monthly income - Medicaid -
                                        Eligibility requirements to be
                                        determined at state level. (Medicaid
                                        specific/deleted 9/93)
                                   24 = Medicaid rate code - Medicaid -
                                        Eligibility requirements to be
                                        determined at state level. (Medicaid
                                        specific/deleted 9/93)
                                   31 = Patient liability amount - Amount
                                        shown is that which you or the PRO
                                        approved to charge the bene for
                                        noncovered accommodations, diagnostic
                                        procedures or treatments.
                                   37 = Pints of blood furnished - Total
                                        number of pints of whole blood or units
1          CLM_VAL_TB                                     Claim Value Table
           ----------                                     -----------------

                                        of packed red cells furnished to the
                                        patient. (eff 10/93)
                                   38 = Blood deductible pints - The number
                                        of unreplaced pints of whole blood or
                                        units of packed red cells furnished for
                                        which the patient is responsible.
                                        (eff 10/93)
                                   39 = Pints of blood replaced - The total
                                        number of pints of whole blood or units
                                        of packed red cells furnished to the
                                        patient that have been replaced by or
                                        on behalf of the patient. (eff 10/93)
                                   40 = New coverage not implemented by HMO -
                                        amount shown is for inpatient charges
                                        covered by HMO (eff 3/92).
                                        (use this code when the bill includes
                                        inpatient charges for newly covered
                                        services which are not paid by HMO.)
                                   41 = Amount is that portion of
                                        a payment from higher priority BL
                                        program made on behalf of
                                        bene the provider applied
                                        to Medicare covered services on this
                                        bill. Six zeroes indicate the
                                        provider claimed conditional Medicare
                                        payment.
                                   42 = Amount is that portion of a payment
                                        from higher priority VA made on behalf
                                        of bene the provider applied
                                        to Medicare covered services on this
                                        bill. Six zeroes indicate the
                                        provider claimed conditional Medicare
                                        payment.
                                   43 = Disabled bene under age 65 with
                                        LGHP - Amount is that portion of
                                        a payment from a higher priority LGHP
                                        made on behalf of a disabled Medicare
                                        bene the provider applied to
                                        Medicare covered services on this bill.
                                   44 = Amount provider agreed to accept from
                                        primary payer when amount less than charges
                                        but more than payment received -
                                        When a lesser amount is received and the
                                        received amount is less than charges, a
                                        Medicare secondary payment is due.
                                   46 = Number of grace days - Following the
                                        date of the PRO/UR determination, this
                                        is the number of days determined by the
                                        PRO/UR to be necessary to arrange for
                                        the patient's post-discharge care.
                                        (eff 10/93)
                                   47 = Any liability insurance - Amount
                                        is that portion from a higher priority
                                        liability insurance made on behalf of
                                        Medicare bene the provider
                                        is applying to Medicare covered
                                        services on this bill. (Eff 9/93)
                                   48 = Hemoglobin reading - The latest
1          CLM_VAL_TB                                     Claim Value Table
           ----------                                     -----------------

                                        hemoglobin reading taken during this
                                        billing cycle.
                                   49 = Latest hematocrit reading taken
                                        during billing cycle - Usually
                                        reported in two pos. (a percentage) to
                                        left of the dollar/cent delimiter.
                                        if provided with a
                                        a decimal, use the 3rd pos. to right
                                        of the delimiter for the third digit.
                                   50 = Physical therapy visits - Indicates
                                        the number of physical therapy
                                        visits from onset (at billing provider)
                                        through this billing period.
                                   51 = Occupational therapy visits - Indicates
                                        the number of occupational therapy
                                        visits from onset (at the billing
                                        provider) through this billing period.
                                   52 = Speech therapy visits - Indicates
                                        the number of speech therapy
                                        visits from onset (at billing provider)
                                        through this billing period.
                                   53 = Cardiac rehabilitation - Indicates
                                        the number of cardiac rehabilitation
                                        visits from onset (at billing
                                        provider) through this billing period.
                                   54 = Reserved for national assignment.
                                   55 = Reserved for national assignment.
                                   56 = Hours skilled nursing provided - The
                                        number of hours skilled nursing
                                        provided during the billing period.  Count
                                        only hours spent in the home.
                                   57 = Home health visit hours - The number
                                        of home health aide services provided
                                        during the billing period.  Count only
                                        the hours spent in the home.
                                   58 = Arterial blood gas - Arterial blood
                                        gas value at beginning of each reporting
                                        period for oxygen therapy. This
                                        value or value 59 will be required on
                                        the initial bill for oxygen therapy and
                                        on the fourth month's bill.
                                   59 = Oxygen saturation - Oxygen saturation
                                        at the beginning of each reporting
                                        period for oxygen therapy.  This value or
                                        value 58 will be required on the
                                        initial bill for oxygen therapy and on
                                        the fourth month's bill.
                                   60 = HHA branch MSA - MSA in which HHA
                                        branch is located.
                                   61 = Location of HHA service or hospice
                                        service - the balanced budget act
                                        (BBA) requires that the geographic
                                        location of where the service was
                                        provided be furnished instead of the
                                        geographic location of the provider.
                                        (eff. 10/1/97)
                                   62 = Number of Part A home health visits
                                        accrued during a period of continuous
1          CLM_VAL_TB                                     Claim Value Table
           ----------                                     -----------------

                                        care - necessitated by the change in
                                        payment basis under HH PPS (eff. 10/00)
                                   63 = Number of Part B home health visits
                                        accrued during a period of continuous
                                        care - necessitated by the change in
                                        payment basis under HH PPS (eff. 10/00)
                                   64 = Amount of home health payments attributed
                                        to the Part A trust fund in a period
                                        of continuous care - necessitated by the
                                        change in payment basis under HH PPS
                                        (eff. 10/00)
                                   65 = Amount of home health payments attributed
                                        to the Part B trust fund in a period
                                        of continuous care - necessitated by the
                                        change in payment basis under HH PPS
                                        (eff. 10/00)
                                   66 = Reserved for national assignment.
                                   67 = Peritoneal dialysis - The number of
                                        hours of peritoneal dialysis provided
                                        during the billing period (only the
                                        hours spent in the home).
                                        (eff. 10/97)
                                   68 = EPO drug - Number of units of EPO
                                        administered relating to the billing
                                        period.
                                   69 = Reserved for national assignment
                                   70 = Interest amount - (Providers do not
                                        report this.)  Report the amount
                                        applied to this bill.
                                   71 = Funding of ESRD networks - (Providers
                                        do not report this.)  Report the
                                        amount the Medicare payment was
                                        reduced to help fund the ESRD networks.
                                   72 = Flat rate surgery charge - Code
                                        indicates the amount of the charge for
                                        outpatient surgery where the hospital
                                        has such a charging structure.
                                   73 = Drug deductible - (For internal use by
                                        third party payers only).  Report the
                                        amount of the drug deductible to be
                                        applied to the claim.
                                   74 = Drug coinsurance - (For internal use
                                        by third party payers only).  Report
                                        the amount of drug coinsurance to be
                                        applied to the claim.
                                   75 = Gramm/Rudman/Hollings - (Providers do
                                        not report this.)  Report the amount of
                                        the sequestration applied to this bill.
                                   76 = Report provider's percentage of
                                        billed charges interim rate during
                                        billing period.  Applies to OP
                                        hospital, SNF and HHA claims
                                        where interim rate is applicable.
                                        Report to left of dollar/cents delimiter.
                                        (TP payers internal use only)
                                   77 = Payer code - This codes is set
                                        aside for payer use only.  Providers
                                        do not report these codes.
1          CLM_VAL_TB                                     Claim Value Table
           ----------                                     -----------------

                                   78 = Payer code - This codes is set
                                        aside for payer use only.  Providers
                                        do not report these codes.
                                   79 = Payer code - This code is set
                                        aside for payer use only.  Providers
                                        do not report these codes.
                                   80 - 99 = Reserved for state assignment.
                                   A1 = Deductible Payer A - The amount
                                        assumed by the provider to be applied
                                        to the patient's deductible amount
                                        involving the indicated payer. (eff 10/93)
                                        - Prior value 07
                                   A2 = Coinsurance Payer A - The amount assumed
                                        by the provider to be applied to the
                                        patient's Part B coinsurance amount
                                        involving the indicated payer. (eff 10/93)
                                   A4 = Self-administered drugs administered in an
                                        emergency situation - Ordinarily the only
                                        noncovered self-administered drug
                                        paid for under Medicare in an emergency
                                        situation is insulin administered to a
                                        patient in a diabetic coma. (eff 7/97)
                                   B1 = Deductible Payer B - The amount
                                        assumed by the provider to be applied
                                        to the patient's deductible amount
                                        involving the indicated payer. (eff 10/93)
                                        - Prior value 07
                                   B2 = Coinsurance Payer B - the amount assumed
                                        by the provider to be applied to the
                                        patient's Part B coinsurance amount
                                        involving the indicated payer. (eff 10/93)
                                   C1 = Deductible Payer C - The amount
                                        assumed by the provider to be applied
                                        to the patient's deductible amount
                                        involving the indicated payer. (eff 10/93)
                                        - Prior value 07
                                   C2 = Coinsurance Payer C - The amount assumed
                                        by the provider to be applied to the
                                        patient's Part B coinsurance amount
                                        involving the indicated payer. (eff 10/93)
                                   Y1 = Part A demo payment - Portion of the
                                        payment designated as reimbursement for
                                        Part A services per the ORD contract.  No
                                        deductible or coinsurance has been
                                        applied.  (eff. 5/97)
                                   Y2 = Part B demo payment - Portion of the
                                        payment designated as reimbursement for
                                        Part B services for the ORD contract.
                                        No deductible or coinsurance has been
                                        applied.  (eff. 5/97)
                                   Y3 = Part B coinsurance - Amount of Part B
                                        coinsurance applied by the intermediary
                                        to this demo claim.   (eff. 5/97)
                                   Y4 = Conventional provider Part A payment -
                                        Amount Medicare would have reimbursed
                                        the provider for Part A services if
                                        there had been no demo.  (eff. 5/97)
1  CTGRY_EQTBL_BENE_IDENT_TB        Category Equatable Beneficiary Identification Code (BIC) Table
   -------------------------        --------------------------------------------------------------


                                   NCH BIC              SSA Categories
                                   -------              --------------

                                   A  = A;J1;J2;J3;J4;M;M1;T;TA
                                   B  = B;B2;B6;D;D4;D6;E;E1;K1;K2;K3;K4;W;W6;
                                        TB(F);TD(F);TE(F);TW(F)
                                   B1 = B1;BR;BY;D1;D5;DC;E4;E5;W1;WR;TB(M)
                                        TD(M);TE(M);TW(M)
                                   B3 = B3;B5;B9;D2;D7;D9;E2;E3;K5;K6;K7;K8;W2
                                        W7;TG(F);TL(F);TR(F);TX(F)
                                   B4 = B4;BT;BW;D3;DM;DP;E6;E9;W3;WT;TG(M)
                                        TL(M);TR(M);TX(M)
                                   B8 = B8;B7;BN;D8;DA;DV;E7;EB;K9;KA;KB;KC;W4
                                        W8;TH(F);TM(F);TS(F);TY(F)
                                   BA = BA;BK;BP;DD;DL;DW;E8;EC;KD;KE;KF;KG;W9
                                        WC;TJ(F);TN(F);TT(F);TZ(F)
                                   BD = BD;BL;BQ;DG;DN;DY;EA;ED;KH;KJ;KL;KM;WF
                                        WJ;TK(F);TP(F);TU(F);TV(F)
                                   BG = BG;DH;DQ;DS;EF;EJ;W5;TH(M);TM(M);TS(M)
                                        TY(M)
                                   BH = BH;DJ;DR;DX;EG;EK;WB;TJ(M);TN(M);TT(M)
                                        TZ(M)
                                   BJ = BJ;DK;DT;DZ;EH;EM;WG;TK(M);TP(M);TU(M)
                                        TV(M)
                                   C1 = C1;TC
                                   C2 = C2;T2
                                   C3 = C3;T3
                                   C4 = C4;T4
                                   C5 = C5;T5
                                   C6 = C6;T6
                                   C7 = C7;T7
                                   C8 = C8;T8
                                   C9 = C9;T9
                                   F1 = F1;TF
                                   F2 = F2;TQ
                                   F3-F8 = Equatable only to itself (e.g., F3 IS
                                           equatable to F3)
                                   CA-CZ = Equatable only to itself.  (e.g., CA is
                                           only equatable to CA)

                                        ---------------------------------------
                                                   RRB Categories

                                   10 = 10
                                   11 = 11
                                   13 = 13;17
                                   14 = 14;16
                                   15 = 15
                                   43 = 43
                                   45 = 45
                                   46 = 46
                                   80 = 80
                                   83 = 83
                                   84 = 84;86
                                   85 = 85

1 DMERC_LINE_SCRN_RSLT_IND_TB                  DMERC Line Screen Result Indicator Table
  ---------------------------                  ----------------------------------------


                                   A = Denied for lack of medical necessity;
                                       highest level of review was automated
                                       level I review
                                   B = Reduced (partially denied) for lack
                                       of medical necessity; highest level
                                       of review was automated level I review
                                   C = Denied as statutorily noncovered;
                                       highest level of review was automated
                                       level I review
                                   D = Reserved for future use
                                   E = Paid after automated level I review
                                   F = Denied for lack of medical necessity;
                                       highest level of review was manual
                                       level I review
                                   G = Reduced (partially denied) for lack
                                       of medical necessity; highest level
                                       of review was manual level I review
                                   H = Denied as statutorily noncovered;
                                       highest level of review was manual
                                       level I review
                                   I = Denied for coding/unbundling reasons;
                                       highest level of review was manual
                                       level I review
                                   J = Paid after manual level I review
                                   K = Denied for lack of medical necessity;
                                       highest level of review was manual
                                       level II review
                                   L = Reduced (partially denied) for lack
                                       of medical necessity; highest level
                                       of review was manual level II review
                                   M = Denied as statutorily noncovered;
                                       highest level of review was manual
                                       level II review
                                   N = Denied for coding/unbundling reasons;
                                       highest level of review was manual
                                       level II review
                                   O = Paid after manual level II review
                                   P = Denied for lack of medical necessity;
                                       highest level of review was manual
                                       level III review
                                   Q = Reduced (partially denied) for lack
                                       of medical necessity; highest level
                                       of review was manual level III review
                                   R = Denied as statutorily noncovered;
                                       highest level of review was manual
                                       level III review
                                   S = Denied for coding/unbundling reasons;
                                       highest level of review was manual
                                       level III review
                                   T = Paid after manual level III review
1   DMERC_LINE_SUPLR_TYPE_TB                        DMERC Line Supplier Type Table
    ------------------------                        ------------------------------

                                   0 = Clinics, groups, associations,
                                       partnerships, or other entities
                                       for whom the carrier's own ID number
                                       has been assigned.
                                   1 = Physicians or suppliers billing as
                                       solo practitioners for whom SSN's are
                                       shown in the physician ID code field.
                                   2 = Physicians or suppliers billing as
                                       solo practitioners for whom the carrier's
                                       own physician ID code is shown.
                                   3 = Suppliers (other than sole proprietorship)
                                       for whom EI numbers are used in coding the
                                       ID field.
                                   4 = Suppliers (other than sole proprietorship)
                                       for whom the carrier's own code has been
                                       shown.
                                   5 = Institutional providers and
                                       independent laboratories for whom EI
                                       numbers are used in coding the ID field.
                                   6 = Institutional providers and
                                       independent laboratories for whom the
                                       carrier's own ID number is shown.
                                   7 = Clinics, groups, associations, or
                                       partnerships for whom EI numbers
                                       are used in coding the ID field.
                                   8 = Other entities for whom EI numbers
                                       are used in coding the ID field or
                                       proprietorship for whom EI numbers are
                                       used in coding the ID field.

1     DRG_OUTLIER_STAY_TB                 Diagnosis Related Group Outlier Patient Stay Table
      -------------------                 --------------------------------------------------

                                   0 = No outlier
                                   1 = Day outlier (condition code 60)
                                   2 = Cost outlier, (condition code 61)

                                          *** Non-PPS Only ***

                                   6 = Valid diagnosis related groups (DRG)
                                       received from the intermediary
                                   7 = HCFA developed DRG
                                   8 = HCFA developed DRG using patient status
                                       code
                                   9 = Not groupable

1        FI_CLM_ACTN_TB                         Fiscal Intermediary Claim Action Table
         --------------                         --------------------------------------

                                   1 = Original debit action (includes non-
                                       adjustment RTI correction items) - it
                                       will always be a 1 in regular bills.
                                   2 = Cancel by credit adjustment - used
                                       only in credit/debit pairs (under HHPPS,
                                       updates the RAP).
                                   3 = Secondary debit adjustment - used only
                                       in credit/debit pairs (under HHPPS, would
                                       be the final claim or an adjustment on
                                       a LUPA).
                                   4 = Cancel only adjustment (under HHPPS,
                                       RAP/final claim/LUPA).
                                   5 = Force action code 3
                                   6 = Force action code 2
                                   8 = Benefits refused (for inpatient bills,
                                       an 'R' nonpayment code must also be
                                       present
                                   9 = Payment requested (used on bills that
                                       replace previously-submitted benefits-
                                       refused bills, action code 8.  In such
                                       cases a debit/credit pair is not re-
                                       quired.  For inpatient bills, a 'P'
                                       should be entered in the nonpayment
                                       code.)

1          FI_NUM_TB                               Fiscal Intermediary Number Table
           ---------                               --------------------------------

                                   00010 = Alabama BC
                                   00020 = Arkansas BC
                                   00030 = Arizona BC
                                   00040 = California BC (term. 12/00)
                                   00050 = New Mexico BC/CO
                                   00060 = Connecticut BC
                                   00070 = Delaware BC - terminated 2/98
                                   00080 = Florida BC
                                   00090 = Florida BC
                                   00101 = Georgia BC
                                   00121 = Illinois - HCSC
                                   00123 = Michigan - HCSC
                                   00130 = Indiana BC/Administar Federal
                                   00131 = Illinois - Administar
                                   00140 = Iowa - Wellmark (term. 6/2000)
                                   00150 = Kansas BC
                                   00160 = Kentucky/Administar
                                   00180 = Maine BC
                                   00181 = Maine BC - Massachusetts
                                   00190 = Maryland BC
                                   00200 = Massachusetts BC - terminated 7/97
                                   00210 = Michigan BC - terminated 9/94
                                   00220 = Minnesota BC
                                   00230 = Mississippi BC
                                   00231 = Mississippi BC/LA
                                   00232 = Mississippi BC
                                   00241 = Missouri BC - terminated 9/92
                                   00250 = Montana BC
                                   00260 = Nebraska BC
                                   00270 = New Hampshire/VT BC
                                   00280 = New Jersey BC (term. 8/2000)
                                   00290 = New Mexico BC - terminated 11/95
                                   00308 = Empire BC
                                   00310 = North Carolina BC
                                   00320 = North Dakota BC
                                   00332 = Community Mutual Ins Co; Ohio-Administar
                                   00340 = Oklahoma BC
                                   00350 = Oregon BC
                                   00351 = Oregon BC/ID.
                                   00355 = Oregon-CWF
                                   00362 = Independence BC - terminated 8/97
                                   00363 = Veritus, Inc (PITTS)
                                   00370 = Rhode Island BC
                                   00380 = South Carolina BC
                                   00390 = Tennessee BC
                                   00400 = Texas BC
                                   00410 = Utah BC
                                   00423 = Virginia BC; Trigon
                                   00430 = Washington/Alaska BC
                                   00450 = Wisconsin BC
                                   00452 = Michigan - Wisconsin BC
                                   00454 = United Government Services -
                                           Wisconsin BC (eff. 12/00)
                                   00460 = Wyoming BC
                                   00468 = N Carolina BC/CPRTIVA
                                   00993 = BC/BS Assoc.
                                   17120 = Hawaii Medical Service
1          FI_NUM_TB                               Fiscal Intermediary Number Table
           ---------                               --------------------------------

                                   50333 = Travelers; Connecticut United Healthcare
                                           (terminated - date unknown)
                                   51051 = Aetna California - terminated 6/97
                                   51070 = Aetna Connecticut - terminated 6/97
                                   51100 = Aetna Florida - terminated 6/97
                                   51140 = Aetna Illinois - terminated 6/97
                                   51390 = Aetna Pennsylvania - terminated 6/97
                                   52280 = Mutual of Omaha
                                   57400 = Cooperative, San Juan, PR
                                   61000 = Aetna

1   FI_RQST_CLM_CNCL_RSN_TB                         Claim Cancel Reason Code Table
    -----------------------                         ------------------------------


                                   C = Coverage Transfer
                                   D = Duplicate Billing
                                   H = Other or blank
                                   L = Combining two beneficiary master records
                                   P = Plan Transfer
                                   S = Scramble
                                   ************For Action Code 4 *******************
                                   *********Effective with HHPPS - 10/00************
                                   A = RAP/Final claim/LUPA is cancelled by Interme-
                                       diary.  Does not delete episode.  Do not set
                                       cancellation indicator.
                                   B = RAP/Final claim/LUPA is cancelled by Interme-
                                       diary.  Does not delete episode.  Set
                                       cancellation indicator to 1.
                                   E = RAP/Final claim/LUPA is cancelled by Interme-
                                       diary.  Remove episode.
                                   F = RAP/Final claim/LUPA is cancelled by Provider.
                                       Remove episode.

1       GEO_SSA_STATE_TB                                     State Table
        ----------------                                     -----------


                                   01 = Alabama
                                   02 = Alaska
                                   03 = Arizona
                                   04 = Arkansas
                                   05 = California
                                   06 = Colorado
                                   07 = Connecticut
                                   08 = Delaware
                                   09 = District of Columbia
                                   10 = Florida
                                   11 = Georgia
                                   12 = Hawaii
                                   13 = Idaho
                                   14 = Illinois
                                   15 = Indiana
                                   16 = Iowa
                                   17 = Kansas
                                   18 = Kentucky
                                   19 = Louisiana
                                   20 = Maine
                                   21 = Maryland
                                   22 = Massachusetts
                                   23 = Michigan
                                   24 = Minnesota
                                   25 = Mississippi
                                   26 = Missouri
                                   27 = Montana
                                   28 = Nebraska
                                   29 = Nevada
                                   30 = New Hampshire
                                   31 = New Jersey
                                   32 = New Mexico
                                   33 = New York
                                   34 = North Carolina
                                   35 = North Dakota
                                   36 = Ohio
                                   37 = Oklahoma
                                   38 = Oregon
                                   39 = Pennsylvania
                                   40 = Puerto Rico
                                   41 = Rhode Island
                                   42 = South Carolina
                                   43 = South Dakota
                                   44 = Tennessee
                                   45 = Texas
                                   46 = Utah
                                   47 = Vermont
                                   48 = Virgin Islands
                                   49 = Virginia
                                   50 = Washington
                                   51 = West Virginia
                                   52 = Wisconsin
                                   53 = Wyoming
                                   54 = Africa
                                   55 = Asia
                                   56 = Canada & Islands
                                   57 = Central America and West Indies
1       GEO_SSA_STATE_TB                                     State Table
        ----------------                                     -----------

                                   58 = Europe
                                   59 = Mexico
                                   60 = Oceania
                                   61 = Philippines
                                   62 = South America
                                   63 = U.S. Possessions
                                   64 = American Samoa
                                   65 = Guam
                                   66 = Saipan
                                   97 = Northern Marianas
                                   98 = Guam
                                   99 = With 000 county code is American Samoa;
                                        otherwise unknown

1     HCFA_PRVDR_SPCLTY_TB                          HCFA Provider Specialty Table
      --------------------                          -----------------------------


                                               **Prior to 5/92**

                                   01 = General practice
                                   02 = General surgery
                                   03 = Allergy (revised 10/91 to mean allergy/
                                        immunology)
                                   04 = Otology, laryngology, rhinology
                                        revised 10/91 to mean otolaryngology)
                                   05 = Anesthesiology
                                   06 = Cardiovascular disease (revised 10/91
                                        to mean cardiology)
                                   07 = Dermatology
                                   08 = Family practice
                                   09 = Gynecology--osteopaths only (deleted
                                        10/91; changed to '16')
                                   10 = Gastroenterology
                                   11 = Internal medicine
                                   12 = Manipulative therapy (osteopaths only)
                                        (revised 10/91 to mean osteopathic
                                        manipulative therapy)
                                   13 = Neurology
                                   14 = Neurological surgery (revised 10/91 to
                                        mean neurosurgery)
                                   15 = Obstetrics--osteopaths only (deleted
                                        10/91; changed to '16')
                                   16 = OB-gynecology
                                   17 = Ophthalmology, otology, laryngology
                                        rhinology--osteopaths only (deleted
                                        10/91; changed to '18' if physicians
                                        practice is more than 50% ophthalmology
                                        or to '04' if physician's practice is
                                        more than 50% otolaryngology.  If
                                        practice is 50/50, choose specialty
                                        with greater allowed charges.
                                   18 = Ophthalmology
                                   19 = Oral surgery (dentists only)
                                   20 = Orthopedic surgery
                                   21 = Pathologic anatomy, clinical pathology-
                                        osteopaths only (deleted 10/91;
                                        changed to '22')
                                   22 = Pathology
                                   23 = Peripheral vascular disease or surgery
                                        (deleted 10/91; changed to '76')
                                   24 = Plastic surgery (revised to mean
                                        plastic and reconstructive surgery).
                                   25 = Physical medicine and rehabilitation
                                   26 = Psychiatry
                                   27 = Psychiatry, neurology (osteopaths only)
                                        (deleted 10/91; changed to '86')
                                   28 = Proctology (revised 10/91 to mean
                                        colorectal surgery).
                                   29 = Pulmonary disease
                                   30 = Radiology (revised 10/91 to mean
                                        diagnostic radiology)
                                   31 = Roentgenology, radiology (osteopaths)
                                        (deleted 10/91; changed to '30')
                                   32 = Radiation therapy--osteopaths (deleted
1     HCFA_PRVDR_SPCLTY_TB                          HCFA Provider Specialty Table
      --------------------                          -----------------------------

                                        10/91; changed to '92')
                                   33 = Thoracic surgery
                                   34 = Urology
                                   35 = Chiropractor, licensed (revised 10/91
                                        to mean chiropractic)
                                   36 = Nuclear medicine
                                   37 = Pediatrics (revised 10/91 to mean
                                        pediatric medicine)
                                   38 = Geriatrics (revised 10/91 to mean
                                        geriatric medicine)
                                   39 = Nephrology
                                   40 = Hand surgery
                                   41 = Optometrist - services related to
                                        condition of aphakia (revised 10/91 to
                                        mean optometrist)
                                   42 = Certified nurse midwife (added 7/88)
                                   43 = Certified registered nurse anesthetist
                                        (revised 10/91 to mean CRNA,
                                        anesthesia assistant)
                                   44 = Infectious disease
                                   46 = Endocrinology (added 10/91)
                                   48 = Podiatry - surgery chiropody (revised
                                        10/91 to mean podiatry)
                                   49 = Miscellaneous (include ASCS)
                                   51 = Medical supply company with C.O.
                                        certification (certified orthotist -
                                        certified by American Board for
                                        Certification in Prosthetics and
                                        Orthotics.
                                   52 = Medical supply company with C.P.
                                        certification (certified prosthetist -
                                        certified by American Board for
                                        Certification in Prosthetics and Orthotics).
                                   53 = Medical supply company with C.P.O.
                                        certification (certified prosthetist -
                                        orthotist - certified by American
                                        Board for Certification in Prosthetics
                                        and Orthotics).
                                   54 = Medical supply company not included in
                                        51, 52, or 53.
                                   55 = Individual certified orthotist
                                   56 = Individual certified prosthetist
                                   57 = Individual certified prosthetist -
                                        orthotist
                                   58 = Individuals not included in 55,56 or 57
                                   59 = Ambulance service supplier (e.g.
                                        private ambulance companies, funeral
                                        homes, etc.)
                                   60 = Public health or welfare agencies
                                        (federal, state, and local)
                                   61 = Voluntary health or charitable agencies
                                        (e.g. National Cancer Society, National
                                        Heart Association, Catholic Charities)
                                   62 = Psychologist--billing independently
                                   63 = Portable X-ray supplier--billing
                                        independently (revised 10/91 to mean
                                        portable X-ray supplier)
                                   64 = Audiologist (billing independently)
1     HCFA_PRVDR_SPCLTY_TB                          HCFA Provider Specialty Table
      --------------------                          -----------------------------

                                   65 = Physical therapist (independent practice)
                                   66 = Rheumatology (added 10/91)
                                   67 = Occupational therapist--independent
                                        practice
                                   68 = Clinical psychologist
                                   69 = Independent laboratory--billing
                                        independently (revised 10/91 to mean
                                        independent clinical laboratory --
                                        billing independently)
                                   70 = Clinic or other group practice, except
                                        Group Practice Prepayment Plan (GPPP)
                                   71 = Group Practice Prepayment Plan - diagnostic
                                        X-ray (do not use after 1/92)
                                   72 = Group Practice Prepayment Plan - diagnostic
                                        laboratory (do not use after 1/92)
                                   73 = Group Practice Prepayment Plan -
                                        physiotherapy (do not use after 1/92)
                                   74 = Group Practice Prepayment Plan - occupational
                                        therapy (do not use after 1/92)
                                   75 = Group Practice Prepayment Plan - other
                                        medical care (do not use after 1/92)
                                   76 = Peripheral vascular disease
                                        (added 10/91)
                                   77 = Vascular surgery (added 10/91)
                                   78 = Cardiac surgery (added 10/91)
                                   79 = Addiction medicine (added 10/91)
                                   8O = Clinical social worker (1991)
                                   81 = Critical care-intensivists (added 10/91)
                                   82 = Ophthalmology, cataracts specialty
                                        (added 10/91; used only until 5/92)
                                   83 = Hematology/oncology (added 10/91)
                                   84 = Preventive medicine (added 10/91)
                                   85 = Maxillofacial surgery (added 10/91)
                                   86 = Neuropsychiatry (added 10/91)
                                   87 = All other (e.g. drug and department
                                        stores) (revised 10/91 to mean all
                                        other suppliers)
                                   88 = Unknown (revised 10/91 to mean
                                        physician assistant)
                                   90 = Medical oncology (added 10/91)
                                   91 = Surgical oncology (added 10/91)
                                   92 = Radiation oncology (added 10/91)
                                   93 = Emergency medicine (added 10/91)
                                   94 = Interventional radiology (added 10/91)
                                   95 = Independent physiological laboratory
                                        (added 10/91)
                                   96 = Unknown physician specialty
                                        (added 10/91)
                                   99 = Unknown--incl. social worker's
                                        psychiatric services (revised 10/91 to
                                        mean unknown supplier/provider)
                                         ---------------------------------------
                                                 **Effective 5/92**

                                   00 = Carrier wide
                                   01 = General practice
                                   02 = General surgery
                                   03 = Allergy/immunology
1     HCFA_PRVDR_SPCLTY_TB                          HCFA Provider Specialty Table
      --------------------                          -----------------------------

                                   04 = Otolaryngology
                                   05 = Anesthesiology
                                   06 = Cardiology
                                   07 = Dermatology
                                   08 = Family practice
                                   09 = Gynecology (osteopaths only)
                                        (discontinued 5/92 use code 16)
                                   10 = Gastroenterology
                                   11 = Internal medicine
                                   12 = Osteopathic manipulative therapy
                                   13 = Neurology
                                   14 = Neurosurgery
                                   15 = Obstetrics (osteopaths only)
                                        (discontinued 5/92 use code 16)
                                   16 = Obstetrics/gynecology
                                   17 = Ophthalmology, otology, laryngology,
                                        rhinology (osteopaths only)
                                        (discontinued 5/92 use codes 18 or 04
                                        depending on percentage of practice)
                                   18 = Ophthalmology
                                   19 = Oral surgery (dentists only)
                                   20 = Orthopedic surgery
                                   21 = Pathologic anatomy, clinical
                                        pathology (osteopaths only)
                                        (discontinued 5/92 use code 22)
                                   22 = Pathology
                                   23 = Peripheral vascular disease, medical
                                        or surgical (osteopaths only)
                                        (discontinued 5/92 use code 76)
                                   24 = Plastic and reconstructive surgery
                                   25 = Physical medicine and rehabilitation
                                   26 = Psychiatry
                                   27 = Psychiatry, neurology (osteopaths
                                        only) (discontinued 5/92 use code 86)
                                   28 = Colorectal surgery (formerly
                                        proctology)
                                   29 = Pulmonary disease
                                   30 = Diagnostic radiology
                                   31 = Roentgenology, radiology (osteopaths
                                        only) (discontinued 5/92 use code 30)
                                   32 = Radiation therapy (osteopaths only)
                                        (discontinued 5/92 use code 92)
                                   33 = Thoracic surgery
                                   34 = Urology
                                   35 = Chiropractic
                                   36 = Nuclear medicine
                                   37 = Pediatric medicine
                                   38 = Geriatric medicine
                                   39 = Nephrology
                                   40 = Hand surgery
                                   41 = Optometry (revised 10/93 to
                                        mean optometrist)
                                   42 = Certified nurse midwife (eff 1/87)
                                   43 = Crna, anesthesia assistant
                                        (eff 1/87)
                                   44 = Infectious disease
                                   45 = Mammography screening center
                                   46 = Endocrinology (eff 5/92)
1     HCFA_PRVDR_SPCLTY_TB                          HCFA Provider Specialty Table
      --------------------                          -----------------------------

                                   47 = Independent Diagnostic Testing Facility
                                        (IDTF) (eff. 6/98)
                                   48 = Podiatry
                                   49 = Ambulatory surgical center
                                        (formerly miscellaneous)
                                   50 = Nurse practitioner
                                   51 = Medical supply company with
                                        certified orthotist (certified by
                                        American Board for Certification in
                                        Prosthetics And Orthotics)
                                   52 = Medical supply company with
                                        certified prosthetist
                                        (certified by American Board for
                                        Certification In Prosthetics And
                                        Orthotics)
                                   53 = Medical supply company with
                                        certified prosthetist-orthotist
                                        (certified by American Board for
                                        Certification in Prosthetics
                                        and Orthotics)
                                   54 = Medical supply company not included
                                        in 51, 52, or 53.  (Revised 10/93
                                        to mean medical supply company for DMERC)
                                   55 = Individual certified orthotist
                                   56 = Individual certified prosthetist
                                   57 = Individual certified prosthetist-
                                        orthotist
                                   58 = Individuals not included in 55, 56,
                                        or 57 (revised 10/93  to mean medical
                                        supply company with registered
                                        pharmacist)
                                   59 = Ambulance service supplier, e.G.,
                                        private ambulance companies, funeral
                                        homes, etc.
                                   60 = Public health or welfare agencies
                                        (federal, state, and local)
                                   61 = Voluntary health or charitable
                                        agencies (e.G., National Cancer
                                        Society, National Heart Associiation,
                                        Catholic Charities)
                                   62 = Psychologist (billing independently)
                                   63 = Portable X-ray supplier
                                   64 = Audiologist (billing independently)
                                   65 = Physical therapist (independently
                                        practicing)
                                   66 = Rheumatology (eff 5/92)
                                        Note: during 93/94 DMERC also used this
                                        to mean medical supply company with
                                        respiratory therapist
                                   67 = Occupational therapist (independently
                                        practicing)
                                   68 = Clinical psychologist
                                   69 = Clinical laboratory (billing
                                        independently)
                                   70 = Multispecialty clinic or group
                                        practice
                                   71 = Diagnostic X-ray (GPPP) (not to
                                        be assigned after 5/92)
1     HCFA_PRVDR_SPCLTY_TB                          HCFA Provider Specialty Table
      --------------------                          -----------------------------

                                   72 = Diagnostic laboratory (GPPP)
                                        (not to be assigned after 5/92)
                                   73 = Physiotherapy (GPPP) (not to be
                                        assigned after 5/92)
                                   74 = Occupational therapy (GPPP)
                                        (not to be assigned after 5/92)
                                   75 = Other medical care (GPPP) (not to
                                        assigned after 5/92)
                                   76 = Peripheral vascular disease
                                        (eff 5/92)
                                   77 = Vascular surgery (eff 5/92)
                                   78 = Cardiac surgery (eff 5/92)
                                   79 = Addiction medicine (eff 5/92)
                                   80 = Licensed clinical social worker
                                   81 = Critical care (intensivists)
                                        (eff 5/92)
                                   82 = Hematology (eff 5/92)
                                   83 = Hematology/oncology (eff 5/92)
                                   84 = Preventive medicine (eff 5/92)
                                   85 = Maxillofacial surgery (eff 5/92)
                                   86 = Neuropsychiatry (eff 5/92)
                                   87 = All other suppliers (e.g. drug and
                                        department stores) (note: DMERC used
                                        87 to mean department store from 10/93
                                        through 9/94; recoded eff 10/94 to A7;
                                        NCH cross-walked DMERC reported 87 to A7.
                                   88 = Unknown supplier/provider specialty
                                        (note: DMERC used 87 to mean grocery
                                        store from 10/93 - 9/94; recoded eff
                                        10/94 to A8; NCH cross-walked DMERC
                                        reported 88 to A8.
                                   89 = Certified clinical nurse specialist
                                   90 = Medical oncology (eff 5/92)
                                   91 = Surgical oncology (eff 5/92)
                                   92 = Radiation oncology (eff 5/92)
                                   93 = Emergency medicine (eff 5/92)
                                   94 = Interventional radiology (eff 5/92)
                                   95 = Independent physiological
                                        laboratory (eff 5/92)
                                   96 = Optician (eff 10/93)
                                   97 = Physician assistant (eff 5/92)
                                   98 = Gynecologist/oncologist (eff 10/94)
                                   99 = Unknown physician specialty
                                   A0 = Hospital (eff 10/93) (DMERCs only)
                                   A1 = SNF (eff 10/93) (DMERCs only)
                                   A2 = Intermediate care nursing facility
                                        (eff 10/93) (DMERCs only)
                                   A3 = Nursing facility, other (eff 10/93)
                                        (DMERCs only)
                                   A4 = HHA (eff 10/93) (DMERCs only)
                                   A5 = Pharmacy (eff 10/93) (DMERCs only)
                                   A6 = Medical supply company with respiratory
                                        therapist (eff 10/93) (DMERCs only)
                                   A7 = Department store (for DMERC use:
                                        eff 10/94, but cross-walked from
                                        code 87 eff 10/93)
                                   A8 = Grocery store (for DMERC use:
                                        eff 10/94, but cross-walked from
1     HCFA_PRVDR_SPCLTY_TB                          HCFA Provider Specialty Table
      --------------------                          -----------------------------

                                        code 88 eff 10/93)

1      HCFA_TYPE_SRVC_TB                              HCFA Type of Service Table
       -----------------                              --------------------------


                                   1 = Medical care
                                   2 = Surgery
                                   3 = Consultation
                                   4 = Diagnostic radiology
                                   5 = Diagnostic laboratory
                                   6 = Therapeutic radiology
                                   7 = Anesthesia
                                   8 = Assistant at surgery
                                   9 = Other medical items or services
                                   0 = Whole blood only eff 01/96,
                                       whole blood or packed red cells before 01/96
                                   A = Used durable medical equipment (DME)
                                   B = High risk screening mammography
                                       (obsolete 1/1/98)
                                   C = Low risk screening mammography
                                       (obsolete 1/1/98)
                                   D = Ambulance (eff 04/95)
                                   E = Enteral/parenteral nutrients/supplies
                                       (eff 04/95)
                                   F = Ambulatory surgical center (facility
                                       usage for surgical services)
                                   G = Immunosuppressive drugs
                                   H = Hospice services (discontinued 01/95)
                                   I = Purchase of DME (installment basis)
                                       (discontinued 04/95)
                                   J = Diabetic shoes (eff 04/95)
                                   K = Hearing items and services (eff 04/95)
                                   L = ESRD supplies (eff 04/95)
                                       (renal supplier in the home before 04/95)
                                   M = Monthly capitation payment for dialysis
                                   N = Kidney donor
                                   P = Lump sum purchase of DME, prosthetics,
                                       orthotics
                                   Q = Vision items or services
                                   R = Rental of DME
                                   S = Surgical dressings or other medical supplies
                                       (eff 04/95)
                                   T = Psychological therapy (term. 12/31/97)
                                       outpatient mental health limitation (eff. 1/1/98)
                                   U = Occupational therapy
                                   V = Pneumococcal/flu vaccine (eff 01/96),
                                       Pneumococcal/flu/hepatitis B vaccine (eff 04/95-12/95),
                                       Pneumococcal only before 04/95
                                   W = Physical therapy
                                   Y = Second opinion on elective surgery
                                       (obsoleted 1/97)
                                   Z = Third opinion on elective surgery
                                       (obsoleted 1/97)

1 LINE_ADDTNL_CLM_DCMTN_IND_TB           Line Additional Claim Documentation Indicator Table
  ----------------------------           ---------------------------------------------------


                                   0 = No additional documentation
                                   1 = Additional documentation submitted for
                                       non-DME EMC claim
                                   2 = CMN/prescription/other documentation submitted
                                       which justifies medical necessity
                                   3 = Prior authorization obtained and approved
                                   4 = Prior authorization requested but not approved
                                   5 = CMN/prescription/other documentation submitted
                                       but did not justify medical necessity
                                   6 = CMN/prescription/other documentation submitted
                                       and approved after prior authorization rejected
                                   7 = Recertification CMN/prescription/other
                                       documentation

1       LINE_PLC_SRVC_TB                             Line Place Of Service Table
        ----------------                             ---------------------------

                                               **Prior To 1/92**

                                   1 = Office
                                   2 = Home
                                   3 = Inpatient hospital
                                   4 = SNF
                                   5 = Outpatient hospital
                                   6 = Independent lab
                                   7 = Other
                                   8 = Independent kidney disease treatment
                                       center
                                   9 = Ambulatory
                                   A = Ambulance service
                                   H = Hospice
                                   M = Mental health, rural mental health
                                   N = Nursing home
                                   R = Rural codes

                                         ---------------------------------------
                                                **Effective 1/92**

                                   11 = Office
                                   12 = Home
                                   21 = Inpatient hospital
                                   22 = Outpatient hospital
                                   23 = Emergency room - hospital
                                   24 = Ambulatory surgical center
                                   25 = Birthing center
                                   26 = Military treatment facility
                                   31 = Skilled nursing facility
                                   32 = Nursing facility
                                   33 = Custodial care facility
                                   34 = Hospice
                                   35 = Adult living care facilities (ALCF)
                                        (eff. NYD - added 12/3/97)
                                   41 = Ambulance - land
                                   42 = Ambulance - air or water
                                   50 = Federally qualified health centers
                                        (eff. 10/1/93)
                                   51 = Inpatient psychiatric facility
                                   52 = Psychiatric facility partial hospitalization
                                   53 = Community mental health center
                                   54 = Intermediate care facility/mentally
                                        retarded
                                   55 = Residential substance abuse treatment
                                        facility
                                   56 = Psychiatric residential treatment
                                        center
                                   60 = Mass immunizations center (eff. 9/1/97)
                                   61 = Comprehensive inpatient rehabilitation
                                        facility
                                   62 = Comprehensive outpatient rehabilitation
                                        facility
                                   65 = End stage renal disease treatment facility
                                   71 = State or local public health clinic
                                   72 = Rural health clinic
                                   81 = Independent laboratory
1       LINE_PLC_SRVC_TB                             Line Place Of Service Table
        ----------------                             ---------------------------

                                   99 = Other unlisted facility

1       LINE_PMT_IND_TB                              Line Payment Indicator Table
        ---------------                              ----------------------------

                                   1 = Actual charge
                                   2 = Customary charge
                                   3 = Prevailing charge (adjusted, unadjusted
                                       gap fill, etc)
                                   4 = Other (ASC fees, radiology and
                                       outpatient limits, and non-payment
                                       because of denial.
                                   5 = Lab fee schedule
                                   6 = Physician fee schedule - full fee
                                       schedule amount
                                   7 = Physician fee schedule - transition
                                   8 = Clinical psychologist fee schedule
                                   9 = DME and prosthetics/orthotics fee
                                       schedules (eff. 4/97)

1      LINE_PRCSG_IND_TB                           Line Processing Indicator Table
       -----------------                           -------------------------------


                                   A = Allowed
                                   B = Benefits exhausted
                                   C = Noncovered care
                                   D = Denied (existed prior to 1991; from
                                       BMAD)
                                   I = Invalid data
                                   L = CLIA (eff 9/92)
                                   M = Multiple submittal--duplicate line item
                                   N = Medically unnecessary
                                   O = Other
                                   P = Physician ownership denial (eff 3/92)
                                   Q = MSP cost avoided (contractor #88888) -
                                       voluntary agreement (eff. 1/98)
                                   R = Reprocessed--adjustments based on
                                       subsequent reprocessing of claim
                                   S = Secondary payer
                                   T = MSP cost avoided - IEQ contractor
                                       (eff. 7/76)
                                   U = MSP cost avoided - HMO rate cell
                                       adjustment (eff. 7/96)
                                   V = MSP cost avoided - litigation
                                       settlement (eff. 7/96)
                                   X = MSP cost avoided - generic
                                   Y = MSP cost avoided - IRS/SSA data
                                       match project
                                   Z = Bundled test, no payment
                                       (eff. 1/1/98)

1  LINE_PRVDR_PRTCPTG_IND_TB                 Line Provider Participating Indicator Table
   -------------------------                 -------------------------------------------


                                   1 = Participating
                                   2 = All or some covered and allowed
                                       expenses applied to deductible Participating
                                   3 = Assignment accepted/non-participating
                                   4 = Assignment not accepted/non-participating
                                   5 = Assignment accepted but all or some
                                       covered and allowed expenses applied
                                       to deductible Non-participating.
                                   6 = Assignment not accepted and all covered
                                       and allowed expenses applied to deductible
                                       non-participating.
                                   7 = Participating provider not accepting
                                       assignment.

1       NCH_CLM_TYPE_TB                                  NCH Claim Type Table
        ---------------                                  --------------------


                                   10 = HHA claim
                                   20 = Non swing bed SNF claim
                                   30 = Swing bed SNF claim
                                   40 = Outpatient claim
                                   41 = Outpatient 'Full-Encounter' claim
                                        (available in NMUD)
                                   42 = Outpatient 'Abbreviated-Encounter' claim
                                        (available in NMUD)
                                   50 = Hospice claim
                                   60 = Inpatient claim
                                   61 = Inpatient 'Full-Encounter' claim
                                   62 = Inpatient 'Abbreviated-Encounter claim
                                        (available in NMUD)
                                   71 = RIC O local carrier non-DMEPOS claim
                                   72 = RIC O local carrier DMEPOS claim
                                   73 = Physician 'Full-Encounter' claim
                                        (available in NMUD)
                                   81 = RIC M DMERC non-DMEPOS claim
                                   82 = RIC M DMERC DMEPOS claim

1         NCH_EDIT_TB                                       NCH EDIT TABLE
          -----------                                       --------------


                                   A0X1 = (C) PHYSICIAN-SUPPLIER ZIP CODE
                                   A000 = (C) REIMB > $100,000 OR UNITS > 150
                                   A002 = (C) CLAIM IDENTIFIER (CAN)
                                   A003 = (C) BENEFICIARY IDENTIFICATION (BIC)
                                   A004 = (C) PATIENT SURNAME BLANK
                                   A005 = (C) PATIENT 1ST INITIAL NOT-ALPHABETIC
                                   A006 = (C) DATE OF BIRTH IS NOT NUMERIC
                                   A007 = (C) INVALID GENDER (0, 1, 2)
                                   A008 = (C) INVALID QUERY-CODE (WAS CORRECTED)
                                   A025 = (C) FOR OV 4, TOB MUST = 13,83,85,73
                                   A1X1 = (C) PERCENT ALLOWED INDICATOR
                                   A1X2 = (C) DT>97273,DG1=7611,DG<>103,163,1589
                                   A1X3 = (C) DT>96365,DIAG=V725
                                   A1X4 = (C) INVALID DIAGNOSTIC CODES
                                   C050 = (U) HOSPICE - SPELL VALUE INVALID
                                   D102 = (C) DME DATE OF BIRTH INVALID
                                   D2X2 = (C) DME SCREEN SAVINGS INVALID
                                   D2X3 = (C) DME SCREEN RESULT INVALID
                                   D2X4 = (C) DME DECISION IND INVALID
                                   D2X5 = (C) DME WAIVER OF PROV LIAB INVALID
                                   D3X1 = (C) DME NATIONAL DRUG CODE INVALID
                                   D4X1 = (C) DME BENE RESIDNC STATE CODE INVALID
                                   D4X2 = (C) DME OUT OF DMERC SERVICE AREA
                                   D4X3 = (C) DME STATE CODE INVALID
                                   D5X1 = (C) TOS INVALID FOR DME HCPCS
                                   D5X2 = (C) DME HCPCS NOC & NOC DESCRIP MISSING
                                   D5X3 = (C) DME INVALID USE OF MS MODIFIER
                                   D5X4 = (C) TOS9 NDC REQD WHEN HCPCS OMITTED
                                   D5X5 = (C) TOS9 NDC REQD FOR Q0127-130 HCPCS
                                   D5X6 = (C) TOS9 NDC/DIAGNOSIS CODE INVALID
                                   D6X1 = (C) DME SUPPLIER NUMBER MISSING
                                   D7X1 = (C) DME PURCHASE ALLOWABLE INVALID
                                   D919 = (C) CAPPED/PEN PUMPS,NUM OF SRVCS > 1
                                   D921 = (C) SHOE HCPC W/O MOD RT,LT REQ U=2/4/6
                                   XXXX = (D) SYS DUPL: HOST/BATCH/QUERY-CODE
                                   Y001 = (C) HCPCS R0075/UNITS>1/SERVICES=1
                                   Y002 = (C) HCPCS R0075/UNITS=1/SERVICES>1
                                   Y003 = (C) HCPCS R0075/UNITS=SERVICES
                                   Y010 = (C) TOB=13X/14X AND T.C.>$7,500
                                   Y011 = (C) INP CLAIM/REIM > $75,000
                                   Z001 = (C) RVNU 820-859 REQ COND CODE 71-76
                                   Z002 = (C) CC M2 PRESENT/REIMB > $150,000
                                   Z003 = (C) CC M2 PRESENT/UNITS > 150
                                   Z004 = (C) CC M2 PRESENT/UNITS & REIM < MAX
                                   Z005 = (C) REIMB>99999 AND REIMB<150000
                                   Z006 = (C) UNITS>99 AND UNITS<150
                                   Z237 = (E) HOSPICE OVERLAP - DATE ZERO
                                   0011 = (C) ACTION CODE INVALID
                                   0013 = (C) CABG/PCOE AND INVALID ADMIT DATE
                                   0014 = (C) DEMO NUM NOT=01-06,08,15,31
                                   0015 = (C) ESRD PLAN BUT DEMO ID NOT = 15
                                   0016 = (C) INVALID VA CLAIM
                                   0017 = (C) DEMO=31,TOB<>11 OR SPEC<>08
                                   0018 = (C) DEMO=31,ACT CD<>1/5 OR ENT CD<>1/5
                                   0020 = (C) CANCEL ONLY CODE INVALID
                                   0021 = (C) DEMO COUNT > 1
                                   0301 = (C) INVALID HI CLAIM NUMBER
1         NCH_EDIT_TB                                       NCH EDIT TABLE
          -----------                                       --------------

                                   0302 = (C) BENE IDEN CDE (BIC) INVAL OR BLK
                                   04A1 = (C) PATIENT SURNAME BLANK (PHYS/SUP)
                                   04B1 = (C) PATIENT 1ST INITIAL NOT-ALPHABETIC
                                   0401 = (C) BILL TYPE/PROVIDER INVALID
                                   0402 = (C) BILL TYPE/REV CODE/PROVR RANGE
                                   0406 = (C) MAMMOGRAPHY WITH NO HCPCS 76092
                                   0407 = (C) RESPITE CARE BILL TYPE 34X,NO REV 66
                                   0408 = (C) REV CODE 403 /TYPE 71X/ PROV3800-974
                                   0410 = (C) IMMUNO DRUG OCCR-36,NO REV-25 OR 636
                                   0412 = (C) BILL TYPE XX5 HAS ACCOM. REV. CODES
                                   0413 = (C) CABG/PCOE BUT TOB = HHA,OUT,HOS
                                   0414 = (C) VALU CD 61,MSA AMOUNT MISSING
                                   0415 = (C) HOME HEALTH INCORRECT ALPHA RIC
                                   05X4 = (C) UPIN REQUIRED FOR TYPE-OF-SERVICE
                                   05X5 = (C) UPIN REQUIRED FOR DME HCPCS
                                   0501 = (C) UNIQUE PHY IDEN. (UPIN) BLANK
                                   0502 = (C) UNIQUE PHY IDEN. (UPIN) INVALID
                                   0601 = (C) GENDER INVALID
                                   0701 = (C) CONTRACTOR INVALID CARRIER/ETC
                                   0702 = (C) PROVIDER NUMBER INCONSISTANT
                                   0703 = (C) MAMMOGRAPHY FOR NOT FEMALE
                                   0704 = (C) INVALID CONT FOR CABG DEMO
                                   0705 = (C) INVALID CONT FOR PCOE DEMO
                                   0901 = (C) INVALID DISP CODE OF 02
                                   0902 = (C) INVALID DISP CODE OF SPACES
                                   0903 = (C) INVALID DISP CODE
                                   1001 = (C) PROF REVIEW/ACT CODE/BILL TYPE
                                   13X2 = (C) MULTIPLE ITEMS FOR SAME SERVICE
                                   1301 = (C) LINE COUNT NOT NUMERIC OR > 13
                                   1302 = (C) RECORD LENGTH INVALID
                                   1401 = (C) INVALID MEDICARE STATUS CODE
                                   1501 = (C) ADMIT DATE/ENTRY CODE INVALID
                                   1502 = (C) ADMIT DATE > STAY FROM DATE
                                   1503 = (C) ADMIT DATE INVALID WITH THRU DATE
                                   1504 = (C) ADM/FROM/THRU DATE > TODAYS DATE
                                   1505 = (C) HCPCS W SERVICE DATES > 09-30-94
                                   1601 = (C) INVESTIGATION IND INVALID
                                   1701 = (C) SPLIT IND INVALID
                                   1801 = (C) PAY-DENY CODE INVALID
                                   1802 = (C) HEADER AMT AND NOT DENIED CLAIM
                                   1803 = (C) MSP COST AVD/ALL MSP LI NOT SAME
                                   1901 = (C) AB CROSSOVER IND INVALID
                                   2001 = (C) HOSPICE OVERRIDE INVALID
                                   2101 = (C) HMO-OVERRIDE/PATIENT-STAT INVALID
                                   2102 = (C) FROM/THRU DATE OR KRON/PAT STAT
                                   2201 = (C) FROM/THRU DATE OR HCPCS YR INVAL
                                   2202 = (C) STAY-FROM DATE > THRU-DATE
                                   2203 = (C) THRU DATE INVALID
                                   2204 = (C) FROM DATE BEFORE EFFECTIVE DATE
                                   2205 = (C) DATE YEARS DIFFERENT ON OUTPAT
                                   2207 = (C) MAMMOGRAPHY BEFORE 1991
                                   2301 = (C) DOCUMENT CNTL OR UTIL DYS INVALID
                                   2302 = (C) COVERED DAYS INVALID OR INCONSIST
                                   2303 = (C) COST REPORT DAYS > ACCOMIDATION
                                   2304 = (C) UTIL DAYS = ZERO ON PATIENT BILL
                                   2305 = (C) UTIL DAYS = INCONSISTENCIES
                                   2306 = (C) UTIL DYS/NOPAY/REIMB INCONSISTENT
                                   2307 = (C) COND=40,UTL DYS >0/VAL CDE A1,08,09
1         NCH_EDIT_TB                                       NCH EDIT TABLE
          -----------                                       --------------

                                   2308 = (C) NOPAY = R WHEN UTIL DAYS = ZERO
                                   2401 = (C) NON-UTIL DAYS INVALID
                                   2501 = (C) CLAIM RCV DT OR COINSURANCE INVAL
                                   2502 = (C) COIN+LR>UTIL DAYS/RCPT DTE>CUR DTE
                                   2503 = (C) COIN/TR TYP/UTIL DYS/RCPT DTE>PD/DEN
                                   2504 = (C) COINSURANCE AMOUNT EXCESSIVE
                                   2505 = (C) COINSURANCE RATE > ALLOWED AMOUNT
                                   2506 = (C) COINSURANCE DAYS/AMOUNT INCONSIST
                                   2507 = (C) COIN+LR DAYS > TOTAL DAYS FOR YR
                                   2508 = (C) COINSURANCE DAYS INVALID FOR TRAN
                                   2601 = (C) CLAIM PAID DT INVALID OR LIFE RES
                                   2602 = (C) LR-DYS, NO VAL 08,10/PD/DEN>CUR+27
                                   2603 = (C) LIFE RESERVE > RATE FOR CAL YEAR
                                   2604 = (C) PPS BILL, NO DAY OUTLIER
                                   2605 = (C) LIFE RESERVE RATE > DAILY RATE AVR.
                                   28XA = (C) UTIL DAYS > FROM TO BENEF EXH
                                   28XB = (C) BENEFITS EXH DATE > FROM DATE
                                   28XC = (C) BENEFITS EXH DATE/INVALID TRANS TYPE
                                   28XD = (C) OCCUR 23 WITH SPAN 70 ON INPAT HOSP
                                   28XE = (C) MULTI BENE EXH DATE (OCCR A3,B3,C3)
                                   28XF = (C) ACE DATE ON SNF (NOPAY =B, C, N, W)
                                   28XG = (C) SPAN CD 70+4+6+9 NOT = NONUTIL DAYS
                                   28XM = (C) OCC CD 42 DATE NOT = SRVCE THRU DTE
                                   28XN = (C) INVALID OCC CODE
                                   28X0 = (C) BENE EXH DATE OUTSIDE SERVICE DATES
                                   28X1 = (C) OCCUR DATE INVALID
                                   28X2 = (C) OCCUR = 20 AND TRANS = 4
                                   28X3 = (C) OCCUR 20 DATE < ADMIT DATE
                                   28X4 = (C) OCCUR 20 DATE > ADMIT + 12
                                   28X5 = (C) OCCUR 20 AND ADMIT NOT = FROM
                                   28X6 = (C) OCCUR 20 DATE < BENE EXH DATE
                                   28X7 = (C) OCCUR 20 DATE+UTIL-COIN>COVERAGE
                                   28X8 = (C) OCCUR 22 DATE < FROM OR > THRU
                                   28X9 = (C) UTIL > FROM - THRU LESS NCOV
                                   33X1 = (C) QUAL STAY DATES INVALID (SPAN=70)
                                   33X2 = (C) QS FROM DATE NOT < THRU (SPAN=70)
                                   33X3 = (C) QS DAYS/ADMISSION ARE INVALID
                                   33X4 = (C) QS THRU DATE > ADMIT DATE (SPAN=70)
                                   33X5 = (C) SPAN 70 INVALID FOR DATE OF SERVICE
                                   33X6 = (C) TOB=18/21/28/51,COND=WO,HMO<>90091
                                   33X7 = (C) TOB<>18/21/28/51,COND=WO
                                   33X8 = (C) TOB=18/21/28/51,CO=WO,ADM DT<97001
                                   33X9 = (C) TOB=32X SPAN 70 OR OCCR BO PRESENT
                                   34X2 = (C) DEMO ID = 04 AND COND WO NOT SHOWN
                                   3401 = (C) DEMO ID = 04 AND RIC NOT = 1
                                   35X1 = (C) 60, 61, 66 & NON-PPS / 65 & PPS
                                   35X2 = (C) COND = 60 OR 61 AND NO VALU 17
                                   35X3 = (C) PRO APPROVAL COND C3,C7 REQ SPAN M0
                                   36X1 = (C) SURG DATE < STAY FROM/ > STAY THRU
                                   3701 = (C) ASSIGN CODE INVALID
                                   3705 = (C) 1ST CHAR OF IDE# IS NOT ALPHA
                                   3706 = (C) INVALID IDE NUMBER-NOT IN FILE
                                   3710 = (C) NUM OF IDE# > REV 0624
                                   3715 = (C) NUM OF IDE# < REV 0624
                                   3720 = (C) IDE AND LINE ITEM NUMBER > 2
                                   3801 = (C) AMT BENE PD INVALID
                                   4001 = (C) BLOOD PINTS FURNISHED INVALID
                                   4002 = (C) BLOOD FURNISHED/REPLACED INVALID
1         NCH_EDIT_TB                                       NCH EDIT TABLE
          -----------                                       --------------

                                   4003 = (C) BLOOD FURNISHED/VERIFIED/DEDUCT
                                   4201 = (C) BLOOD PINTS UNREPLACED INVALID
                                   4202 = (C) BLOOD PINTS UNREPLACED/BLOOD DED
                                   4203 = (C) INVALID CPO PROVIDER NUMBER
                                   4301 = (C) BLOOD DEDUCTABLE INVALID
                                   4302 = (C) BLOOD DEDUCT/FURNISHED PINTS
                                   4303 = (C) BLOOD DEDUCT > UNREPLACED BLOOD
                                   4304 = (C) BLOOD DEDUCT > 3 - REPLACED
                                   4501 = (C) PRIMARY DIAGNOSIS INVALID
                                   46XA = (C) MSP VET AND VET AT MEDICARE
                                   46XB = (C) MULTIPLE COIN VALU CODES (A2,B2,C2)
                                   46XC = (C) COIN VALUE (A2,B2,C2) ON INP/SNF
                                   46XG = (C) VALU CODE 20 INVALID
                                   46XN = (C) VALUE CODE 37,38,39 INVALID
                                   46XO = (C) VALUE CDE 38>0/VAL CDE 06 MISSNG
                                   46XP = (C) BLD UNREP VS REV CDS AND/OR UNITS
                                   46XQ = (C) VALUE CDE 37=39 AND 38 IS PRESENT
                                   46XR = (C) BLD FIELDS VS REV CDE 380,381,382
                                   46XS = (C) VALU CODE 39, AND 37 IS NOT PRESENT
                                   46XT = (C) CABG/PCOE,VC<>Y1,Y2,Y3,Y4,VA NOT>0
                                   46X1 = (C) VALUE AMOUNT INVALID
                                   46X2 = (C) VALU 06 AND BLD-DED-PTS IS ZERO
                                   46X3 = (C) VALU 06 AND TTL-CHGS=NC-CHGS(001)
                                   46X4 = (C) VALU (A1,B1,C1): AMT > DEDUCT
                                   46X5 = (C) DEDUCT VALUE (A1,B1,C1) ON SNF BILL
                                   46X6 = (C) VALU 17 AND NO COND CODE 60 OR 61
                                   46X7 = (C) OUTLIER(VAL 17) > REIMB + VAL6-16
                                   46X8 = (C) MULTI CASH DED VALU CODES (A1,B1,C1)
                                   46X9 = (C) DEMO ID=03,REQUIRED HCPCS NOT SHOWN
                                   4600 = (C) CAPITAL TOTAL NOT = CAP VALUES
                                   4601 = (C) CABG/PCOE, MSP CODE PRESENT
                                   4603 = (C) DEMO ID = 03 AND RIC NOT=6,7
                                   4901 = (C) PCOE/CABG,DEN CD NOT D
                                   4902 = (C) PCOE/CABG BUT DME
                                   50X1 = (C) RVCD=54,TOB<>13,23,32,33,34,83,85
                                   50X2 = (C) REV CD=054X,MOD NOT = QM,QN
                                   5051 = (E) EDB: NOMATCH ON 3 CHARACTERISTICS
                                   5052 = (E) EDB: NOMATCH ON MASTER-ID RECORD
                                   5053 = (E) EDB: NOMATCH ON CLAIM-NUMBER
                                   51XA = (C) HCPCS EYEWARE & REV CODE NOT 274
                                   51XC = (C) HCPCS REQUIRES DIAG CODE OF CANCER
                                   51XD = (C) HCPCS REQUIRES UNITS > ZERO
                                   51XE = (C) HCPCS REQUIRES REVENUE CODE 636
                                   51XF = (C) INV BILL TYP/ANTI-CAN DRUG HCPCS
                                   51XG = (C) HCPCS REQUIRES DIAG OF HEMOPHILL1A
                                   51XH = (C) TOB 21X/P82=2/3/4;REV CD<9001,>9044
                                   51XI = (C) TOB 21X/P82<>2/3/4:REV CD>8999<9045
                                   51XJ = (C) TOB 21X/REV CD: SVC-FROM DT INVALID
                                   51XK = (C) TOB 21X/P82=2/3/4,REV CD = NNX
                                   51XL = (C) REV 0762/UNT>48,TOB NOT=12,13,85,83
                                   51XM = (C) 21X,RC>9041/<9045,RC<>4/234
                                   51XN = (C) 21X,RC>9032/<9042,RC<>4/234
                                   51XP = (C) HHA RC DATE OF SRVC MISSING
                                   51XQ = (C) NO RC 0636 OR DTE INVALID
                                   51XR = (C) DEMO ID=01,RIC NOT=2
                                   51XS = (C) DEMO ID=01,RUGS<>2,3,4 OR BILL<>21
                                   51X0 = (C) REV CENTER CODE INVALID
                                   51X1 = (C) REV CODE CHECK
1         NCH_EDIT_TB                                       NCH EDIT TABLE
          -----------                                       --------------

                                   51X2 = (C) REV CODE INCOMPATIBLE BILL TYPE
                                   51X3 = (C) UNITS MUST BE > 0
                                   51X4 = (C) INP:CHGS/YR-RATE,ETC; OUTP:PSYCH>YR
                                   51X5 = (C) REVENUE NON-COVERED > TOTAL CHRGE
                                   51X6 = (C) REV TOTAL CHARGES EQUAL ZERO
                                   51X7 = (C) REV CDE 403 WTH NO BILL 14 23 71 85
                                   51X8 = (C) MAMMOGRAPHY SUBMISSION INVALID
                                   51X9 = (C) HCPCS/REV CODE/BILL TYPE
                                   5100 = (U) TRANSITION SPELL / SNF
                                   5160 = (U) LATE CHG HSP BILL STAY DAYS > 0
                                   5166 = (U) PROVIDER NE TO 1ST WORK PRVDR
                                   5167 = (U) PROVIDER 1 NE 2: FROM DT < START DT
                                   5169 = (U) PROVIDER NE TO WORK PROVIDER
                                   5177 = (U) PROVIDER NE TO WORK PROVIDER
                                   5178 = (U) HOSPICE BILL THRU < DOLBA
                                   5181 = (U) HOSP BILL OCCR 27 DISCREPANCY
                                   5200 = (E) ENTITLEMENT EFFECTIVE DATE
                                   5201 = (U) HOSP DATE DIFFERENCE NE 60 OR 90
                                   5202 = (E) ENTITLEMENT HOSPICE EFFECTIVE DATE
                                   5202 = (U) HOSPICE TRAILER ERROR
                                   5203 = (E) ENTITLEMENT HOSPICE PERIODS
                                   5203 = (U) HOSPICE START DATE ERROR
                                   5204 = (U) HOSPICE DATE DIFFERENCE NE 90
                                   5205 = (U) HOSPICE DATE DISCREPANCY
                                   5206 = (U) HOSPICE DATE DISCREPANCY
                                   5207 = (U) HOSPICE THRU > TERM DATE 2ND
                                   5208 = (U) HOSPICE PERIOD NUMBER BLANK
                                   5209 = (U) HOSPICE DATE DISCREPANCY
                                   5210 = (E) ENTITLEMENT FRM/TRU/END DATES
                                   5211 = (E) ENTITLEMENT DATE DEATH/THRU
                                   5212 = (E) ENTITLEMENT DATE DEATH/THRU
                                   5213 = (E) ENTITLEMENT DATE DEATH MBR
                                   5220 = (E) ENTITLEMENT FROM/EFF DATES
                                   5225 = (E) ENT INP PPS SPAN 70 DATES
                                   5232 = (E) ENTL HMO NO HMO OVERRIDE CDE
                                   5233 = (E) ENTITLEMENT HMO PERIODS
                                   5234 = (E) ENTITLEMENT HMO NUMBER NEEDED
                                   5235 = (E) ENTITLEMENT HMO HOSP+NO CC07
                                   5236 = (E) ENTITLEMENT HMO HOSP + CC07
                                   5237 = (E) ENTITLEMENT HOSP OVERLAP
                                   5238 = (U) HOSPICE CLAIM OVERLAP > 90
                                   5239 = (U) HOSPICE CLAIM OVERLAP > 60
                                   524Z = (E) HOSP OVERLAP NO OVD NO DEMO
                                   5240 = (U) HOSPICE DAYS STAY+USED > 90
                                   5241 = (U) HOSPICE DAYS STAY+USED > 60
                                   5242 = (C) INVALID CARRIER FOR RRB
                                   5243 = (C) HMO=90091,INVALID SERVICE DTE
                                   5244 = (E) DEMO CABG/PCOE MISSING ENTL
                                   5245 = (C) INVALID CARRIER FOR NON RRB
                                   525Z = (E) HMO/HOSP 6/7 NO OVD NO DEMO
                                   5250 = (U) HOSPICE DOEBA/DOLBA
                                   5255 = (U) HOSPICE DAYS USED
                                   5256 = (U) HOSPICE DAYS USED > 999
                                   526Y = (E) HMO/HOSP DEMO 5/15 REIMB > 0
                                   526Z = (E) HMO/HOSP DEMO 5/15 REIMB = 0
                                   527Y = (E) HMO/HOSP DEMO OVD=1 REIMB > 0
                                   527Z = (E) HMO/HOSP DEMO OVD=1 REIMB = 0
                                   5299 = (U) HOSPICE PERIOD NUMBER ERROR
1         NCH_EDIT_TB                                       NCH EDIT TABLE
          -----------                                       --------------

                                   5320 = (U) BILL > DOEBA AND IND-1 = 2
                                   5350 = (U) HOSPICE DOEBA/DOLBA SECONDARY
                                   5355 = (U) HOSPICE DAYS USED SECONDARY
                                   5378 = (C) SERVICE DATE < AGE 50
                                   5399 = (U) HOSPICE PERIOD NUM MATCH
                                   5410 = (U) INPAT DEDUCTABLE
                                   5425 = (U) PART B DEDUCTABLE CHECK
                                   5430 = (U) PART B DEDUCTABLE CHECK
                                   5450 = (U) PART B COMPARE MED EXPENSE
                                   5460 = (U) PART B COMPARE MED EXPENSE
                                   5499 = (U) MED EXPENSE TRAILER MISSING
                                   5500 = (U) FULL DAYS/SNF-HOSP FULL DAYS
                                   5510 = (U) COIN DAYS/SNF COIN DAYS
                                   5515 = (U) FULL DAYS/COIN DAYS
                                   5516 = (U) SNF FULL DAYS/SNF COIN DAYS
                                   5520 = (U) LIFE RESERVE DAYS
                                   5530 = (U) UTIL DAYS/LIFE PSYCH DAYS
                                   5540 = (U) HH VISITS NE AFT PT B TRLR
                                   5550 = (E) SNF LESS THAN PT A EFF DATE
                                   5600 = (D) LOGICAL DUPE, COVERED
                                   5601 = (D) LOGICAL DUPE, QRY-CDE, RIC 123
                                   5602 = (D) LOGICAL DUPE, PANDE C, E OR I
                                   5603 = (D) LOGICAL DUPE, COVERED
                                   5605 = (D) POSS DUPE, OUTPAT REIMB
                                   5606 = (D) POSS DUPE, HOME HEALTH COVERED U
                                   5623 = (U) NON-PAY CODE IS P
                                   57X1 = (C) PROVIDER SPECIALITY CODE INVALID
                                   57X2 = (C) PHYS THERAPY/PROVIDER SPEC INVAL
                                   57X3 = (C) PLACE/TYPE/SPECIALTY/REIMB IND
                                   57X4 = (C) SPECIALTY CODE VS. HCPCS INVALID
                                   5700 = (U) LINKED TO THREE SPELLS
                                   5701 = (C) DEMO ID=02,RIC NOT = 5
                                   5702 = (C) DEMO ID=02,INVALID PROVIDER NUM
                                   58X1 = (C) PROVIDER TYPE INVALID
                                   58X9 = (C) TYPE OF SERVICE INVALID
                                   5802 = (C) REIMB > $150,000
                                   5803 = (C) UNITS/VISITS > 150
                                   5804 = (C) UNITS/VISITS > 99
                                   59XA = (C) PROST ORTH HCPCS/FROM DATE
                                   59XB = (C) HCPCS/FROM DATE/TYPE P OR I
                                   59XC = (C) HCPCS Q0036,37,42,43,46/FROM DATE
                                   59XD = (C) HCPCS Q0038-41/FROM DATE/TYPE
                                   59XE = (C) HCPCS/MAMMOGRAPHY-RISK/ DIAGNOSIS
                                   59XG = (C) CAPPED/FREQ-MAINT/PROST HCPCS
                                   59XH = (C) HCPCS E0620/TYPE/DATE
                                   59XI = (C) HCPCS E0627-9/ DATE < 1991
                                   59XL = (C) HCPCS 00104 - TOS/POS
                                   59X1 = (C) INVALID HCPCS/TOS COMBINATION
                                   59X2 = (C) ASC IND/TYPE OF SERVICE INVALID
                                   59X3 = (C) TOS INVALID TO MODIFIER
                                   59X4 = (C) KIDNEY DONOR/TYPE/PLACE/REIMB
                                   59X5 = (C) MAMMOGRAPHY FOR MALE
                                   59X6 = (C) DRUG AND NON DRUG BILL LINE ITEMS
                                   59X7 = (C) CAPPED-HCPCS/FROM DATE
                                   59X8 = (C) FREQUENTLY MAINTAINED HCPCS
                                   59X9 = (C) HCPCS E1220/FROM DATE/TYPE IS R
                                   5901 = (U) ERROR CODE OF Q
                                   60X1 = (C) ASSIGN IND INVALID
1         NCH_EDIT_TB                                       NCH EDIT TABLE
          -----------                                       --------------

                                   6000 = (U) ADJUSTMENT BILL SPELL DATA
                                   6020 = (U) CURRENT SPELL DOEBA < 1990
                                   6030 = (U) ADJUSTMENT BILL SPELL DATA
                                   6035 = (U) ADJUSTMENT BILL THRU DTE/DOLBA
                                   61X1 = (C) PAY PROCESS IND INVALID
                                   61X2 = (C) DENIED CLAIM/NO DENIED LINE
                                   61X3 = (C) PAY PROCESS IND/ALLOWED CHARGES
                                   61X4 = (C) RATE MISSING OR NON-NUMERIC
                                   6100 = (C) REV 0001 NOT PRESENT ON CLAIM
                                   6101 = (C) REV COMPUTED CHARGES NOT=TOTAL
                                   6102 = (C) REV COMPUTED NON-COVERED/NON-COV
                                   6103 = (C) REV TOTAL CHARGES < PRIMARY PAYER
                                   62XA = (C) PSYC OT PT/REIM/TYPE
                                   62X1 = (C) DME/DATE/100% OR INVAL REIMB IND
                                   62X6 = (C) RAD PATH/PLACE/TYPE/DATE/DED
                                   62X8 = (C) KIDNEY DONO/TYPE/100%
                                   62X9 = (C) PNEUM VACCINE/TYPE/100%
                                   6201 = (C) TOTAL DEDUCT > CHARGES/NON-COV
                                   6203 = (U) HOSPICE ADJUSTMENT PERIOD/DATE
                                   6204 = (U) HOSPICE ADJUSTMENT THRU>DOLBA
                                   6260 = (U) HOSPICE ADJUSTMENT STAY DAYS
                                   6261 = (U) HOSPICE ADJUSTMENT DAYS USED
                                   6265 = (U) HOSPICE ADJUSTMENT DAYS USED
                                   6269 = (U) HOSPICE ADJUSTMENT PERIOD# (MAIN)
                                   63X1 = (C) DEDUCT IND INVALID
                                   63X2 = (C) DED/HCFA COINS IN PCOE/CABG
                                   6365 = (U) HOSPICE ADJUSTMENT SECONDARY DAYS
                                   6369 = (U) HOSPICE ADJUSTMENT PERIOD# (SECOND)
                                   64X1 = (C) PROVIDER IND INVALID
                                   6430 = (U) PART B DEDUCTABLE CHECK
                                   65X1 = (C) PAYSCREEN IND INVALID
                                   66?? = (D) POSS DUPE, CR/DB, DOC-ID
                                   66XX = (D) POSS DUPE, CR/DB, DOC-ID
                                   66X1 = (C) UNITS AMOUNT INVALID
                                   66X2 = (C) UNITS IND > 0; AMT NOT VALID
                                   66X3 = (C) UNITS IND = 0; AMT > 0
                                   66X4 = (C) MT INDICATOR/AMOUNT
                                   6600 = (U) ADJUSTMENT BILL FULL DAYS
                                   6610 = (U) ADJUSTMENT BILL COIN DAYS
                                   6620 = (U) ADJUSTMENT BILL LIFE RESERVE
                                   6630 = (U) ADJUSTMENT BILL LIFE PSYCH DYS
                                   67X1 = (C) UNITS INDICATOR INVALID
                                   67X2 = (C) CHG ALLOWED > 0; UNITS IND = 0
                                   67X3 = (C) TOS/HCPCS=ANEST, MTU IND NOT = 2
                                   67X4 = (C) HCPCS = AMBULANCE, MTU IND NOT = 1
                                   67X6 = (C) INVALID PROC FOR MT IND 2, ANEST
                                   67X7 = (C) INVALID UNITS IND WITH TOS OF BLOOD
                                   67X8 = (C) INVALID PROC FOR MT IND 4, OXYGEN
                                   6700 = (U) ADJUSTMENT BILL FULL/SNF DAYS
                                   6710 = (U) ADJUSTMENT BILL COIN/SNF DAYS
                                   68X1 = (C) INVALID HCPCS CODE
                                   68X2 = (C) MAMMOGRAPY/DATE/PROC NOT 76092
                                   68X3 = (C) TYPE OF SERVICE = G /PROC CODE
                                   68X4 = (C) HCPCS NOT VALID FOR SERVICE DATE
                                   68X5 = (C) MODIFIER NOT VALID FOR HCPCS, ETC
                                   68X6 = (C) TYPE SERVICE INVALID FOR HCPCS, ETC
                                   68X7 = (C) ZX MOD REQ FOR THER SHOES/INS/MOD.
                                   68X8 = (C) LINE ITEM INCORRECT OR DATE INVAL.
1         NCH_EDIT_TB                                       NCH EDIT TABLE
          -----------                                       --------------

                                   69XA = (C) MODIFIER NOT VALID FOR HCPCS/GLOBAL
                                   69X3 = (C) PROC CODE MOD = LL / TYPE = R
                                   69X6 = (C) PROC CODE MOD/NOT CAPPED
                                   69X8 = (C) SPEC CODE NURSE PRACT, MOD INVAL
                                   6901 = (C) KRON IND AND UTIL DYS EQUALS ZERO
                                   6902 = (C) KRON IND AND NO-PAY CODE B OR N
                                   6903 = (C) KRON IND AND INPATIENT DEDUCT = 0
                                   6904 = (C) KRON IND AND TRANS CODE IS 4
                                   6910 = (C) REV CODES ON HOME HEALTH
                                   6911 = (C) REV CODE 274 ON OUTPAT AND HH ONLY
                                   6912 = (C) REV CODE INVAL FOR PROSTH AND ORTHO
                                   6913 = (C) REV CODE INVAL FOR OXYGEN
                                   6914 = (C) REV CODE INVAL FOR DME
                                   6915 = (C) PURCHASE OF RENT DME INVAL ON DATES
                                   6916 = (C) PURCHASE OF RENT DME INVAL ON DATES
                                   6917 = (C) PURCHASE OF LIFT CHAIR INVAL > 91000
                                   6918 = (C) HCPCS INVALID ON DATE RANGES
                                   6919 = (C) DME OXYGEN ON HH INVAL BEFORE 7/1/89
                                   6920 = (C) HCPCS INVAL ON REV 270/BILL 32-33
                                   6921 = (C) HCPCS ON REV CODE 272 BILL TYPE 83X
                                   6922 = (C) HCPCS ON BILL TYPE 83X -NOT REV 274
                                   6923 = (C) RENTAL OF DME CUSTOMIZE AND REV 291
                                   6924 = (C) INVAL MODIFIER FOR CAPPED RENTAL
                                   6925 = (C) HCPCS ALLOWED ON BILL TYPES 32X-34X
                                   6929 = (U) ADJUSTMENT BILL LIFE RESERVE
                                   6930 = (U) ADJUSTMENT BILL LIFE PSYCH DYS
                                   7000 = (U) INVALID DOEBA/DOLBA
                                   7002 = (U) LESS THAN 60/61 BETWEEN SPELLS
                                   7010 = (E) TOB 85X/ELECTN PRD: COND CD 07 REQD
                                   71X1 = (C) SUBMITTED CHARGES INVALID
                                   71X2 = (C) MAMMOGRPY/PROC CODE MOD TC,26/CHG
                                   72X1 = (C) ALLOWED CHGS INVALID
                                   72X2 = (C) ALLOWED/SUBMITTED CHARGES/TYPE
                                   72X3 = (C) DENIED LINE/ALLOWED CHARGES
                                   73X1 = (C) SS NUMBER INVALID
                                   73X2 = (C) CARRIER ASSIGNED PROV NUM MISSING
                                   74X1 = (C) LOCALITY CODE INVAL FOR CONTRACT
                                   76X1 = (C) PL OF SER INVAL ON MAMMOGRAPHY BILL
                                   77X1 = (C) PLACE OF SERVICE INVALID
                                   77X2 = (C) PHYS THERAPY/PLACE
                                   77X3 = (C) PHYS THERAPY/SPECIALTY/TYPE
                                   77X4 = (C) ASC/TYPE/PLACE/REIMB IND/DED IND
                                   77X6 = (C) TOS=F, PL OF SER NOT = 24
                                   7701 = (C) INCORRECT MODIFIER
                                   7777 = (D) POSS DUPE, PART B DOC-ID
                                   78XA = (C) MAMMOGRAPHY BEFORE 1991
                                   78X1 = (C) THRU DATE INVALID
                                   78X3 = (C) FROM DATE GREATER THAN THRU DATE
                                   78X4 = (C) FROM DATE > RCVD DATE/PAY-DENY
                                   78X5 = (C) FROM DATE > PAID DATE/TYPE/100%
                                   78X7 = (C) LAB EDIT/TYPE/100%/FROM DATE
                                   79X3 = (C) THRU DATE>RECD DATE/NOT DENIED
                                   79X4 = (C) THRU DATE>PAID DATE/NOT DENIED
                                   8000 = (U) MAIN & 2NDARY DOEBA < 01/01/90
                                   8028 = (E) NO ENTITLEMENT
                                   8029 = (U) HH BEFORE PERIOD NOT PRESENT
                                   8030 = (U) HH BILL VISITS > PT A REMAINING
                                   8031 = (U) HH PT A REMAINING > 0
1         NCH_EDIT_TB                                       NCH EDIT TABLE
          -----------                                       --------------

                                   8032 = (U) HH DOLBA+59 NOT GT FROM-DATE
                                   8050 = (U) HH QUALIFYING INDICATOR = 1
                                   8051 = (U) HH # VISITS NE AFT PT B APPLIED
                                   8052 = (U) HH # VISITS NE AFT TRAILER
                                   8053 = (U) HH BENEFIT PERIOD NOT PRESENT
                                   8054 = (U) HH DOEBA/DOLBA NOT > 0
                                   8060 = (U) HH QUALIFYING INDICATOR NE 1
                                   8061 = (U) HH DATE NE DOLBA IN AFT TRLR
                                   8062 = (U) HH NE PT-A VISITS REMAINING
                                   81X1 = (C) NUM OF SERVICES INVALID
                                   83X1 = (C) DIAGNOSIS INVALID
                                   8301 = (C) HCPCS/GENDER DIAGNOSIS
                                   8302 = (C) HCPCS G0101 V-CODE/SEX CODE
                                   8304 = (C) BILL TYPE INVALID FOR G0123/4
                                   84X1 = (C) PAP SMEAR/DIAGNOSIS/GENDER/PROC
                                   84X2 = (C) INVALID DME START DATE
                                   84X3 = (C) INVALID DME START DATE W/HCPCS
                                   84X4 = (C) HCPCS G0101 V-CODE/SEX CODE
                                   84X5 = (C) HCPCS CODE WITH INV DIAG CODE
                                   86X8 = (C) CLIA REQUIRES NON-WAIVER HCPCS
                                   88XX = (D) POSS DUPE, DOC-ID,UNITS,ENT,ALWD
                                   9000 = (U) DOEBA/DOLBA CALC
                                   9005 = (U) FULL/COINS HOSP DAYS CALC
                                   9010 = (U) FULL/COINS SNF DAYS CALC
                                   9015 = (U) LIFE RESERVE DAYS CALC
                                   9020 = (U) LIFE PSYCH DAYS CALC
                                   9030 = (U) INPAT DEDUCTABLE CALC
                                   9040 = (U) DATA INDICATOR 1 SET
                                   9050 = (U) DATA INDICATOR 2 SET
                                   91X1 = (C) PATIENT REIMB/PAY-DENY CODE
                                   92X1 = (C) PATIENT REIMB INVALID
                                   92X2 = (C) PROVIDER REIMB INVALID
                                   92X3 = (C) LINE DENIED/PATIENT-PROV REIMB
                                   92X4 = (C) MSP CODE/AMT/DATE/ALLOWED CHARGES
                                   92X5 = (C) CHARGES/REIMB AMT NOT CONSISTANT
                                   92X7 = (C) REIMB/PAY-DENY INCONSISTANT
                                   9201 = (C) UPIN REF NAME OR INITIAL MISSING
                                   9202 = (C) UPIN REF FIRST 3 CHAR INVALID
                                   9203 = (C) UPIN REF LAST 3 CHAR NOT NUMERIC
                                   93X1 = (C) CASH DEDUCTABLE INVALID
                                   93X2 = (C) DEDUCT INDICATOR/CASH DEDUCTIBLE
                                   93X3 = (C) DENIED LINE/CASH DEDUCTIBLE
                                   93X4 = (C) FROM DATE/CASH DEDUCTIBLE
                                   93X5 = (C) TYPE/CASH DEDUCTIBLE/ALLOWED CHGS
                                   9300 = (C) UPIN OTHER, NOT PRESENT
                                   9301 = (C) UPIN NME MIS/DED TOT LI>0 FR DEN CLM
                                   9302 = (C) UPIN OPERATING, FIRST 3 NOT NUMERIC
                                   9303 = (C) UPIN L 3 CH NT NUM/DED TOT LI>YR DED
                                   94A1 = (C) NON-COVERED FROM DATE INVALID
                                   94A2 = (C) NON-COVERED FROM > THRU DATE
                                   94A3 = (C) NON-COVERED THRU DATE INVALID
                                   94A4 = (C) NON-COVERED THRU DATE > ADMIT
                                   94A5 = (C) NON-COVERED THRU DATE/ADMIT DATE
                                   94C1 = (C) PR-PSYCH DAYS INVALID
                                   94C3 = (C) PR-PSYCH DAYS > PROVIDER LIMIT
                                   94F1 = (C) REIMBURSEMENT AMOUNT INVALID
                                   94F2 = (C) REIMBURSE AMT NOT 0 FOR HMO PAID
                                   94G1 = (C) NO-PAY CODE INVALID
1         NCH_EDIT_TB                                       NCH EDIT TABLE
          -----------                                       --------------

                                   94G2 = (C) NO-PAY CODE SPACE/NON-COVERD=TOTL
                                   94G3 = (C) NO-PAY/PROVIDER INCONSISTANT
                                   94G4 = (C) NO PAY CODE = R & REIMB PRESENT
                                   94X1 = (C) BLOOD LIMIT INVALID
                                   94X2 = (C) TYPE/BLOOD DEDUCTIBLE
                                   94X3 = (C) TYPE/DATE/LIMIT AMOUNT
                                   94X4 = (C) BLOOD DED/TYPE/NUMBER OF SERVICES
                                   94X5 = (C) BLOOD/MSP CODE/COMPUTED LINE MAX
                                   9401 = (C) BLOOD DEDUCTIBLE AMT > 3
                                   9402 = (C) BLOOD FURNISHED > DEDUCTIBLE
                                   9403 = (C) DATE OF BIRTH MISSING ON PRO-PAY
                                   9404 = (C) INVALID GENDER CODE ON PRO-PAY
                                   9407 = (C) INVALID DRG NUMBER
                                   9408 = (C) INVALID DRG NUMBER (GLOBAL)
                                   9409 = (C) HCFA DRG<>DRG ON BILL
                                   9410 = (C) CABG/PCOE,INVALID DRG
                                   95X1 = (C) MSP CODE G/DATE BEFORE 1/1/87
                                   95X2 = (C) MSP AMOUNT APPLIED INVALID
                                   95X3 = (C) MSP AMOUNT APPLIED > SUB CHARGES
                                   95X4 = (C) MSP PRIMARY PAY/AMOUNT/CODE/DATE
                                   95X5 = (C) MSP CODE = G/DATE BEFORE 1987
                                   95X6 = (C) MSP CODE = X AND NOT AVOIDED
                                   95X7 = (C) MSP CODE VALID, CABG/PCOE
                                   96X1 = (C) OTHER AMOUNTS INVALID
                                   96X2 = (C) OTHER AMOUNTS > PAT-PROV REIMB
                                   97X1 = (C) OTHER AMOUNTS INDICATOR INVALID
                                   97X2 = (C) GRUDMAN SW/GRUDMAN AMT NOT > 0
                                   98X1 = (C) COINSURANCE INVALID
                                   98X3 = (C) MSP CODE/TYPE/COIN AMT/ALLOW/CSH
                                   98X4 = (C) DATE/MSP/TYPE/CASH DED/ALLOW/COI
                                   98X5 = (C) DATE/ALLOW/CASH DED/REIMB/MSP/TYP
                                   99XX = (D) POSS DUPE, PART B DOC-ID
                                   9901 = (C) REV CODE INVALID OR TRAILER CNT=0
                                   9902 = (C) ACCOMMODATION DAYS/FROM/THRU DATE
                                   9903 = (C) NO CLINIC VISITS FOR RHC
                                   9904 = (C) INCOMPATIBLE DATES/CLAIM TYPE
                                   991X = (C) NO DATE OF SERVICE
                                   9910 = (C) EDIT 9910 (NEW)
                                   9911 = (C) BLOOD VERIFIED INVALID
                                   9920 = (C) EDIT 9920 (NEW)
                                   9930 = (C) EDIT 9930 (NEW)
                                   9931 = (C) OUTPAT COINSURANCE VALUES
                                   9933 = (C) RATE EXCEDES MAMMOGRAPHY LIMIT
                                   9940 = (C) EDIT 9940 (NEW)
                                   9942 = (C) EDIT 9942 (NEW)
                                   9944 = (C) STAY FROM>97273,DIAG<>V103,163,7612
                                   9945 = (C) SERVICE DATE < 98001
                                   9946 = (C) INVALID DIAGNOSIS CODE
                                   9947 = (C) INVALID DIAGNOSIS CODE
                                   9948 = (C) STAY FROM>96365,DIAG=V725
                                   9960 = (C) MED CHOICE BUT HMO DATA MISSING
                                   9965 = (C) HMO PRESENT BUT MED CHOICE MISSING
                                   9968 = (C) MED CHOICE NOT= HMO PLAN NUMBER

1   NCH_IP_PRO_APRVL_TYPE_TB          NCH Inpatient Peer Review Organization Approval Type Table
    ------------------------          ----------------------------------------------------------


                                   1 = Approved by the PRO as billed - Code
                                       indicates that the claim has been
                                       reviewed by the PRO and has been fully
                                       approved including any day or cost
                                       outliers.
                                   2 = Automatic approval - Does not apply to
                                       Medicare claim.
                                   3 = Partial approval - Code indicates the
                                       bill has been reviewed by the PRO, and
                                       some portion (days or services) has
                                       been denied.  The from/thru dates of
                                       the approved portion of the stay,
                                       excluding grace days and any period at
                                       a noncovered level of care are shown
                                       on the bill.
                                   4 = Admission denied - Code indicates the
                                       patient's need for inpatient services
                                       was reviewed upon admission and the
                                       PRO found that the stay was not
                                       medically necessary.
                                   5 = Post payment review - Code indicates
                                       that any medical review will be
                                       completed after the claim is paid.
                                       The bill may be a day outlier, part of
                                       the sample review, or may not be
                                       reviewed.
                                   6 = Pre-admission authorization - Pre-
                                       admission authorization obtained, but
                                       services not reviewed by the PRO.
                                   7 THRU 9 = Reserved.

1     NCH_NEAR_LINE_RIC_TB                  NCH Near-Line Record Identification Code Table
      --------------------                  ----------------------------------------------


                                   O = Part B physician/supplier claim
                                       record (processed by local carriers;
                                       can include DMEPOS services)
                                   V = Part A institutional claim record
                                       (inpatient (IP), skilled nursing
                                       facility (SNF), christian science
                                       (CS), home health agency (HHA), or
                                       hospice)
                                   W = Part B institutional claim record
                                       (outpatient (OP), HHA)
                                   U = Both Part A and B institutional home
                                       health agency (HHA) claim records --
                                       due to HHPPS and HHA A/B split.
                                       (effective 10/00)
                                   M = Part B DMEPOS claim record (processed
                                       by DME Regional Carrier) (effective 10/93)

1         NCH_PATCH_TB                                     NCH Patch Table
          ------------                                     ---------------

                                   01 = RRB Category Equatable BIC - changed (all
                                        claim types) -- applied during the Nearline
                                        'G' conversion to claims with NCH weekly
                                        process date before 3/91.   Prior to Version
                                        'H', patch indicator stored in redefined Claim
                                        Edit Group, 3rd occurrence, position 2.
                                   02 = Claim Transaction Code made consistent with
                                        NCH payment/edit RIC code (OP and HHA) --
                                        effective 3/94, CWFMQA began patch.  During
                                        'H' conversion, patch applied to claims with
                                        NCH weekly process date prior to 3/94.  Prior
                                        to version 'H', patch indicator stored in
                                        redefined Claim Edit Group, 4th occurrence,
                                        position 1.
                                   03 = Garbage/nonnumeric Claim Total Charge Amount
                                        set to zeroes (Instnl) --  during the Version
                                        'G' conversion, error occurred in the deriva-
                                        tion of this field where the claim was missing
                                        revenue center code = '0001'.   In 1994, patch
                                        was applied to the OP and HHA SAFs only. (This
                                        SAF patch indicator was stored in the redefined
                                        Claim Edit Group, 4th occurrence, position 2).
                                        During the 'H' ocnversion, patch applied to
                                        Nearline claims where garbage or nonnumeric
                                        values.
                                   04 = Incorrect bene residence SSA standard county
                                        code '999' changed (all claim types) --
                                        applied during the Nearline 'G' conversion and
                                        ongoing through 4/21/94, calling EQSTZIP
                                        routine to claims with NCH weekly process
                                        date prior to 4/22/94.  Prior to Version 'H'
                                        patch indicator stored in redefined Claim
                                        Edit Group, 3rd occurrence, position 4.
                                   05 = Wrong century bene birth date corrected (all
                                        claim types) -- applied during Nearline 'H'
                                        conversion to all history where century
                                        greater than 1700 and less than 1850; if
                                        century less than 1700, zeroes moved.
                                   06 = Inconsistent CWF bene medicare status code
                                        made consistent with age (all claim types) --
                                        applied during Nearline 'H' conversion to all
                                        history and patched ongoing.  Bene age is
                                        calculated to determine the correct value;
                                        if greater than 64, 1st position MSC ='1';
                                        if less than 65, 1st position MSC = '2'.
                                   07 = Missing CWF bene mediare status code derived
                                        (all claim types) -- applied during Nearline
                                        'H' conversion to all history and patched
                                        ongoing, except claims with unknown DOB and/
                                        or Claim From Date='0' (left blank).   Bene
                                        age is calculated to determine missing value;
                                        if greater than 64, MSC='10'; if less than
                                        65, MSC = '20'.
                                   08 = Invalid NCH primary payer code set to blanks
                                        (Instnl) -- applied during Version 'H' con-
                                        version to claims with NCH weekly process
                                        date 10/1/93-10/30/95, where MSP values =
1         NCH_PATCH_TB                                     NCH Patch Table
          ------------                                     ---------------

                                        invalid '0', '1', '2', '3' or '4' (caused
                                        by erroneous logic in HCFA program code,
                                        which was corrected on 11/1/95).
                                   09 = Zero CWF claim accretion date replaced with
                                        NCH weekly process date (all claim types)
                                        -- applied during Version 'H' conversion to
                                        Instnl and DMERC claims; applied during
                                        Version 'G' conversion to non-institutional
                                        (non-DMERC) claims.  Prior to Version 'H',
                                        patch indicator stored in redefined claim
                                        edit group, 3rd occurrence, position 1.
                                   10 = Multiple Revenue Center 0001 (Outpatient,
                                        HHA and Hospice) -- patch applied to 1998 &
                                        1999 Nearline and SAFs to delete any revenue
                                        codes that followed the first '0001' revenue
                                        center code.   The edit was applied across all
                                        institutional claim types, including Inpatient/
                                        SNF (the problem was only found with OP/HHA/
                                        Hospice claims).  The problem was corrected
                                        6/25/99.
                                   11 = Truncated claim total charge amount in the
                                        fixed portion replaced with the total charge
                                        amount in the revenue center 0001 amount field
                                        -- service years 1998 & 1999 patched during
                                        quarterly merge.  The 1998 & 1999 SAFs were
                                        corrected when finalized in 7/99.  The patch
                                        was done for records with NCH Daily Process
                                        Date 1/4/99 - 5/14/99.
                                   12 = Missing claim-level HHA Total Visit Count --
                                        service years 1998, 1999 & 2000 patch applied
                                        during Version 'I' conversion of both the
                                        Nearline and SAFs.   Problem occurs in those
                                        claims recovered during the missing claims
                                        effort.
                                   13 = Inconsistent Claim MCO Paid Switch made consistent
                                        with criteria used to identify an inpatient
                                        encounter claim -- if MCO paid switch equal to blank
                                        or '0' and ALL conditions are met to indicate an
                                        inpatient encounter claim (bene enrolled in a risk
                                        MCO during the service period), change the switch to
                                        a '1'.  The patch was applied during the Version 'I'
                                        conversion, for claims back to 7/1/97 service thru date.

1      NCH_STATE_SGMT_TB                               NCH State Segment Table
       -----------------                               -----------------------

                                   01 = Alabama
                                   02 = Alaska
                                   03 = Arizona
                                   04 = Arkansas
                                   05 = California
                                   06 = Colorado
                                   07 = Connecticut
                                   08 = Delaware
                                   09 = District of Columbia
                                   10 = Florida
                                   11 = Georgia
                                   12 = Hawaii
                                   13 = Idaho
                                   14 = Illinois
                                   15 = Indiana
                                   16 = Iowa
                                   17 = Kansas
                                   18 = Kentucky
                                   19 = Louisiana
                                   20 = Maine
                                   21 = Maryland
                                   22 = Massachusetts
                                   23 = Michigan
                                   24 = Minnesota
                                   25 = Mississippi
                                   26 = Missouri
                                   27 = Montana
                                   28 = Nebraska
                                   29 = Nevada
                                   30 = New Hampshire
                                   31 = New Jersey
                                   32 = New Mexico
                                   33 = New York
                                   34 = North Carolina
                                   35 = North Dakota
                                   36 = Ohio
                                   37 = Oklahoma
                                   38 = Oregon
                                   39 = Pennsylvania
                                   40 = Puerto Rico
                                   41 = Rhode Island
                                   42 = South Carolina
                                   43 = South Dakota
                                   44 = Tennesee
                                   45 = Texas
                                   46 = Utah
                                   47 = Vermont
                                   48 = Virgin Islands
                                   49 = Virginia
                                   50 = Washington
                                   51 = West Virginia
                                   52 = Wisconsin
                                   53 = Wyoming
                                   54 = Africa
                                   55 = Asia
                                   56 = Canada
                                   57 = Central America & West Indies
1      NCH_STATE_SGMT_TB                               NCH State Segment Table
       -----------------                               -----------------------

                                   58 = Europe
                                   59 = Mexico
                                   60 = Oceania
                                   61 = Philippines
                                   62 = South America
                                   63 = US Possessions
                                   97 = Saipan - MP
                                   98 = Guam
                                   99 = American Samoa

1         PRVDR_NUM_TB                                  Provider Number Table
          ------------                                  ---------------------


                                   -   First two positions are the GEO SSA State Code.
                                        Exception: 55 = California
                                                   67 = Texas
                                                   68 = Florida

                                   -   Positions 3 and sometimes 4 are used as a
                                       category identifier.  The remaining positions
                                       are serial numbers.  The following blocks of numbers
                                       are reserved for the facilities indicated (NOTE:
                                       may have different meanings dependent on the Type
                                       of Bill (TOB):

                                       0001-0879   Short-term (general and specialty)
                                                   hospitals where TOB = 11X; ESRD
                                                   clinic where TOB = 72X
                                       0880-0899   Reserved for hospitals participating
                                                   in ORD demonstration projects where
                                                   TOB = 11X; ESRD clinic where TOB =
                                                   72X
                                       0900-0999   Multiple hospital component in a
                                                   medical complex (numbers retired)
                                                   where TOB = 11X; ESRD clinic where
                                                   TOB = 72X
                                       1000-1199   Reserved for future use
                                       1200-1224   Alcohol/drug hospitals (excluded
                                                   from PPS-numbers retired)
                                                   where TOB = 11X; ESRD clinic where
                                                   TOB = 72X
                                       1225-1299   Medical assistance facilities
                                                   (Montana project); ESRD clinic where
                                                   TOB = 72X
                                       1300-1399   Rural Primary Care Hospital (RCPH) -
                                                   eff. 10/97 changed to Critical Access
                                                   Hospitals (CAH)
                                       1400-1499   Continuation of 4900-4999 series (CMHC)
                                       1500-1799   Hospices
                                       1800-1989   Federally Qualified Health Centers
                                                   (FQHC) where TOB = 73X; SNF (IP PTB)
                                                   where TOB = 22X; HHA where TOB = 32X,
                                                   33X, 34X
                                       1990-1999   Christian Science Sanatoria
                                                   (hospital services)
                                       2000-2299   Long-term hospitals (excluded from PPS)
                                       2300-2499   Chronic renal disease facilities
                                                   (hospital based)
                                       2500-2899   Non-hospital renal disease
                                                   treatment centers
                                       2900-2999   Independent special purpose renal
                                                   dialysis facility (1)
                                       3000-3024   Formerly tuberculosis hospitals
                                                   (numbers retired)
                                       3025-3099   Rehabilitation hospitals (excluded
                                                   from PPS)
                                       3100-3199   Continuation of Subunits of Nonprofit
                                                   and Proprietary Home Health Agencies
                                                   (7300-7399) Series (3) (eff. 4/96)
                                       3200-3299   Continuation of 4800-4899 series (CORF)
1         PRVDR_NUM_TB                                  Provider Number Table
          ------------                                  ---------------------

                                       3300-3399   Children's hospitals (excluded from PPS)
                                                   where TOB = 11X; ESRD clinic where TOB =
                                                   72X
                                       3400-3499   Continuation of rural health clinics
                                                   (provider-based) (3975-3999)
                                       3500-3699   Renal disease treatment centers
                                                   (hospital satellites)
                                       3700-3799   Hospital based special purpose renal
                                                   dialysis facility (1)
                                       3800-3974   Rural health clinics (free-standing)
                                       3975-3999   Rural health clinics (provider-based)
                                       4000-4499   Psychiatric hospitals (excluded
                                                   from PPS)
                                       4500-4599   Comprehensive Outpatient
                                                   Rehabilitation Facilities (CORF)
                                       4600-4799   Community Mental Health Centers (CMHC);
                                                   9/30/91 - 3/31/97 used for clinic OPT
                                                   where TOB = 74X
                                       4800-4899   Continuation of 4500-4599 series (CORF)
                                                    (eff. 10/95)
                                       4900-4999   Continuation of 4600-4799 series (CMHC)
                                                   (eff. 10/95); 9/30/91 - 3/31/97 used for
                                                   clinic OPT where TOB = 74X
                                       5000-6499   Skilled Nursing Facilities
                                       6500-6989   CMHC / Outpatient physical therapy services
                                                   where TOB = 74X; CORF where TOB =
                                                   75X
                                       6990-6999   Christian Science Sanatoria (skilled
                                                   nursing services)
                                       7000-7299   Home Health Agencies (HHA) (2)
                                       7300-7399   Subunits of 'nonprofit' and
                                                   'proprietary' Home Health Agencies (3)
                                       7400-7799   Continuation of 7000-7299 series
                                       7800-7999   Subunits of state and local governmental
                                                   Home Health Agencies (3)
                                       8000-8499   Continuation of 7400-7799 series (HHA)
                                       8500-8899   Continuation of rural health
                                                   center (provider based) (3400-3499)
                                       8900-8999   Continuation of rural health
                                                   center (free-standing) (3800-3974)
                                       9000-9499   Continuation of 8000-8499 series (HHA)
                                                   (eff. 10/95)
                                       9500-9999   Reserved for future use (eff. 8/1/98)
                                                   NOTE: 10/95-7/98 this series was
                                                   assigned to HHA's but rescinded - no
                                                   HHA's were ever assigned a number
                                                   from this series.

                                       Exception:

                                       P001-P999   Organ procurement organization

                                   (1) These facilities (SPRDFS) will be assigned
                                       the same provider number whenever they
                                       are recertified.

                                   (2) The 6400-6499 series of provider numbers
                                       in Iowa (16), South Dakota (43) and Texas (45)
1         PRVDR_NUM_TB                                  Provider Number Table
          ------------                                  ---------------------

                                       have been used in reducing acute care costs (RACC)
                                       experiments.

                                   (3) In Virginia (49), the series 7100-7299 has
                                       been reserved for statewide subunit components
                                       of the Virginia state home health agencies.

                                   (4) Parent agency must have a number in the
                                       7000-7299, 7400-7799 or 8000-8499 series.

                                   NOTE:
                                     There is a special numbering system for units
                                     of hospitals that are excluded from prospective
                                     payment system (PPS) and hospitals with SNF
                                     swing-bed designation.  An alpha character in
                                     the third position of the provider number
                                     identifies the type of unit or swing-bed
                                     designation as follows:

                                       S = Psychiatric unit (excluded from PPS)
                                       T = Rehabilitation unit (excluded from PPS)
                                       U = Short term/acute care swing-bed hospital
                                       V = Alcohol drug unit (prior to 10/87 only)
                                       W = Long term SNF swing-bed hospital
                                           (eff 3/91)
                                       Y = Rehab hospital swing-bed (eff 9/92)
                                       Z = Rural primary care swing-bed hospital

                                     There is also a special numbering system for
                                     assigning emergency hospital identification
                                     numbers (non participating hospitals).  The
                                     sixth position of the provider number is as
                                     follows:

                                       E = Non-federal emergency hospital
                                       F = Federal emergency hospital

1     PTNT_DSCHRG_STUS_TB                           Patient Discharge Status Table
      -------------------                           ------------------------------


                                   01 = Discharged to home/self care (routine
                                        charge).
                                   02 = Discharged/transferred to other short term
                                        general hospital for inpatient care.
                                   03 = Discharged/transferred to skilled
                                        nursing facility (SNF) - (For hospitals
                                        with an approved swing bed arrangement,
                                        use Code 61 - swing bed.  For reporting
                                        discharges/transfers to a non-certified
                                        SNF, the hospital must use Code 04 - ICF.
                                   04 = Discharged/transferred to intermediate
                                        care facility (ICF).
                                   05 = Discharged/transferred to another type
                                        of institution for inpatient care (including
                                        distinct parts).
                                   06 = Discharged/transferred to home care of
                                        organized home health service organization.
                                   07 = Left against medical advice or discontinued
                                        care.
                                   08 = Discharged/transferred to home under
                                        care of a home IV drug therapy provider.
                                   09 = Admitted as an inpatient to this
                                        hospital (effective 3/1/91).  In situa-
                                        tions  where a patient is admitted before
                                        midnight of the third day following the
                                        day of an outpatient service, the out-
                                        patient services are considered inpatient.
                                   20 = Expired (did not recover - Christian
                                        Science patient).
                                   30 = Still patient.
                                   40 = Expired at home (hospice claims only)
                                   41 = Expired in a medical facility such as
                                        hospital, SNF, ICF, or freestanding
                                        hospice. (Hospice claims only)
                                   42 = Expired - place unknown (Hospice claims
                                        only)
                                   50 = Hospice - home (eff. 10/96)
                                   51 = Hospice - medical facility (eff. 10/96)
                                   61 = Discharged/transferred within this insti-
                                        tution to a hospital-based Medicare
                                        approved swing bed (to be implemented in
                                        1999)
                                   71 = Discharged/transferred/referred to another
                                        institution for outpatient services as
                                        specified by the discharge plan of care (to
                                        be implemented in 1999).
                                   72 = Discharged/transferred/referred to this
                                        institution for outpatient services as
                                        specified by the discharge plan of care
                                        (to be implemented in 1999).

1       REV_CNTR_ANSI_TB                            Revenue Center ANSI Code Table
        ----------------                            ------------------------------


                                   *******EXPLANATION OF CLAIM ADJUSTMENT GROUP CODES*******
                                   **************POSITIONS 1 & 2 OF ANSI CODE***************
                                   CO = Contractual Obligations -- this group code should
                                        be used when a contractual agreement between the
                                        payer and payee, or a regulatory requirement, re-
                                        sulted in an adjustment.  Generally, these adjust-
                                        ments are considered a write-off for the provider
                                        and are not billed to the patient.

                                   CR = Corrections and Reversals -- this group code should
                                        be used for correcting a prior claim.  It applies
                                        when there is a change to a previously adjudicated
                                        claim.

                                   OA = Other Adjustments -- this group code should be used
                                        when no other group code applies to the adjustment.

                                   PI = Payer Initiated Reductions -- this group code should
                                        be used when, in the opinion of the payer, the adjust-
                                        ment is not the responsibility of the patient, but
                                        there is no supporting contract between the provider
                                        and the payer (i.e., medical review or professional
                                        review organization adjustments).

                                   PR = Patient Responsibility -- this group should be used
                                        when the adjustment represents an amount that should
                                        be billed to the patient or insured.  This group
                                        would typically be used for deductible and copay
                                        adjustments.

                                   ***********Claim Adjustment Reason Codes***************
                                   ***********POSITIONS 3 through 5 of ANSI CODE**********

                                   1 = Deductible Amount
                                   2 = Coinsurance Amount
                                   3 = Co-pay Amount
                                   4 = The procedure code is inconsistent with the modifier
                                       used or a required modifier is missing.
                                   5 = The procedure code/bill type is inconsistent with the
                                       place of service.
                                   6 = The procedure code is inconsistent with the patient's
                                       age.
                                   7 = The procedure code is inconsistent with the patient's
                                       gender.
                                   8 = The procedure code is inconsistent with the provider
                                       type.
                                   9 = The diagnosis is inconsistent with the patient's age.
                                   10 = The diagnosis is inconsistent with the patient's
                                        gender.
                                   11 = The diagnosis is inconsistent with the procedure.
                                   12 = The diagnosis is inconsistent with the provider type.
                                   13 = the date of death precedes the date of service.
                                   14 = The date of birth follows the date of service.
                                   15 = Claim/service adjusted because the submitted auth-
                                        orization number is missing, invalid, or does not
                                        apply to the billed services or provider.
                                   16 = Claim/service lacks information which is needed for
1       REV_CNTR_ANSI_TB                            Revenue Center ANSI Code Table
        ----------------                            ------------------------------

                                        adjudication.
                                   17 = Claim/service adjusted because requested information
                                        was not provided or was insufficient/incomplete.
                                   18 = Duplicate claim/service.
                                   19 = Claim denied because this is a work-related injury/
                                        illness and thus the liability of the Worker's Com-
                                        pensation Carrier.
                                   20 = Claim denied because this injury/illness is covered
                                        by the liability carrier.
                                   21 = Claim denied because this injury/illness is the
                                        liability of the no-fault carrier.
                                   22 = Claim adjusted because this care may be covered by
                                        another payer per coordination of benefits.
                                   23 = Claim adjusted because charges have been paid by
                                        another payer.
                                   24 = Payment for charges adjusted.  Charges are covered
                                        under a capitation agreement/managed care plan.
                                   25 = Payment denied.  Your Stop loss deductible has not
                                        been met.
                                   26 = Expenses incurred prior to coverage.
                                   27 = Expenses incurred after coverage terminated.
                                   28 = Coverage not in effect at the time the service was
                                        provided.
                                   29 = The time limit for filing has expired.
                                   30 = Claim/service adjusted because the patient has not met
                                        the required eligibility, spend down, waiting, or
                                        residency requirements.
                                   31 = Claim denied as patient cannot be identified as our
                                        insured.
                                   32 = Our records indicate that this dependent is not an
                                        eligible dependent as defined.
                                   33 = Claim denied.  Insured has no dependent coverage.
                                   34 = Claim denied.  Insured has no coverage for newborns.
                                   35 = Benefit maximum has been reached.
                                   36 = Balance does not exceed copayment amount.
                                   37 = Balance does not exceed deductible amount.
                                   38 = Services not provided or authorized by designated
                                        (network) providers.
                                   39 = Services denied at the time authorization/pre-certi-
                                        fication was requested.
                                   40 = Charges do not meet qualifications for emergency/urgent
                                        care.
                                   41 = Discount agreed to in Preferred Provider contract.
                                   42 = Charges exceed our fee schedule or maximum allowable
                                        amount.
                                   43 = Gramm-Rudman reduction.
                                   44 = Prompt-pay discount.
                                   45 = Charges exceed your contracted/legislated fee arrange-
                                        ment.
                                   46 = This (these) service(s) is(are) not covered.
                                   47 = This (these) diagnosis(es) is(are) not covered,
                                        missing, or are invalid.
                                   48 = This (these) procedure(s) is(are) not covered.
                                   49 = These are non-covered services because this is a
                                        routine exam or screening procedure done in conjunc-
                                        tion with a routine exam.
                                   50 = These are non-covered services because this is not
                                        deemed a 'medical necessity' by the payer.
1       REV_CNTR_ANSI_TB                            Revenue Center ANSI Code Table
        ----------------                            ------------------------------

                                   51 = These are non-covered services because this a pre-
                                        existing condition.
                                   52 = The referring/prescribing/rendering provider is not
                                        eligible to refer/prescribe/order/perform the service
                                        billed.
                                   53 = Services by an immediate relative or a member of the
                                        same household are not covered.
                                   54 = Multiple physicians/assistants are not covered in this
                                        case.
                                   55 = Claim/service denied because procedure/treatment is
                                        deemed experimental/investigational by the payer.
                                   56 = Claim/service denied because procedure/treatment has
                                        not been deemed 'proven to be effective' by payer.
                                   57 = Claim/service adjusted because the payer deems the
                                        information submitted does not support this level of
                                        service, this many services, this length of service, or
                                        this dosage.
                                   58 = Claim/service adjusted because treatment was deemed by
                                        the payer to have been rendered in an inappropriate
                                        or invalid place of service.
                                   59 = Charges are adjusted based on multiple surgery rules or
                                        concurrent anesthesia rules.
                                   60 = Charges for outpatient services with the proximity to
                                        inpatient services are not covered.
                                   61 = Charges adjusted as penalty for failure to obtain second
                                        surgical opinion.
                                   62 = Claim/service denied/reduced for absence of, or exceeded,
                                        precertification/authorization.
                                   63 = Correction to a prior claim. INACTIVE
                                   64 = Denial reversed per Medical Review. INACTIVE
                                   65 = Procedure code was incorrect.  This payment reflects the
                                        correct code. INACTIVE
                                   66 = Blood Deductible.
                                   67 = Lifetime reserve days. INACTIVE
                                   68 = DRG weight. INACTIVE
                                   69 = Day outlier amount.
                                   70 = Cost outlier amount.
                                   71 = Primary Payer amount.
                                   72 = Coinsurance day. INACTIVE
                                   73 = Administrative days. INACTIVE
                                   74 = Indirect Medical Education Adjustment.
                                   75 = Direct Medical Education Adjustment.
                                   76 = Disproportionate Share Adjustment.
                                   77 = Covered days. INACTIVE
                                   78 = Non-covered days/room charge adjustment.
                                   79 = Cost report days. INACTIVE
                                   80 = Outlier days. INACTIVE
                                   81 = Discharges. INACTIVE
                                   82 = PIP days. INACTIVE
                                   83 = Total visits. INACTIVE
                                   84 = Capital adjustments. INACTIVE
                                   85 = Interest amount. INACTIVE
                                   86 = Statutory adjustment. INACTIVE
                                   87 = Transfer amounts.
                                   88 = Adjustment amount represents collection against
                                        receivable created in prior overpayment.
                                   89 = Professional fees removed from charges.
                                   90 = Ingredient cost adjustment.
1       REV_CNTR_ANSI_TB                            Revenue Center ANSI Code Table
        ----------------                            ------------------------------

                                   91 = Dispensing fee adjustment.
                                   92 = Claim paid in full. INACTIVE
                                   93 = No claim level adjustment. INACTIVE
                                   94 = Process in excess of charges.
                                   95 = Benefits adjusted.  Plan procedures not followed.
                                   96 = Non-covered charges.
                                   97 = Payment is included in allowance for another
                                        service/procedure.
                                   98 = The hospital must file the Medicare claim for this
                                        inpatient non-physician service. INACTIVE
                                   99 = Medicare Secondary Payer Adjustment Amount. INACTIVE
                                   100 = Payment made to patient/insured/responsible party.
                                   101 = Predetermination: anticipated payment upon comple-
                                         tion of services or claim ajudication.
                                   102 = Major medical adjustment.
                                   103 = Provider promotional discount (i.e. Senior citizen
                                         discount).
                                   104 = Managed care withholding.
                                   105 = Tax withholding.
                                   106 = Patient payment option/election not in effect.
                                   107 = Claim/service denied because the related or qualifying
                                         claim/service was not paid or identified on the claim.
                                   108 = Claim/service reduced because rent/purchase guidelines
                                         were not met.
                                   109 = Claim not covered by this payer/contractor.  You must
                                         send the claim to the correct payer/contractor.
                                   110 = Billing date predates service date.
                                   111 = Not covered unless the provider accepts assignment.
                                   112 = Claim/service adjusted as not furnished directly
                                         to the patient and/or not documented.
                                   113 = Claim denied because service/procedure was provided
                                         outside the United States or as a result of war.
                                   114 = Procedure/product not approved by the Food and Drug
                                         Administration.
                                   115 = Claim/service adjusted as procedure postponed or
                                         canceled.
                                   116 = Claim/service denied.  The advance indemnification
                                         notice signed by the patient did not comply with
                                         requirements.
                                   117 = Claim/service adjusted because transportation is only
                                         covered to the closest facility that can provide
                                         the necessary care.
                                   118 = Charges reduced for ESRD network support.
                                   119 = Benefit maximum for this time period has been reached.
                                   120 = Patient is covered by a managed care plan. INACTIVE
                                   121 = Indemnification adjustment.
                                   122 = Psychiatric reduction.
                                   123 = Payer refund due to overpayment.  INACTIVE
                                   124 = Payer refund amount - not our patient. INACTIVE
                                   125 = Claim/service adjusted due to a submission/billing
                                         error(s).
                                   126 = Deductible - Major Medical.
                                   127 = Coinsurance - Major Medical.
                                   128 = Newborn's services are covered in the mother's
                                         allowance.
                                   129 = Claim denied - prior processing information appears
                                         incorrect.
                                   130 = Paper claim submission fee.
1       REV_CNTR_ANSI_TB                            Revenue Center ANSI Code Table
        ----------------                            ------------------------------

                                   131 = Claim specific negotiated discount.
                                   132 = Prearranged demonstration project adjustment.
                                   133 = The disposition of this claim/service is pending
                                         further review.
                                   134 = Technical fees removed from charges.
                                   135 = Claim denied.  Interim bills cannot be processed.
                                   136 = Claim adjusted.  Plan procedures of a prior payer
                                         were not followed.
                                   137 = Payment/Reduction for Regulatory Surcharges, Assess-
                                         ments, Allowances or Health Related Taxes.
                                   138 = Claim/service denied.  Appeal procedures not
                                         followed or time limits not met.
                                   139 = Contracted funding agreement - subscriber is employed
                                         by the provider of services.
                                   140 = Patient/Insured health identification number and name
                                         do not match.
                                   141 = Claim adjustment because the claim spans eligible
                                         and ineligible periods of coverage.
                                   142 = Claim adjusted by the monthly Medicaid patient
                                         liability amount.
                                   A0 = Patient refund amount
                                   A1 = Claim denied charges.
                                   A2 = Contractual adjustment.
                                   A3 = Medicare Secondary Payer liability met. INACTIVE
                                   A4 = Medicare Claim PPS Capital Day Outlier Amount.
                                   A5 = Medicare Claim PPS Capital Cost Outlier Amount.
                                   A6 = Prior hospitalization or 30 day transfer requirement
                                        not met.
                                   A7 = Presumptive Payment Adjustment.
                                   A8 = Claim denied; ungroupable DRG.
                                   B1 = Non-covered visits.
                                   B2 = Covered visits. INACTIVE
                                   B3 = Covered charges. INACTIVE
                                   B4 = Late filing penalty.
                                   B5 = Claim/service adjusted because coverage/program
                                        guidelines were not met or were exceeded.
                                   B6 = This service/procedure is adjusted when performed/
                                        billed by this type of provider, by this type of
                                        facility, or by a provider of this specialty.
                                   B7 = This provider was not certified/eligible to be
                                        paid for this procedure/service on this date of
                                        service.
                                   B8 = Claim/service not covered/reduced because alter-
                                        native services were available, and should have
                                        been utilized.
                                   B9 = Services not covered because the patient is en-
                                        rolled in a Hospice.
                                   B10 = Allowed amount has been reduced because a com-
                                         ponent of the basic procedure/test was paid.  The
                                         beneficiary is not liable for more than the charge
                                         limit for the basic procedure/test.
                                   B11 = The claim/service has been transferred to the
                                         proper payer/processor for processing.  Claim/
                                         service not covered by this payer/processor.
                                   B12 = Services not documented in patients' medical re-
                                         cords.
                                   B13 = Previously paid.  Payment for this claim/service
                                         may have been provided in a previous payment.
1       REV_CNTR_ANSI_TB                            Revenue Center ANSI Code Table
        ----------------                            ------------------------------

                                   B14 = Claim/service denied because only one visit or
                                         consultation per physician per day is covered.
                                   B15 = Claim/service adjusted because this procedure/
                                         service is not paid separately.
                                   B16 = Claim/service adjusted because 'New Patient'
                                         qualifications were not met.
                                   B17 = Claim/service adjusted because this service was
                                         not prescribed by a physician, not prescribed
                                         prior to delivery, the prescription is incomplete,
                                         or the prescription is not current.
                                   B18 = Claim/service denied because this procedure code/
                                         modifier was invalid on the date of service or
                                         claim submission.
                                   B19 = Claim/service adjusted because of the finding of a
                                         Review Organization.  INACTIVE
                                   B20 = Charges adjusted because procedure/service was
                                         partially or fully furnished by another provider.
                                   B21 = The charges were reduced because the service/care
                                         was partially furnished by another physician.
                                         INACTIVE
                                   B22 = This claim/service is adjusted based on the
                                         diagnosis.
                                   B23 = Claim/service denied because this provider has
                                         failed an aspect of a proficiency testing program.
                                   W1 = Workers Compensation State Fee Schedule Adjustment.

1       REV_CNTR_APC_TB                 Revenue Center Ambulatory Payment Classification (APC)
        ---------------                 ------------------------------------------------------


                                   0001 = Photochemotherapy
                                   0002 = Fine needle Biopsy/Aspiration
                                   0003 = Bone Marrow Biopsy/Aspiration
                                   0004 = Level I Needle Biopsy/ Aspiration Except
                                          Bone Marrow
                                   0005 = Level II Needle Biopsy /Aspiration Except
                                          Bone Marrow
                                   0006 = Level I Incision & Drainage
                                   0007 = Level II Incision & Drainage
                                   0008 = Level III Incision & Drainage
                                   0009 = Nail Procedures
                                   0010 = Level I Destruction of Lesion
                                   0011 = Level II Destruction of Lesion
                                   0012 = Level I Debridement & Destruction
                                   0013 = Level II Debridement & Destruction
                                   0014 = Level III Debridement & Destruction
                                   0015 = Level IV Debridement & Destruction
                                   0016 = Level V Debridement & Destruction
                                   0017 = Level VI Debridement & Destruction
                                   0018 = Biopsy Skin, Subcutaneous Tissue or Mucous Membrane
                                   0019 = Level I Excision/ Biopsy
                                   0020 = Level II Excision/ Biopsy
                                   0021 = Level III Excision/ Biopsy
                                   0022 = Level IV Excision/ Biopsy
                                   0023 = Exploration Penetrating Wound
                                   0024 = Level I Skin Repair
                                   0025 = Level II Skin Repair
                                   0026 = Level III Skin Repair
                                   0027 = Level IV Skin Repair
                                   0029 = Incision/Excision Breast
                                   0030 = Breast Reconstruction/Mastectomy
                                   0031 = Hyperbaric Oxygen
                                   0032 = Placement Transvenous Catheters/Arterial Cutdown
                                   0033 = Partial Hospitalization
                                   0040 = Arthrocentesis & Ligament/Tendon Injection
                                   0041 = Arthroscopy
                                   0042 = Arthroscopically-Aided Procedures
                                   0043 = Closed Treatment Fracture Finger/Toe/Trunk
                                   0044 = Closed Treatment Fracture/Dislocation Except
                                          Finger/Toe/Trunk
                                   0045 = Bone/Joint Manipulation Under Anesthesia
                                   0046 = Open/Percutaneous Treatment Fracture or Dislocation
                                   0047 = Arthroplasty without Prosthesis
                                   0048 = Arthroplasty with Prosthesis
                                   0049 = Level I Musculoskeletal Procedures Except Hand
                                          and Foot
                                   0050 = Level II Musculoskeletal Procedures Except Hand
                                          and Foot
                                   0051 = Level III Musculoskeletal Procedures Except Hand
                                          and Foot
                                   0052 = Level IV Musculoskeletal Procedures Except Hand
                                          and Foot
                                   0053 = Level I Hand Musculoskeletal Procedures
                                   0054 = Level II Hand Musculoskeletal Procedures
                                   0055 = Level I Foot Musculoskeletal Procedures
                                   0056 = Level II Foot Musculoskeletal Procedures
                                   0057 = Bunion Procedures
1       REV_CNTR_APC_TB                 Revenue Center Ambulatory Payment Classification (APC)
        ---------------                 ------------------------------------------------------

                                   0058 = Level I Strapping and Cast Application
                                   0059 = Level II Strapping and Cast Application
                                   0060 = Manipulation Therapy
                                   0070 = Thoracentesis/Lavage Procedures
                                   0071 = Level I Endoscopy Upper Airway
                                   0072 = Level II Endoscopy Upper Airway
                                   0073 = Level III Endoscopy Upper Airway
                                   0074 = Level IV Endoscopy Upper Airway
                                   0075 = Level V Endoscopy Upper Airway
                                   0076 = Endoscopy Lower Airway
                                   0077 = Level I Pulmonary Treatment
                                   0078 = Level II Pulmonary Treatment
                                   0079 = Ventilation Initiation and Management
                                   0080 = Diagnostic Cardiac Catheterization
                                   0081 = Non-Coronary Angioplasty or Atherectomy
                                   0082 = Coronary Atherectomy
                                   0083 = Coronary Angiosplasty
                                   0084 = Level I Electrophysiologic Evaluation
                                   0085 = Level II Electrophysiologic Evaluation
                                   0086 = Ablate Heart Dysrhythm Focus
                                   0087 = Cardiac Electrophysiologic Recording/Mapping
                                   0088 = Thrombectomy
                                   0089 = Level I Implantation/Removal/Revision of Pacemaker,
                                          AICD Vascular Device
                                   0090 = Level II Implantation/Removal/Revision of Pacemaker,
                                          AICD Vascular Device
                                   0091 = Level I Vascular Ligation
                                   0092 = Level II Vascular Ligation
                                   0093 = Vascular Repair/Fistula Construction
                                   0094 = Resuscitation and Cardioversion
                                   0095 = Cardiac Rehabilitation
                                   0096 = Non-Invasive Vascular Studies
                                   0097 = Cardiovascular Stress Test
                                   0098 = Injection of Sclerosing Solution
                                   0099 = Continuous Cardiac Monitoring
                                   0100 = Continuous ECG
                                   0101 = Tilt Table Evaluation
                                   0102 = Electronic Analysis of Pacemakers/other Devices
                                   0109 = Bone Marrow Harvesting and Bone Marrow/Stem Cell
                                          Transplant
                                   0110 = Transfusion
                                   0111 = Blood Product Exchange
                                   0112 = Extracorporeal Photopheresis
                                   0113 = Excision Lymphatic System
                                   0114 = Thyroid/Lymphadenectomy Procedures
                                   0116 = Chemotherapy Administration by Other Technique
                                          Except Infusion
                                   0117 = Chemotherapy Administration by Infusion Only
                                   0118 = Chemotherapy Administration by Both Infusion and
                                          Other Technique
                                   0120 = Infusion Therapy Except Chemotherapy
                                   0121 = Level I Tube changes and Repositioning
                                   0122 = Level II Tube changes and Repositioning
                                   0123 = Level III Tube changes and Repositioning
                                   0130 = Level I Laparoscopy
                                   0131 = Level II Laparoscopy
                                   0132 = Level III Laparoscopy
                                   0140 = Esophageal Dilation without Endoscopy
1       REV_CNTR_APC_TB                 Revenue Center Ambulatory Payment Classification (APC)
        ---------------                 ------------------------------------------------------

                                   0141 = Upper GI Procedures
                                   0142 = Small Intestine Endoscopy
                                   0143 = Lower GI Endoscopy
                                   0144 = Diagnostic Anoscopy
                                   0145 = Therapeutic Anoscopy
                                   0146 = Level I Sigmoidoscopy
                                   0147 = Level II Sigmoidoscopy
                                   0148 = Level I Anal/Rectal Procedure
                                   0149 = Level II Anal/Rectal Procedure
                                   0150 = Level III Anal/Rectal Procedure
                                   0151 = Endoscopic Retrograde Cholangio-Pancreatography (ERCP)
                                   0152 = Percutaneous Biliary Endoscopic Procedures
                                   0153 = Peritoneal and Abdominal Procedures
                                   0154 = Hernia/Hydrocele Procedures
                                   0157 = Colorectal Cancer Screening: Barium Enema
                                          (Not subject to National coinsurance)
                                   0158 = Colorectal Cancer Screening: Colonoscopy
                                          Not subject to National coinsurance.  Minimum
                                          unadjusted coinsurance is 25% of the payment rate.
                                          Payment rate is lower of the HOPD payment rate or
                                          the Ambulatory Surgical Center payment.
                                   0159 = Colorectal Cancer Screening: Flexible Sigmoidoscopy
                                          Not subject to National coinsurance.  Minimum
                                          unadjusted coinsurance is 25% of the payment rate.
                                          Payment rate is lower of the HOPD payment rate or
                                          the Ambulatory Surgical Center payment.
                                   0160 = Level I Cystourethroscopy and other Genitourinary
                                          Procedures
                                   0161 = Level II Cystourethroscopy and other Genitourinary
                                          Procedures
                                   0162 = Level III Cystourethroscopy and other Genitourinary
                                          Procedures
                                   0163 = Level IV Cystourethroscopy and other Genitourinary
                                          Procedures
                                   0164 = Level I  Urinary and Anal Procedures
                                   0165 = Level II  Urinary and Anal Procedures
                                   0166 = Level I Urethral Procedures
                                   0167 = Level II Urethral Procedures
                                   0168 = Level III Urethral Procedures
                                   0169 = Lithotripsy
                                   0170 = Dialysis for Other Than ESRD Patients
                                   0180 = Circumcision
                                   0181 = Penile Procedures
                                   0182 = Insertion of Penile Prosthesis
                                   0183 = Testes/Epididymis Procedures
                                   0184 = Prostate Biopsy
                                   0190 = Surgical Hysteroscopy
                                   0191 = Level I Female Reproductive Procedures
                                   0192 = Level II Female Reproductive Procedures
                                   0193 = Level III Female Reproductive Procedures
                                   0194 = Level IV Female Reproductive Procedures
                                   0195 = Level V Female Reproductive Procedures
                                   0196 = Dilatation & Curettage
                                   0197 = Infertility Procedures
                                   0198 = Pregnancy and Neonatal Care Procedures
                                   0199 = Vaginal Delivery
                                   0200 = Therapeutic Abortion
                                   0201 = Spontaneous Abortion
1       REV_CNTR_APC_TB                 Revenue Center Ambulatory Payment Classification (APC)
        ---------------                 ------------------------------------------------------

                                   0210 = Spinal Tap
                                   0211 = Level I Nervous System Injections
                                   0212 = Level II Nervous System Injections
                                   0213 = Extended EEG Studies and Sleep Studies
                                   0214 = Electroencephalogram
                                   0215 = Level I Nerve and Muscle Tests
                                   0216 = Level II Nerve and Muscle Tests
                                   0217 = Level III Nerve and Muscle Tests
                                   0220 = Level I Nerve Procedures
                                   0221 = Level II Nerve Procedures
                                   0222 = Implantation of Neurological Device
                                   0223 = Level I Revision/Removal Neurological Device
                                   0224 = Level II Revision/Removal Neurological Device
                                   0225 = Implantation of Neurostimulator Electrodes
                                   0230 = Level I Eye Tests
                                   0231 = Level II Eye Tests
                                   0232 = Level I Anterior Segment Eye
                                   0233 = Level II Anterior Segment Eye
                                   0234 = Level III Anterior Segment Eye Procedures
                                   0235 = Level I Posterior Segment Eye Procedures
                                   0236 = Level II Posterior Segment Eye Procedures
                                   0237 = Level III Posterior Segment Eye Procedures
                                   0238 = Level I Repair and Plastic Eye Procedures
                                   0239 = Level II Repair and Plastic Eye Procedures
                                   0240 = Level III Repair and Plastic Eye Procedures
                                   0241 = Level IV Repair and Plastic Eye Procedures
                                   0242 = Level V Repair and Plastic Eye Procedures
                                   0243 = Strabismus/Muscle Procedures
                                   0244 = Corneal Transplant
                                   0245 = Cataract Procedures without IOL Insert
                                   0246 = Cataract Procedures with IOL Insert
                                   0247 = Laser Eye Procedures Except Retinal
                                   0248 = Laser Retinal Procedures
                                   0250 = Nasal Cauterization/Packing
                                   0251 = Level I ENT Procedures
                                   0252 = Level II ENT Procedures
                                   0253 = Level III ENT Procedures
                                   0254 = Level IV ENT Procedures
                                   0256 = Level V ENT Procedures
                                   0257 = Implantation of Cochlear Device
                                   0258 = Tonsil and Adenoid Procedures
                                   0260 = Level I Plain Film Except Teeth
                                   0261 = Level II Plain Film Except Teeth Including Bone
                                          Density Measurement
                                   0262 = Plain Film of Teeth
                                   0263 = Level I Miscellaneous Radiology Procedures
                                   0264 = Level II Miscellaneous Radiology Procedures
                                   0265 = Level I Diagnostic Ultrasound Except Vascular
                                   0266 = Level II Diagnostic Ultrasound Except Vascular
                                   0267 = Vascular Ultrasound
                                   0268 = Guidance Under Ultrasound
                                   0269 = Echocardiogram Except Transesophageal
                                   0270 = Transesophageal Echocardiogram
                                   0271 = Mammography
                                   0272 = Level I Fluoroscopy
                                   0273 = Level II Fluoroscopy
                                   0274 = Myelography
                                   0275 = Arthrography
1       REV_CNTR_APC_TB                 Revenue Center Ambulatory Payment Classification (APC)
        ---------------                 ------------------------------------------------------

                                   0276 = Level I Digestive Radiology
                                   0277 = Level II Digestive Radiology
                                   0278 = Diagnostic Urography
                                   0279 = Level I Diagnostic Angiography and Venography
                                          Except Extremity
                                   0280 = Level II Diagnostic Angiography and Venography
                                          Except Extremity
                                   0281 = Venography of Extremity
                                   0282 = Level I Computerized Axial Tomography
                                   0283 = Level II Computerized Axial Tomography
                                   0284 = Magnetic Resonance Imaging
                                   0285 = Positron Emission Tomography (PET)
                                   0286 = Myocardial Scans
                                   0290 = Standard Non-Imaging Nuclear Medicine
                                   0291 = Level I Diagnostic Nuclear Medicine Excluding
                                          Myocardial Scans
                                   0292 = Level II Diagnostic Nuclear Medicine Excluding
                                          Myocardial Scans
                                   0294 = Level I Therapeutic Nuclear Medicine
                                   0295 = Level II Therapeutic Nuclear Medicine
                                   0296 = Level I Therapeutic Radiologic Procedures
                                   0297 = Level II Therapeutic Radiologic Procedures
                                   0300 = Level I Radiation Therapy
                                   0301 = Level II Radiation Therapy
                                   0302 = Level III Radiation Therapy
                                   0303 = Treatment Device Construction
                                   0304 = Level  I Therapeutic Radiation Treatment
                                          Preparation
                                   0305 = Level II Therapeutic Radiation Treatment
                                          Preparation
                                   0310 = Level III Therapeutic Radiation Treatment
                                          Preparation
                                   0311 = Radiation Physics Services
                                   0312 = Radioelement Applications
                                   0313 = Brachytherapy
                                   0314 = Hyperthermic Therapies
                                   0320 = Electroconvulsive Therapy
                                   0321 = Biofeedback and Other Training
                                   0322 = Brief Individual Psychotherapy
                                   0323 = Extended Individual Psychotherapy
                                   0324 = Family Psychotherapy
                                   0325 = Group Psychotherapy
                                   0330 = Dental Procedures
                                   0340 = Minor Ancillary Procedures
                                   0341 = Immunology Tests
                                   0342 = Level I Pathology
                                   0343 = Level II Pathology
                                   0344 = Level III Pathology
                                   0354 = Administration of Influenza Vaccine (Not
                                          subject to national coinsurance)
                                   0355 = Level I Immunizations
                                   0356 = Level II Immunizations
                                   0357 = Level III Immunizations
                                   0358 = Level IV Immunizations
                                   0359 = Injections
                                   0360 = Level I Alimentary Tests
                                   0361 = Level II Alimentary Tests
                                   0362 = Fitting of Vision Aids
1       REV_CNTR_APC_TB                 Revenue Center Ambulatory Payment Classification (APC)
        ---------------                 ------------------------------------------------------

                                   0363 = Otorhinolaryngologic Function Tests
                                   0364 = Level I Audiometry
                                   0365 = Level II Audiometry
                                   0366 = Electrocardiogram (ECG)
                                   0367 = Level I Pulmonary Test
                                   0368 = Level II Pulmonary Test
                                   0369 = Level III Pulmonary Test
                                   0370 = Allergy Tests
                                   0371 = Allergy Injections
                                   0372 = Therapeutic Phlebotomy
                                   0373 = Neuropsychological Testing
                                   0374 = Monitoring Psychiatric Drugs
                                   0600 = Low Level Clinic Visits
                                   0601 = Mid Level Clinic Visits
                                   0602 = High Level Clinic Visits
                                   0603 = Interdisciplinary Team Conference
                                   0610 = Low Level Emergency Visits
                                   0611 = Mid Level Emergency Visits
                                   0612 = High Level Emergency Visits
                                   0620 = Critical Care
                                   0701 = Strontium (eligible for pass-through payments)
                                   0702 = Samariam (eligible for pass-through payments)
                                   0704 = Satumomab Pendetide (eligible for pass-through
                                          payments)
                                   0705 = Tc99 Tetrofosmin (eligible for pass-through
                                          payments)
                                   0725 = Leucovorin Calcium (eligible for pass-through
                                          payments)
                                   0726 = Dexrazoxane Hydrochloride (eligible for pass-)
                                          through payments)
                                   0727 = Injection, Etidronate Disodium (eligible for
                                          pass-through payments)
                                   0728 = Filgrastim (G-CSF) (eligible for pass-through
                                          payments)
                                   0730 = Pamidronate Disodium (eligible for pass-through
                                          payments)
                                   0731 = Sargramostim (GM-CSF) (eligible for pass-through
                                          payments)
                                   0732 = Mesna (eligible for pass-through payments)
                                   0733 = Epoetin Alpha (eligible for pass-through)
                                          payments)
                                   0750 = Dolasetron Mesylate 10 mg (eligible for pass-
                                          through payments)
                                   0754 = Metoclopramide HCL (eligible for pass-through
                                          payments)
                                   0755 = Thiethylperazine Maleate (eligible for pass-through
                                          payments)
                                   0761 = Oral Substitute for IV Antiemtic (eligible for pass-
                                          through payments)
                                   0762 = Dronabinol (elibible for pass-through payments)
                                   0763 = Dolasetron Mesylate 100 mg Oral (eligible for
                                          pass-through payments)
                                   0764 = Granisetron HCL, 100 mcg (eligible for pass-
                                          through payments)
                                   0765 = Granisetron HCL, 1mg Oral (eligible for pass-
                                          through payments)
                                   0768 = Ondansetron Hydrochloride per 1 mg Injection
                                          (eligible for pass-through payments)
1       REV_CNTR_APC_TB                 Revenue Center Ambulatory Payment Classification (APC)
        ---------------                 ------------------------------------------------------

                                   0769 = Ondansetron Hydrochloride 8 mg oral
                                          (eligible for pass-through payments)
                                   0800 = Leuprolide Acetate per 3.75 mg (eligible for
                                          pass-through payments)
                                   0801 = Cyclophosphamide (eligible for pass-through
                                          payments)
                                   0802 = Etoposide (eligible for pass-through payments)
                                   0803 = Melphalan (eligible for pass-through payments)
                                   0807 = Aldesleukin single use vial (eligible for pass-
                                          through payments)
                                   0809 = BCG (Intravesical) one vial (eligible for pass-
                                          through payments)
                                   0810 = Goserelin Acetate Implant, per 3.6 mg (eligible for
                                          pass-through payments)
                                   0811 = Carboplatin 50 mg (eligible for pass-through
                                          payments)
                                   0812 = Carmustine 100 mg (eligible for pass-through
                                          payments)
                                   0813 = Cisplatin 10 mg (eligible for pass-through
                                          payments)
                                   0814 = Asparaginase, 10,000 units (eligible for pass-
                                          through payments)
                                   0815 = Cyclophosphamide 100 mg (eligible for pass-
                                          through payments)
                                   0816 = Cyclophosphamide, Lyophilized 100 mg (eligible
                                          for pass-through payments)
                                   0817 = Cytrabine 100 mg (eligible for pass-through
                                          payments)
                                   0818 = Dactinomycin 0.5 mg (eligible for pass-through
                                          payments)
                                   0819 = Dacarbazine 100 mg (eligible for pass-through
                                          payments)
                                   0820 = Daunorubicin HCI 10 mg (eligible for pass-through
                                          payments)
                                   0821 = Daunorubicin Citrate, Liposomal Formulation, 10 mg
                                          (eligible for pass-through payments)
                                   0822 = Diethylstibestrol Diphosphate 250 mg
                                          (eligible for pass-through payments)
                                   0823 = Docetaxel 20 mg (eligible for pass-through
                                          payments)
                                   0824 = Etoposide 10 mg (eligible for pass-through
                                          payments)
                                   0826 = Methotrexate Oral 2.5 mg (eligible for pass-through
                                          payments)
                                   0827 = Floxuridine 500 mg (eligible for pass-through
                                          payments)
                                   0828 = Gemcitabine HCL 200 mg (eligibile for pass-
                                          through payments)
                                   0830 = Irinotecan 20 mg (eligible for pass-through
                                          payments)
                                   0831 = Ifosfamide per 1 gram (eligible for pass-through
                                          payments)
                                   0832 = Idarubicin Hydrochloride 5 mg (eligible for pass-
                                          through payments)
                                   0833 = Interferon Alfacon-1, Recombinant, 1 mcg
                                          (eligible for pass-through payments)
                                   0834 = Interferon,  Alfa-2A, Recombinant 3 million units
                                          (eligible for pass-through payments)
1       REV_CNTR_APC_TB                 Revenue Center Ambulatory Payment Classification (APC)
        ---------------                 ------------------------------------------------------

                                   0836 = Interferon,  Alfa-2B, Recombinant, 1 million units
                                          (eligible for pass-through payments)
                                   0838 = Interferon, Gamma 1-B, 3 million units
                                          (eligible for pass-through payments)
                                   0839 = Mechlorethamine HCI 10 mg
                                          (eligible for pass-through payments)
                                   0840 = Melphalan HCI 50 mg (eligible for pass-
                                          through payments)
                                   0841 = Methotrexate Sodium 5 mg (eligible for pass-
                                          through payments)
                                   0842 = Fludarabine Phosphate 50 mg (eligible for pass-
                                          through payments)
                                   0843 = Pegaspargase per single dose vial (eligible for
                                          pass-through payments)
                                   0844 = Pentostatin 10 mg (eligible for pass-through
                                          payments)
                                   0847 = Doxorubicin HCL 10 mg (eligible for pass-through
                                          payments)
                                   0849 = Rituximab, 100 mg (eligible for pass-through
                                          payments)
                                   0850 = Streptozocin 1 gm (eligible for pass-through
                                          payments)
                                   0851 = Thiotepa 15 mg (eligible for pass-through pay-
                                          ments)
                                   0852 = Topotecan 4 mg (eligible for pass-through payments)
                                   0853 = Vinblastine Sulfate 1 mg (eligible for pass-through
                                          payments)
                                   0854 = Vincristine Sulfate 1 mg (eligible for pass-through
                                          payments)
                                   0855 = Vinorelbine Tartrate per 10 mg (eligible for pass-
                                          through payments)
                                   0856 = Porfimer Sodium 75 mg (eligible for pass-through
                                          payments)
                                   0857 = Bleomycin Sulfate 15 units (eligible for pass-through
                                          payments)
                                   0858 = Cladribine, 1mg (eligible for pass-through payments)
                                   0859 = Fluorouracil (eligible for pass-through payments)
                                   0860 = Plicamycin 2.5 mg (eligible for pass-through payments)
                                   0861 = Leuprolide Acetate 1 mg (eligible for pass-through
                                          payments)
                                   0862 = Mitomycin, 5mg (eligible for pass-through payments)
                                   0863 = Paclitaxel, 30mg (eligible for pass-through payments)
                                   0864 = Mitoxantrone HCl,  per 5mg (eligible for pass-through
                                          payments)
                                   0865 = Interferon alfa-N3, 250,000 IU (eligible for pass-
                                          through payments)
                                   0884 = Rho (D) Immune Globulin, Human one dose pack
                                          (eligible for pass-through payments)
                                   0886 = Azathioprine,  50 mg oral
                                          (Not subject to national coinsurance)
                                   0887 = Azathioprine, Parenteral 100 mg, 20 ml each injection
                                          (Not subject to national coinsurance)
                                   0888 = Cyclosporine, Oral 100 mg
                                          (Not subject to national coinsurance)
                                   0889 = Cyclosporine, Parenteral
                                          (Not subject to national coinsurance)
                                   0890 = Lymphocyte Immune Globulin 50 mg/ ml, 5 ml each
                                          (Not subject to national coinsurance)
1       REV_CNTR_APC_TB                 Revenue Center Ambulatory Payment Classification (APC)
        ---------------                 ------------------------------------------------------

                                   0891 = Tacrolimus per 1 mg oral
                                          (Not subject to national coinsurance)
                                   0892 = Daclizumab, Parenteral, 25 mg
                                          (eligible for pass-through payments)
                                   0900 = Injection, Alglucerase per 10 units
                                          (eligible for pass-through payments)
                                   0901 = Alpha I, Proteinase Inhibitor, Human per 10mg
                                          (eligible for pass-through payments)
                                   0902 = Botulinum Toxin, Type A per unit
                                          (eligible for pass-through payments)
                                   0903 = CMV Immune Globulin
                                          (eligible for pass-through payments)
                                   0905 = Immune Globulin per 500 mg
                                          (eligible for pass-through payments)
                                   0906 = RSV Immune Globulin
                                          (eligible for pass-through payments)
                                   0907 = Ganciclovir Sodium 500 mg injection
                                          (Not subject to national coinsurance)
                                   0908 = Tetanus Immune Globulin, Human, up to 250 units
                                          (Not subject to national coinsurance)
                                   0909 = Interferon Beta - 1a   33 mcg (eligible for pass-
                                          through payments)
                                   0910 = Interferon Beta - 1b   0.25 mg (eligible for pass-
                                          through payments)
                                   0911 = Streptokinase per 250,000 iu
                                          (Not subject to national coinsurance)
                                   0913 = Ganciclovir 4.5  mg, Implant (eligible for pass-
                                          through payments)
                                   0914 = Reteplase, 37.6 mg (Two Single Use Vials)
                                          (Not subject to national coinsurance)
                                   0915 = Alteplase recombinant, 10mg
                                          (Not subject to national coinsurance)
                                   0916 = Imiglucerase per unit (eligible for pass-through
                                          payments)
                                   0917 = Dipyridamole, 10mg / Adenosine 6MG
                                          (Not subject to national coinsurance)
                                   0918 = Brachytherapy Seeds, Any type, Each (eligible
                                          for pass-through payments)
                                   0925 = Factor VIII (Antihemophilic Factor, Human) per iu
                                          (eligible for pass-through payments)
                                   0926 = Factor VIII (Antihemophilic Factor, Porcine) per  iu
                                          (eligible for pass-through payments)
                                   0927 = Factor VIII (Antihemophilic Factor, Recombinant)
                                          per iu (eligible for pass-through payments)
                                   0928 = Factor IX,  Complex (eligible for pass-through
                                          payments)
                                   0929 = Other Hemophilia Clotting Factors per iu (eligible
                                          for pass-through payments)
                                   0930 = Antithrombin III (Human) per iu (eligible for pass-
                                          through payments)
                                   0931 = Factor IX (Antihemophilic Factor, Purified, Non-
                                          Recombinant) (eligible for pass-through payments)
                                   0932 = Factor IX (Antihemophilic Factor, Recombinant)
                                          (eligible for pass-through payments)
                                   0949 = Plasma, Pooled Multiple Donor, Solvent/Detergent
                                          Treated, Frozen (not subject to national coinsurance)
                                   0950 = Blood (Whole) For Transfusion (not subject to
                                          national coinsurance)
1       REV_CNTR_APC_TB                 Revenue Center Ambulatory Payment Classification (APC)
        ---------------                 ------------------------------------------------------

                                   0952 = Cryoprecipitate (not subject to national coinsurance)
                                   0953 = Fibrinogen Unit (not subject to national coinsurance)
                                   0954 = Leukocyte Poor Blood (not subject to national
                                          coinsurance)
                                   0955 = Plasma, Fresh Frozen (not subject to national
                                          coinsurance)
                                   0956 = Plasma Protein Fraction (not subject to national
                                          coinsurance)
                                   0957 = Platelet Concentrate (not subject to national
                                          coinsurance)
                                   0958 = Platelet Rich Plasma (not subject to national
                                          coinsurance)
                                   0959 = Red Blood Cells (not subject to national coinsurance)
                                   0960 = Washed Red Blood Cells (not subject to national
                                          coinsurance)
                                   0961 = Infusion, Albumin (Human) 5%, 500 ml
                                          (not subject to national coinsurance)
                                   0962 = Infusion, Albumin (Human) 25%, 50 ml
                                          (not subject to national coinsurance)
                                   0970 = New Technology - Level I     ($0 - $50)
                                          (not subject to national coinsurance)
                                   0971 = New Technology - Level II    ($50 - $100)
                                          (not subject to national coinsurance)
                                   0972 = New Technology - Level III    ($100 - $200)
                                          (not subject to national coinsurance)
                                   0973 = New Technology - Level IV   ($200 - $300)
                                          (not subject to national coinsurance)
                                   0974 = New Technology - Level V    ($300 - $500)
                                          (not subject to national coinsurance)
                                   0975 = New Technology - Level VI   ($500 - $750)
                                          (not subject to national coinsurance)
                                   0976 = New Technology - Level VII   ($750 - $1000)
                                          (not subject to national coinsurance)
                                   0977 = New Technology - Level VIII  ($1000 - $1250)
                                          (not subject to national coinsurance)
                                   0978 = New Technology - Level IX    ($1250 - $1500)
                                          (not subject to national coinsurance)
                                   0979 = New Technology - Level X     ($1500 - $1750)
                                          (not subject to national coinsurance)
                                   0980 = New Technology - Level XI    ($1750 - $2000)
                                          (not subject to national coinsurance)
                                   0981 = New Technology - Level XII   ($2000 - $2500)
                                          (not subject to national coinsurance)
                                   0982 = New Technology - Level XIII   ($2500 - $3500)
                                          (not subject to national coinsurance)
                                   0983 = New Technology - Level XIV  ($3500 - $5000)
                                          (not subject to national coinsurance)
                                   0984 = New Technology - Level XV   ($5000 - $6000)
                                          (not subject to national coinsurance)
                                   7000 = Amifostine, 500 mg (eligible for pass-through
                                          payments)
                                   7001 = Amphotericin B lipid complex, 50 mg, Inj
                                          (eligible for pass-through payments)
                                   7002 = Clonidine, HCl, 1 MG (eligible for pass-
                                          through payments)
                                   7003 = Epoprostenol, 0.5 MG, inj (eligible for pass-
                                          through payments)
                                   7004 = Immune globulin intravenous human 5g, inj
1       REV_CNTR_APC_TB                 Revenue Center Ambulatory Payment Classification (APC)
        ---------------                 ------------------------------------------------------

                                          (eligible for pass-through payments)
                                   7005 = Gonadorelin hcI, 100 mcg (eligible for pass-
                                          through payments)
                                   7007 = Milrinone lacetate, per 5 ml, inj (not subject
                                          to national coinsurance)
                                   7010 = Morphine sulfate concentrate (preservative free)
                                          per 10 mg (eligible for pass-through payments)
                                   7011 = Oprelevekin, inj, 5 mg (eligible for pass-through
                                          payments)
                                   7012 = Pentamidine isethionate, 300 mg (eligible for
                                          pass-through payments)
                                   7014 = Fentanyl citrate, inj, up to 2 ml (eligible for
                                          pass-through payments)
                                   7015 = Busulfan, oral 2 mg (eligible for pass-through
                                          payments)
                                   7019 = Aprotinin, 10,000 kiu (eligible for pass-through
                                          payments)
                                   7021 = Baclofen, intrathecal, 50 mcg (eligible for pass-
                                          through payments)
                                   7022 = Elliotts B Solution, per ml (eligible for pass-
                                          through payments)
                                   7023 = Treatment for bladder calculi, I.e. Renacidin
                                          per 500 ml (eligible for pass-through payments)
                                   7024 = Corticorelin ovine triflutate, 0.1 mg
                                          (eligible for pass-through payments)
                                   7025 = Digoxin immune FAB (Ovine), 10 mg
                                          (eligible for pass-through payments)
                                   7026 = Ethanolamine oleate, 1000 ml
                                          (eligible for pass-through payments)
                                   7027 = Fomepizole, 1.5 G
                                          (eligible for pass-through payments)
                                   7028 = Fosphenytoin, 50 mg
                                          (eligible for pass-through payments)
                                   7029 = Glatiramer acetate, 25 mg
                                          (eligible for pass-through payments)
                                   7030 = Hemin, 1 mg
                                          (eligible for pass-through payments)
                                   7031 = Octreotide Acetate, 500 mcg
                                          (eligible for pass-through payments)
                                   7032 = Sermorelin acetate, 0.5 mg
                                          (eligible for pass-through payments)
                                   7033 = Somatrem, 5 mg
                                          (eligible for pass-through payments)
                                   7034 = Somatropin, 1 mg
                                          (eligible for pass-through payments)
                                   7035 = Teniposide, 50 mg
                                          (eligible for pass-through payments)
                                   7036 = Urokinase, inj, IV, 250,000 I.U.
                                          (not subject to national coinsurance)
                                   7037 = Urofollitropin, 75 I.U.
                                          (eligible for pass-through payments)
                                   7038 = Muromonab-CD3, 5 mg
                                          (eligible for pass-through payments)
                                   7039 = Pegademase bovine inj 25 I.U.
                                          (eligible for pass-through payments)
                                   7040 = Pentastarch 10% inj, 100 ml
                                          (eligible for pass-through payments)
                                   7041 = Tirofiban HCL, 0.5 mg
1       REV_CNTR_APC_TB                 Revenue Center Ambulatory Payment Classification (APC)
        ---------------                 ------------------------------------------------------

                                          (not subject to national coinsurance)
                                   7042 = Capecitabine, oral 150 mg
                                          (eligible for pass-through payments)
                                   7043 = Infliximab, 10 MG (eligible for pass-through
                                          payments)
                                   7045 = Trimetrexate Glucoronate (eligible for pass-
                                          through payments)
                                   7046 = Doxorubicin Hcl Liposome (eligible for pass-
                                          through payments)

1 REV_CNTR_DDCTBL_COINSRNC_TB                 Revenue Center Deductible Coinsurance Code
  ---------------------------                 ------------------------------------------


                                   0 = Charges are subject to deductible
                                       and coinsurance
                                   1 = Charges are not subject to deductible
                                   2 = Charges are not subject to coinsurance
                                   3 = Charges are not subject to deductible
                                       or coinsurance
                                   4 = No charge or units associated with this
                                       revenue center code.  (For multiple
                                       HCPCS per single revenue center code)

                                   For revenue center code 0001, the following
                                   MSP override values may be present:

                                   M = Override code; EGHP services involved
                                       (eff 12/90 for non-institutional claims;
                                       10/93 for institutional claims)
                                   N = Override code; non-EGHP services involved
                                       (eff 12/90 for non-institutional claims;
                                       10/93 for institutional claims)
                                   X = Override code: MSP cost avoided
                                       (eff 12/90 for non-institutional claims;
                                       10/93 for institutional claims)

1   REV_CNTR_PMT_MTHD_IND_TB                Revenue Center Payment Method Indicator Table
    ------------------------                ---------------------------------------------


                                   **********Service Indicator**************
                                   ********** 1st position *****************
                                   A = Services not paid under OPPS
                                   C = Inpatient procedure
                                   E = Noncovered items or services
                                   F = Corneal issue acquistion
                                   G = Current drug or biological pass-through
                                   H = Device pass-through
                                   J = New drug or new biological pass-through
                                   N = Packaged incidental service
                                   P = Partial hospitalization services
                                   S = Significant procedure not subject to
                                       multiple procedure discounting
                                   T = Significant procedure subject to multiple
                                       procedure discounting
                                   V = Medical visit to clinic or emergency
                                       department
                                   X = Ancillary service

                                   **********Payment Indicator**************
                                   ********** 2nd position *****************
                                   1 = Paid standard hospital OPPS amount
                                       (service indicators S,T,V,X)
                                   2 = Services not paid under OPPS (service
                                       indicator A, or no HCPCS code and not
                                       certain revenue center codes)
                                   3 = Not paid (service indicators C & E)
                                   4 = Acquisition cost paid (service indica-
                                       tor F)
                                   5 = Additional payment for current drug or
                                       biological (service indicator G)
                                   6 = Additional payment for device (service
                                       indicator H)
                                   7 = Additional payment for new drug or new
                                       biological (service indicator J)
                                   8 = Paid partial hospitalization per diem
                                       (service indicator P)
                                   9 = No additional payment, payment included
                                       in line items with APCs (service
                                       indicator N, or no HCPCS code and certain
                                       revenue center codes, or HCPCS codes Q0082
                                       (activity therapy), G0129 (occupational
                                       therapy) or G0172 (partial hospitalization
                                       training)

1    REV_CNTR_PRICNG_IND_TB                     Revenue Center Pricing Indicator Table
     ----------------------                     --------------------------------------

                                   A = A valid HCPCS code not subject to a fee schedule payment.
                                       Reimbursement is calculated on provider submitted
                                       charges.
                                   B = A valid HCPCS code subject to the fee schedule payment.
                                       Reimbursement is the lesser of provider submitted
                                       charges or the fee schedule amount.
                                   D = a valid radiology HCPCS code subject to the Radiology
                                       Pricer and the rate is reflected as zeroes on the HCPCS
                                       file and cost report.  The Radiology Pricer treates this
                                       HCPCS as a non-covered service.  Reimbursement is cal-
                                       culated on provider submitted charges.
                                   E = A valid ASC HCPCS code subject to the ASC Pricer. The
                                       rate is reflected as zeroes on the HCPCS file.  The
                                       ASC Pricer determines the ASC payment rate and is re-
                                       ported on the cost report.
                                   F = A valid ESRD HCPCS code subject to the parameter rate.
                                       Reimbursement is the lesser of provider submitted
                                       charges or the fee schedule amount for non-dialysis
                                       HCPCS.  Reimbursement is calculated on the provider
                                       file rates for dialysis HCPCS.
                                   G = A valid HCPCS, code is subject to a fee schedule, but
                                       the rate is no longer present on the HCPCS file.
                                       Reimbursement is calculated on provider submitted
                                       charges.
                                   H = A valid DME HCPCS, code is subject to a fee schedule.
                                       The rates are reflected under the DME segment.  Reim-
                                       bursement is calculated either on a fee schedule, pro-
                                       vider submitted charges or the lesser of provider
                                       submitted, or the fee schedule depending o the cate-
                                       gory.
                                   I = A valid DME category 5 HCPCS, HCPCS is not found on
                                       the DME history record, but a match was found on HIC,
                                       category and generic code.  Claim must be reviewed by
                                       Medical Review before payment can be calculated.
                                   J = A valid DME HCPCS, no DME history is present, and a
                                       prescription is required before delivery.  Claim must
                                       be reviewed by Medical Review.
                                   K = A valid DME HCPCS, prescribed has been reviewed, and
                                       fee schedule payment is approved as prescription was
                                       present before delivery.
                                   L = A valid TENS HCPCS, rental period is six months or
                                       greater and must be reviewed by Medical Review.
                                   M = A valid TENS HCPCS, Medical Review has approved the
                                       rental charge in excess of five months.
                                   R = A valid radiology HCPCS code and is subject to the
                                       Radiology Pricer.  The rate is reported on the cost
                                       report.  Reimbursement is calculated on provider
                                       submitted charges.
                                   S = Valid influenza/PPV HCPCS.  A fee amount is not
                                       applicable.  The amount payable is present in the
                                       covered charge field.  This amount is not subject
                                       to the coinsurance and deductible.  This charge is
                                       subject to the provider's reimbursement rate.
                                   T = Valid HCPCS.  A fee amount is present.  The amount
                                       payable should be the lower of the billed charge or
1    REV_CNTR_PRICNG_IND_TB                     Revenue Center Pricing Indicator Table
     ----------------------                     --------------------------------------

                                       fee amount.  The system should compute the fee amount
                                       by multiplying the covered units times the rate.
                                       The fee amount is not subject to coinsurance and
                                       deductible or provider's reimbursement rate.

1         REV_CNTR_TB                                    Revenue Center Table
          -----------                                    --------------------
                                   0001 = Total charge
                                   0022 = SNF claim paid under PPS submitted as TOB 21X,
                                          effective for cost reporting periods begin-
                                          ning on or after 7/1/98 (dates of service after
                                          6/30/98).  NOTE:  This code may appear multiple
                                          times on a claim to identify different HIPPS
                                          Rate Code/assessment periods.
                                   0023 = Home Health services paid under PPS submitted as
                                          TOB 32X and 33X, effective 10/00.  This code may
                                          appear multiple times on a claim to identify
                                          different HIPPS/Home Health Resource Groups (HRG).
                                   0100 = All inclusive rate-room and board plus ancillary
                                   0101 = All inclusive rate-room and board
                                   0110 = Private medical or general-general classification
                                   0111 = Private medical or general-medical/surgical/GYN
                                   0112 = Private medical or general-OB
                                   0113 = Private medical or general-pediatric
                                   0114 = Private medical or general-psychiatric
                                   0115 = Private medical or general-hospice
                                   0116 = Private medical or general-detoxification
                                   0117 = Private medical or general-oncology
                                   0118 = Private medical or general-rehabilitation
                                   0119 = Private medical or general-other
                                   0120 = Semi-private 2 bed (medical or general)
                                          general classification
                                   0121 = Semi-private 2 bed (medical or general)
                                          medical/surgical/GYN
                                   0122 = Semi-private 2 bed (medical or general)-OB
                                   0123 = Semi-private 2 bed (medical or general)-pediatric
                                   0124 = Semi-private 2 bed (medical or general)-psychiatric
                                   0125 = Semi-private 2 bed (medical or general)-hospice
                                   0126 = Semi-private 2 bed (medical or general)
                                          detoxification
                                   0127 = Semi-private 2 bed (medical or general)-oncology
                                   0128 = Semi-private 2 bed (medical or general)
                                          rehabilitation
                                   0129 = Semi-private 2 bed (medical or general)-other
                                   0130 = Semi-private 3 and 4 beds-general classification
                                   0131 = Semi-private 3 and 4 beds-medical/surgical/GYN
                                   0132 = Semi-private 3 and 4 beds-OB
                                   0133 = Semi-private 3 and 4 beds-pediatric
                                   0134 = Semi-private 3 and 4 beds-psychiatric
                                   0135 = Semi-private 3 and 4 beds-hospice
                                   0136 = Semi-private 3 and 4 beds-detoxification
                                   0137 = Semi-private 3 and 4 beds-oncology
                                   0138 = Semi_private 3 and 4 beds-rehabilitation
                                   0139 = Semi-private 3 and 4 beds-other
                                   0140 = Private (deluxe)-general classification
                                   0141 = Private (deluxe)-medical/surgical/GYN
                                   0142 = Private (deluxe)-OB
                                   0143 = Private (deluxe)-pediatric
                                   0144 = Private (deluxe)-psychiatric
                                   0145 = Private (deluxe)-hospice
                                   0146 = Private (deluxe)-detoxification
                                   0147 = Private (deluxe)-oncology
                                   0148 = Private (deluxe)-rehabilitation
                                   0149 = Private (deluxe)-other
1         REV_CNTR_TB                                    Revenue Center Table
          -----------                                    --------------------

                                   0150 = Room&Board ward (medical or general)
                                          general classification
                                   0151 = Room&Board ward (medical or general)
                                          medical/surgical/GYN
                                   0152 = Room&Board ward (medical or general)-OB
                                   0153 = Room&Board ward (medical or general)-pediatric
                                   0154 = Room&Board ward (medical or general)-psychiatric
                                   0155 = Room&Board ward (medical or general)-hospice
                                   0156 = Room&Board ward (medical or general)-detoxification
                                   0157 = Room&Board ward (medical or general)-oncology
                                   0158 = Room&Board ward (medical or general)-rehabilitation
                                   0159 = Room&Board ward (medical or general)-other
                                   0160 = Other Room&Board-general classification
                                   0164 = Other Room&Board-sterile environment
                                   0167 = Other Room&Board-self care
                                   0169 = Other Room&Board-other
                                   0170 = Nursery-general classification
                                   0171 = Nursery-newborn
                                          level I (routine)
                                   0172 = Nursery-premature
                                          newborn-level II (continuing care)
                                   0173 = Nursery-newborn-level III (intermediate care)
                                          (eff 10/96)
                                   0174 = Nursery-newborn-level IV (intensive care)
                                          (eff 10/96)
                                   0175 = Nursery-neonatal ICU (obsolete eff 10/96)
                                   0179 = Nursery-other
                                   0180 = Leave of absence-general classification
                                   0182 = Leave of absence-patient convenience charges
                                          billable
                                   0183 = Leave of absence-therapeutic leave
                                   0184 = Leave of absence-ICF mentally retarded-any reason
                                   0185 = Leave of absence-nursing home (hospitalization)
                                   0189 = Leave of absence-other leave of absence
                                   0190 = Subacute care - general classification
                                          (eff. 10/97)
                                   0191 = Subacute care - level I (eff. 10/97)
                                   0192 = Subacute care - level II (eff. 10/97)
                                   0193 = Subacute care - level III (eff. 10/97)
                                   0194 = Subacute care - level IV (eff. 10/97)
                                   0199 = Subacute care - other (eff 10/97)
                                   0200 = Intensive care-general classification
                                   0201 = Intensive care-surgical
                                   0202 = Intensive care-medical
                                   0203 = Intensive care-pediatric
                                   0204 = Intensive care-psychiatric
                                   0206 = Intensive care-post ICU; redefined as
                                          intermediate ICU (eff 10/96)
                                   0207 = Intensive care-burn care
                                   0208 = Intensive care-trauma
                                   0209 = Intensive care-other intensive care
                                   0210 = Coronary care-general classification
                                   0211 = Coronary care-myocardial infraction
                                   0212 = Coronary care-pulmonary care
                                   0213 = Coronary care-heart transplant
                                   0214 = Coronary care-post CCU; redefined as
                                          intermediate CCU (eff 10/96)
                                   0219 = Coronary care-other coronary care
1         REV_CNTR_TB                                    Revenue Center Table
          -----------                                    --------------------

                                   0220 = Special charges-general classification
                                   0221 = Special charges-admission charge
                                   0222 = Special charges-technical support charge
                                   0223 = Special charges-UR service charge
                                   0224 = Special charges-late discharge, medically
                                          necessary
                                   0229 = Special charges-other special charges
                                   0230 = Incremental nursing charge rate-general
                                          classification
                                   0231 = Incremental nursing charge rate-nursery
                                   0232 = Incremental nursing charge rate-OB
                                   0233 = Incremental nursing charge rate-ICU (include
                                          transitional care)
                                   0234 = Incremental nursing charge rate-CCU (include
                                          transitional care)
                                   0235 = Incremental nursing charge rate-hospice
                                   0239 = Incremental nursing charge rate-other
                                   0240 = All inclusive ancillary-general classification
                                   0241 = All inclusive ancillary-basic
                                   0242 = All inclusive ancillary-comprehensive
                                   0243 = All inclusive ancillary-specialty
                                   0249 = All inclusive ancillary-other inclusive ancillary
                                   0250 = Pharmacy-general classification
                                   0251 = Pharmacy-generic drugs
                                   0252 = Pharmacy-nongeneric drugs
                                   0253 = Pharmacy-take home drugs
                                   0254 = Pharmacy-drugs incident to other diagnostic service-
                                          subject to payment limit
                                   0255 = Pharmacy-drugs incident to radiology-
                                          subject to payment limit
                                   0256 = Pharmacy-experimental drugs
                                   0257 = Pharmacy-non-prescription
                                   0258 = Pharmacy-IV solutions
                                   0259 = Pharmacy-other pharmacy
                                   0260 = IV therapy-general classification
                                   0261 = IV therapy-infusion pump
                                   0262 = IV therapy-pharmacy services (eff 10/94)
                                   0263 = IV therapy-drug supply/delivery (eff 10/94)
                                   0264 = IV therapy-supplies (eff 10/94)
                                   0269 = IV therapy-other IV therapy
                                   0270 = Medical/surgical supplies-general classification
                                          (also see 062X)
                                   0271 = Medical/surgical supplies-nonsterile supply
                                   0272 = Medical/surgical supplies-sterile supply
                                   0273 = Medical/surgical supplies-take home supplies
                                   0274 = Medical/surgical supplies-prosthetic/orthotic
                                          devices
                                   0275 = Medical/surgical supplies-pace maker
                                   0276 = Medical/surgical supplies-intraocular lens
                                   0277 = Medical/surgical supplies-oxygen-take home
                                   0278 = Medical/surgical supplies-other implants
                                   0279 = Medical/surgical supplies-other devices
                                   0280 = Oncology-general classification
                                   0289 = Oncology-other oncology
                                   0290 = DME (other than renal)-general classification
                                   0291 = DME (other than renal)-rental
                                   0292 = DME (other than renal)-purchase of new DME
                                   0293 = DME (other than renal)-purchase of used DME
1         REV_CNTR_TB                                    Revenue Center Table
          -----------                                    --------------------

                                   0294 = DME (other than renal)-related to and listed as DME
                                   0299 = DME (other than renal)-other
                                   0300 = Laboratory-general classification
                                   0301 = Laboratory-chemistry
                                   0302 = Laboratory-immunology
                                   0303 = Laboratory-renal patient (home)
                                   0304 = Laboratory-non-routine dialysis
                                   0305 = Laboratory-hematology
                                   0306 = Laboratory-bacteriology & microbiology
                                   0307 = Laboratory-urology
                                   0309 = Laboratory-other laboratory
                                   0310 = Laboratory pathological-general classification
                                   0311 = Laboratory pathological-cytology
                                   0312 = Laboratory pathological-histology
                                   0314 = Laboratory pathological-biopsy
                                   0319 = Laboratory pathological-other
                                   0320 = Radiology diagnostic-general classification
                                   0321 = Radiology diagnostic-angiocardiography
                                   0322 = Radiology diagnostic-arthrography
                                   0323 = Radiology diagnostic-arteriography
                                   0324 = Radiology diagnostic-chest X-ray
                                   0329 = Radiology diagnostic-other
                                   0330 = Radiology therapeutic-general classification
                                   0331 = Radiology therapeutic-chemotherapy injected
                                   0332 = Radiology therapeutic-chemotherapy oral
                                   0333 = Radiology therapeutic-radiation therapy
                                   0335 = Radiology therapeutic-chemotherapy IV
                                   0339 = Radiology therapeutic-other
                                   0340 = Nuclear medicine-general classification
                                   0341 = Nuclear medicine-diagnostic
                                   0342 = Nuclear medicine-therapeutic
                                   0349 = Nuclear medicine-other
                                   0350 = Computed tomographic (CT) scan-general
                                          classification
                                   0351 = CT scan-head scan
                                   0352 = CT scan-body scan
                                   0359 = CT scan-other CT scans
                                   0360 = Operating room services-general classification
                                   0361 = Operating room services-minor surgery
                                   0362 = Operating room services-organ transplant,
                                          other than kidney
                                   0367 = Operating room services-kidney transplant
                                   0369 = Operating room services-other operating room
                                          services
                                   0370 = Anesthesia-general classification
                                   0371 = Anesthesia-incident to RAD and
                                          subject to the payment limit
                                   0372 = Anesthesia-incident to other diagnostic service
                                          and subject to the payment limit
                                   0374 = Anesthesia-acupuncture
                                   0379 = Anesthesia-other anesthesia
                                   0380 = Blood-general classification
                                   0381 = Blood-packed red cells
                                   0382 = Blood-whole blood
                                   0383 = Blood-plasma
                                   0384 = Blood-platelets
                                   0385 = Blood-leukocytes
                                   0386 = Blood-other components
1         REV_CNTR_TB                                    Revenue Center Table
          -----------                                    --------------------

                                   0387 = Blood-other derivatives (cryopricipatates)
                                   0389 = Blood-other blood
                                   0390 = Blood storage and processing-general
                                          classification
                                   0391 = Blood storage and processing-blood
                                          administration
                                   0399 = Blood storage and processing-other
                                   0400 = Other imaging services-general classification
                                   0401 = Other imaging services-diagnostic mammography
                                   0402 = Other imaging services-ultrasound
                                   0403 = Other imaging services-screening mammography
                                          (eff 1/1/91)
                                   0404 = Other imaging services-positron emission
                                          tomography (eff 10/94)
                                   0409 = Other imaging services-other
                                   0410 = Respiratory services-general classification
                                   0412 = Respiratory services-inhalation services
                                   0413 = Respiratory services-hyperbaric oxygen therapy
                                   0419 = Respiratory services-other
                                   0420 = Physical therapy-general classification
                                   0421 = Physical therapy-visit charge
                                   0422 = Physical therapy-hourly charge
                                   0423 = Physical therapy-group rate
                                   0424 = Physical therapy-evaluation or re-evaluation
                                   0429 = Physical therapy-other
                                   0430 = Occupational therapy-general classification
                                   0431 = Occupational therapy-visit charge
                                   0432 = Occupational therapy-hourly charge
                                   0433 = Occupational therapy-group rate
                                   0434 = Occupational therapy-evaluation or re-evaluation
                                   0439 = Occupational therapy-other (may include
                                          restorative therapy)
                                   0440 = Speech language pathology-general classification
                                   0441 = Speech language pathology-visit charge
                                   0442 = Speech language pathology-hourly charge
                                   0443 = Speech language pathology-group rate
                                   0444 = Speech language pathology-evaluation or
                                          re-evaluation
                                   0449 = Speech language pathology-other
                                   0450 = Emergency room-general classification
                                   0451 = Emergency room-emtala emergency medical screening
                                          services (eff 10/96)
                                   0452 = Emergency room-ER beyond emtala screening
                                          (eff 10/96)
                                   0456 = Emergency room-urgent care (eff 10/96)
                                   0459 = Emergency room-other
                                   0460 = Pulmonary function-general classification
                                   0469 = Pulmonary function-other
                                   0470 = Audiology-general classification
                                   0471 = Audiology-diagnostic
                                   0472 = Audiology-treatment
                                   0479 = Audiology-other
                                   0480 = Cardiology-general classification
                                   0481 = Cardiology-cardiac cath lab
                                   0482 = Cardiology-stress test
                                   0483 = Cardiology-Echocardiology
                                   0489 = Cardiology-other
                                   0490 = Ambulatory surgical care-general classification
1         REV_CNTR_TB                                    Revenue Center Table
          -----------                                    --------------------

                                   0499 = Ambulatory surgical care-other
                                   0500 = Outpatient services-general classification
                                          (deleted 9/93)
                                   0509 = Outpatient services-other (deleted 9/93)
                                   0510 = Clinic-general classification
                                   0511 = Clinic-chronic pain center
                                   0512 = Clinic-dental center
                                   0513 = Clinic-psychiatric
                                   0514 = Clinic-OB-GYN
                                   0515 = Clinic-pediatric
                                   0516 = Clinic-urgent care clinic (eff 10/96)
                                   0517 = Clinic-family practice clinic (eff 10/96)
                                   0519 = Clinic-other
                                   0520 = Free-standing clinic-general classification
                                   0521 = Free-standing clinic-rural health clinic
                                   0522 = Free-standing clinic-rural health home
                                   0523 = Free-standing clinic-family practice
                                   0526 = Free-standing clinic-urgent care (eff 10/96)
                                   0529 = Free-standing clinic-other
                                   0530 = Osteopathic services-general classification
                                   0531 = Osteopathic services-osteopathic therapy
                                   0539 = Osteopathic services-other
                                   0540 = Ambulance-general classification
                                   0541 = Ambulance-supplies
                                   0542 = Ambulance-medical transport
                                   0543 = Ambulance-heart mobile
                                   0544 = Ambulance-oxygen
                                   0545 = Ambulance-air ambulance
                                   0546 = Ambulance-neo-natal ambulance
                                   0547 = Ambulance-pharmacy
                                   0548 = Ambulance-telephone transmission EKG
                                   0549 = Ambulance-other
                                   0550 = Skilled nursing-general classification
                                   0551 = Skilled nursing-visit charge
                                   0552 = Skilled nursing-hourly charge
                                   0559 = Skilled nursing-other
                                   0560 = Medical social services-general classification
                                   0561 = Medical social services-visit charge
                                   0562 = Medical social services-hourly charges
                                   0569 = Medical social services-other
                                   0570 = Home health aid (home health)-general
                                          classification
                                   0571 = Home health aid (home health)-visit charge
                                   0572 = Home health aid (home health)-hourly charge
                                   0579 = Home health aid (home health)-other
                                   0580 = Other visits (home health)-general
                                          classification (under HHPPS, not allowed
                                          as covered charges)
                                   0581 = Other visits (home health)-visit charge
                                          (under HHPPS, not allowed as covered charges)
                                   0582 = Other visits (home health)-hourly charge
                                          (under HHPPS, not allowed as covered charges)
                                   0589 = Other visits (home health)-other
                                          (under HHPPS, not allowed as covered charges)
                                   0590 = Units of service (home health)-general
                                          classification (under HHPPS, not allowed
                                          as covered charges)
                                   0599 = Units of service (home health)-other
1         REV_CNTR_TB                                    Revenue Center Table
          -----------                                    --------------------

                                          (under HHPPS, not allowed as covered charges)
                                   0600 = Oxygen-general classification
                                   0601 = Oxygen-stat or port equip/supply or count
                                   0602 = Oxygen-stat/equip/under 1 LPM
                                   0603 = Oxygen-stat/equip/over 4 LPM
                                   0604 = Oxygen-stat/equip/portable add-on
                                   0610 = Magnetic resonance technology (MRT)-general
                                          classification
                                   0611 = MRT/MRI-brain (including brainstem)
                                   0612 = MRT/MRI-spinal cord (including spine)
                                   0614 = MRT/MRI-other
                                   0615 = MRT/MRA-Head and Neck
                                   0616 = MRT/MRA-Lower Extremities
                                   0618 = MRT/MRA-other
                                   0619 = MRT/Other MRI
                                   0621 = Medical/surgical supplies-incident to radiology-
                                          subject to the payment limit - extension of 027X
                                   0622 = Medical/surgical supplies-incident to other
                                          diagnostic service-subject to the payment limit -
                                          extension of 027X
                                   0623 = Medical/surgical supplies-surgical dressings
                                          (eff 1/95) - extension of 027X
                                   0624 = Medical/surgical supplies-medical investigational
                                          devices and procedures with FDA approved IDE's
                                          (eff 10/96) - extension of 027X
                                   0630 = Drugs requiring specific identification-general
                                          classification
                                   0631 = Drugs requiring specific identification-single drug
                                          source (eff 9/93)
                                   0632 = Drugs requiring specific identification-multiple drug
                                          source (eff 9/93)
                                   0633 = Drugs requiring specific identification-restrictive
                                          prescription (eff 9/93)
                                   0634 = Drugs requiring specific identification-EPO under
                                          10,000 units
                                   0635 = Drugs requiring specific identification-EPO 10,000
                                          units or more
                                   0636 = Drugs requiring specific identification-detailed
                                          coding (eff 3/92)
                                   0637 = Self-administered drugs administered in an
                                          emergency situation - not requiring detailed
                                          coding
                                   0640 = Home IV therapy-general classification
                                          (eff 10/94)
                                   0641 = Home IV therapy-nonroutine nursing
                                          (eff 10/94)
                                   0642 = Home IV therapy-IV site care, central line
                                          (eff 10/94)
                                   0643 = Home IV therapy-IV start/change peripheral line
                                          (eff 10/94)
                                   0644 = Home IV therapy-nonroutine nursing, peripheral line
                                          (eff 10/94)
                                   0645 = Home IV therapy-train patient/caregiver, central
                                          line (eff 10/94)
                                   0646 = Home IV therapy-train disabled patient, central
                                          line (eff 10/94)
                                   0647 = Home IV therapy-train patient/caregiver, peripheral
                                          line (eff 10/94)
1         REV_CNTR_TB                                    Revenue Center Table
          -----------                                    --------------------

                                   0648 = Home IV therapy-train disabled patient, peripheral
                                          line (eff 10/94)
                                   0649 = Home IV therapy-other IV therapy services
                                          (eff 10/94)
                                   0650 = Hospice services-general classification
                                   0651 = Hospice services-routine home care
                                   0652 = Hospice services-continuous home care-1/2
                                   0655 = Hospice services-inpatient care
                                   0656 = Hospice services-general inpatient care
                                          (non-respite)
                                   0657 = Hospice services-physician services
                                   0659 = Hospice services-other
                                   0660 = Respite care (HHA)-general classification
                                          (eff 9/93)
                                   0661 = Respite care (HHA)-hourly charge/skilled nursing
                                          (eff 9/93)
                                   0662 = Respite care (HHA)-hourly charge/home health aide/
                                          homemaker (eff 9/93)
                                   0670 = OP special residence charges - general
                                          classification
                                   0671 = OP special residence charges - hospital based
                                   0672 = OP special residence charges - contracted
                                   0679 = OP special residence charges - other special
                                          residence charges
                                   0700 = Cast room-general classification
                                   0709 = Cast room-other
                                   0710 = Recovery room-general classification
                                   0719 = Recovery room-other
                                   0720 = Labor room/delivery-general classification
                                   0721 = Labor room/delivery-labor
                                   0722 = Labor room/delivery-delivery
                                   0723 = Labor room/delivery-circumcision
                                   0724 = Labor room/delivery-birthing center
                                   0729 = Labor room/delivery-other
                                   0730 = EKG/ECG-general classification
                                   0731 = EKG/ECG-Holter moniter
                                   0732 = EKG/ECG-telemetry (include fetal monitering until
                                          9/93)
                                   0739 = EKG/ECG-other
                                   0740 = EEG-general classification
                                   0749 = EEG (electroencephalogram)-other
                                   0750 = Gastro-intestinal services-general classification
                                   0759 = Gastro-intestinal services-other
                                   0760 = Treatment or observation room-general
                                          classification
                                   0761 = Treatment or observation room-treatment room
                                          (eff 9/93)
                                   0762 = Treatment or observation room-observation room
                                          (eff 9/93)
                                   0769 = Treatment or observation room-other
                                   0770 = Preventative care services-general classification
                                          (eff 10/94)
                                   0771 = Preventative care services-vaccine administration
                                          (eff 10/94)
                                   0779 = Preventative care services-other (eff 10/94)
                                   0780 = Telemedicine - general classification
                                          (eff 10/97)
                                   0789 = Telemedicine - telemedicine (eff 10/97)
1         REV_CNTR_TB                                    Revenue Center Table
          -----------                                    --------------------

                                   0790 = Lithotripsy-general classification
                                   0799 = Lithotripsy-other
                                   0800 = Inpatient renal dialysis-general classification
                                   0801 = Inpatient renal dialysis-inpatient hemodialysis
                                   0802 = Inpatient renal dialysis-inpatient peritoneal
                                          (non-CAPD)
                                   0803 = Inpatient renal dialysis-inpatient CAPD
                                   0804 = Inpatient renal dialysis-inpatient CCPD
                                   0809 = Inpatient renal dialysis-other inpatient dialysis
                                   0810 = Organ acquisition-general classification
                                   0811 = Organ acquisition-living donor (eff 10/94);
                                          prior to 10/94, defined as living donor kidney
                                   0812 = Organ acquisition-cadaver donor (eff 10/94);
                                          prior to 10/94, defined as cadaver donor kidney
                                   0813 = Organ acquisition-unknown donor (eff 10/94)
                                          prior to 10/94, defined as unknown donor kidney
                                   0814 = Organ acquisition - unsuccessful organ search-
                                          donor bank charges (eff 10/94); prior to 10/94,
                                          defined as other kidney acquisition
                                   0815 = Organ acquisition-cadaver donor-heart
                                          (obsolete, eff 10/94)
                                   0816 = Organ acquisition-other heart acquisition
                                          (obsolete, eff 10/94)
                                   0817 = Organ acquisition-donor-liver
                                          (obsolete, eff 10/94)
                                   0819 = Organ acquisition-other donor (eff 10/94);
                                          prior to 10/94, defined as other
                                   0820 = Hemodialysis OP or home dialysis-general
                                          classification
                                   0821 = Hemodialysis OP or home dialysis-hemodialysis-
                                          composite or other rate
                                   0822 = Hemodialysis OP or home dialysis-home supplies
                                   0823 = Hemodialysis OP or home dialysis-home equipment
                                   0824 = Hemodialysis OP or home dialysis-maintenance/100%
                                   0825 = Hemodialysis OP or home dialysis-support services
                                   0829 = Hemodialysis OP or home dialysis-other
                                   0830 = Peritoneal dialysis OP or home-general
                                          classification
                                   0831 = Peritoneal dialysis OP or home-peritoneal-
                                          composite or other rate
                                   0832 = Peritoneal dialysis OP or home-home supplies
                                   0833 = Peritoneal dialysis OP or home-home equipment
                                   0834 = Peritoneal dialysis OP or home-maintenance/100%
                                   0835 = Peritoneal dialysis OP or home-support services
                                   0839 = Peritoneal dialysis OP or home-other
                                   0840 = CAPD outpatient-general classification
                                   0841 = CAPD outpatient-CAPD/composite or other rate
                                   0842 = CAPD outpatient-home supplies
                                   0843 = CAPD outpatient-home equipment
                                   0844 = CAPD outpatient-maintenance/100%
                                   0845 = CAPD outpatient-support services
                                   0849 = CAPD outpatient-other
                                   0850 = CCPD outpatient-general classification
                                   0851 = CCPD outpatient-CCPD/composite or other rate
                                   0852 = CCPD outpatient-home supplies
                                   0853 = CCPD outpatient-home equipment
                                   0854 = CCPD outpatient-maintenance/100%
                                   0855 = CCPD outpatient-support services
1         REV_CNTR_TB                                    Revenue Center Table
          -----------                                    --------------------

                                   0859 = CCPD outpatient-other
                                   0880 = Miscellaneous dialysis-general classification
                                   0881 = Miscellaneous dialysis-ultrafiltration
                                   0882 = Miscellaneous dialysis-home dialysis aide visit
                                          (eff 9/93)
                                   0889 = Miscellaneous dialysis-other
                                   0890 = Other donor bank-general classification; changed to
                                          reserved for national assignment (eff 4/94)
                                   0891 = Other donor bank-bone; changed to
                                          reserved for national assignment (eff 4/94)
                                   0892 = Other donor bank-organ (other than kidney); changed
                                          to reserved for national assignment (eff 4/94)
                                   0893 = Other donor bank-skin; changed to
                                          reserved for national assignment (eff 4/94)
                                   0899 = Other donor bank-other; changed to
                                          reserved for national assignment (eff 4/94)
                                   0900 = Psychiatric/psychological treatments-general
                                          classification
                                   0901 = Psychiatric/psychological treatments-electroshock
                                          treatment
                                   0902 = Psychiatric/psychological treatments-milieu
                                          therapy
                                   0903 = Psychiatric/psychological treatments-play
                                          therapy
                                   0904 = Psychiatric/psychological treatments-activity
                                          therapy (eff 4/94)
                                   0909 = Psychiatric/psychological treatments-other
                                   0910 = Psychiatric/psychological services-general
                                          classification
                                   0911 = Psychiatric/psychological services-rehabilitation
                                   0912 = Psychiatric/psychological services-day care-
                                          redefined 10/97 to less Intensive
                                   0913 = Psychiatric/psychological services-night care
                                          redefined 10/97 to Intensive
                                   0914 = Psychiatric/psychological services-individual
                                          therapy
                                   0915 = Psychiatric/psychological services-group therapy
                                   0916 = Psychiatric/psychological services-family therapy
                                   0917 = Psychiatric/psychological services-biofeedback
                                   0918 = Psychiatric/psychological services-testing
                                   0919 = Psychiatric/psychological services-other
                                   0920 = Other diagnostic services-general classification
                                   0921 = Other diagnostic services-peripheral vascular lab
                                   0922 = Other diagnostic services-electromyelogram
                                   0923 = Other diagnostic services-pap smear
                                   0924 = Other diagnostic services-allergy test
                                   0925 = Other diagnostic services-pregnancy test
                                   0929 = Other diagnostic services-other
                                   0940 = Other therapeutic services-general classification
                                   0941 = Other therapeutic services-recreational therapy
                                   0942 = Other therapeutic services-education/training
                                          (include diabetes diet training)
                                   0943 = Other therapeutic services-cardiac rehabilitation
                                   0944 = Other therapeutic services-drug rehabilitation
                                   0945 = Other therapeutic services-alcohol
                                          rehabilitation
                                   0946 = Other therapeutic services-routine complex
                                          medical equipment
1         REV_CNTR_TB                                    Revenue Center Table
          -----------                                    --------------------

                                   0947 = Other therapeutic services-ancillary complex
                                          medical equipment (eff 3/92)
                                   0949 = Other therapeutic services-other
                                   0951 = Professional Fees-athletic training
                                   0952 = Professional Fees-kinesiotherapy
                                   0960 = Professional fees-general classification
                                   0961 = Professional fees-psychiatric
                                   0962 = Professional fees-ophthalmology
                                   0963 = Professional fees-anesthesiologist (MD)
                                   0964 = Professional fees-anesthetist (CRNA)
                                   0969 = Professional fees-other
                                   0971 = Professional fees-laboratory
                                   0972 = Professional fees-radiology diagnostic
                                   0973 = Professional fees-radiology therapeutic
                                   0974 = Professional fees-nuclear medicine
                                   0975 = Professional fees-operating room
                                   0976 = Professional fees-respiratory therapy
                                   0977 = Professional fees-physical therapy
                                   0978 = Professional fees-occupational therapy
                                   0979 = Professional fees-speech pathology
                                   0981 = Professional fees-emergency room
                                   0982 = Professional fees-outpatient services
                                   0983 = Professional fees-clinic
                                   0984 = Professional fees-medical social services
                                   0985 = Professional fees-EKG
                                   0986 = Professional fees-EEG
                                   0987 = Professional fees-hospital visit
                                   0988 = Professional fees-consultation
                                   0989 = Professional fees-private duty nurse
                                   0990 = Patient convenience items-general classification
                                   0991 = Patient convenience items-cafeteria/guest tray
                                   0992 = Patient convenience items-private linen service
                                   0993 = Patient convenience items-telephone/telegraph
                                   0994 = Patient convenience items-tv/radio
                                   0995 = Patient convenience items-nonpatient room rentals
                                   0996 = Patient convenience items-late discharge charge
                                   0997 = Patient convenience items-admission kits
                                   0998 = Patient convenience items-beauty shop/barber
                                   0999 = Patient convenience items-other

                                   NOTE: Following Revenue Codes reported
                                   for NHCMQ (RUGS) demo claims effective
                                   2/96.

                                   9000 = RUGS-no MDS assessment available
                                   9001 = Reduced physical functions-
                                          RUGS PA1/ADL index of 4-5
                                   9002 = Reduced physical functions-
                                          RUGS PA2/ADL index of 4-5
                                   9003 = Reduced physical functions-
                                          RUGS PB1/ADL index of 6-8
                                   9004 = Reduced physical functions-
                                          RUGS PB2/ADL index of 6-8
                                   9005 = Reduced physical functions-
                                          RUGS PC1/ADL index of 9-10
                                   9006 = Reduced physical functions-
                                          RUGS PC2/ADL index of 9-10
                                   9007 = Reduced physical functions-
1         REV_CNTR_TB                                    Revenue Center Table
          -----------                                    --------------------

                                          RUGS PD1/ADL index of 11-15
                                   9008 = Reduced physical functions-
                                          RUGS PD2/ADL index of 11-15
                                   9009 = Reduced physical functions-
                                          RUGS PE1/ADL index of 16-18
                                   9010 = Reduced physical functions-
                                          RUGS PE2/ADL index of 16-18
                                   9011 = Behavior only problems-
                                          RUGS BA1/ADL index of 4-5
                                   9012 = Behavior only problems-
                                          RUGS BA2/ADL index of 4-5
                                   9013 = Behavior only problems-
                                          RUGS BB1/ADL index of 6-10
                                   9014 = Behavior only problems-
                                          RUGS BB2/ADL index of 6-10
                                   9015 = Impaired cognition-
                                          RUGS IA1/ADL index of 4-5
                                   9016 = Impaired cognition-
                                          RUGS IA2/ADL index of 4-5
                                   9017 = Impaired cognition-
                                          RUGS IB1/ADL index of 6-10
                                   9018 = Impaired cognition-
                                          RUGS IB2/ADL index of 6-10
                                   9019 = Clinically complex-
                                          RUGS CA1/ADL index of 4-5
                                   9020 = Clinically complex-
                                          RUGS CA2/ADL index of 4-5d
                                   9021 = Clinically complex-
                                          RUGS CB1/ADL index of 6-10
                                   9022 = Clinically complex-
                                          RUGS CB2/ADL index of 6-10d
                                   9023 = Clinically complex-
                                          RUGS CC1/ADL index of 11-16
                                   9024 = Clinically complex-
                                          RUGS CC2/ADL index of 11-16d
                                   9025 = Clinically complex-
                                          RUGS CD1/ADL index of 17-18
                                   9026 = Clinically complex-
                                          RUGS CD2/ADL index of 17-18d
                                   9027 = Special care-
                                          RUGS SSA/ADL index of 7-13
                                   9028 = Special care-
                                          RUGS SSB/ADL index of 14-16
                                   9029 = Special care-
                                          RUGS SSC/ADL index of 17-18
                                   9030 = Extensive services-
                                          RUGS SE1/1 procedure
                                   9031 = Extensive services-
                                          RUGS SE2/2 procedures
                                   9032 = Extensive services-
                                          RUGS SE3/3 procedures
                                   9033 = Low rehabilitation-
                                          RUGS RLA/ADL index of 4-11
                                   9034 = Low rehabilitation-
                                          RUGS RLB/ADL index of 12-18
                                   9035 = Medium rehabilitation-
                                          RUGS RMA/ADL index of 4-7
                                   9036 = Medium rehabilitation-
1         REV_CNTR_TB                                    Revenue Center Table
          -----------                                    --------------------

                                          RUGS RMB/ADL index of 8-15
                                   9037 = Medium rehabilitation-
                                          RUGS RMC/ADL index of 16-18
                                   9038 = High rehabilitation-
                                          RUGS RHA/ADL index of 4-7
                                   9039 = High rehabilitation-
                                          RUGS RHB/ADL index of 8-11
                                   9040 = High rehabilitation-
                                          RUGS RHC/ADL index of 12-14
                                   9041 = High rehabilitation-
                                          RUGS RHD/ADL index of 15-18
                                   9042 = Very high rehabilitation-
                                          RUGS RVA/ADL index of 4-7
                                   9043 = Very high rehabilitation-
                                          RUGS RVB/ADL index of 8-13
                                   9044 = Very high rehabilitation-
                                          RUGS RVC/ADL index of 14-18

                                   ***Changes effective for providers entering***
                                   **RUGS Demo Phase III as of 1/1/97 or later**

                                   9019 = Clinically complex-
                                          RUGS CA1/ADL index of 11
                                   9020 = Clinically complex-
                                          RUGS CA2/ADL index of 11D
                                   9021 = Clinically complex-
                                          RUGS CB1/ADL index of 12-16
                                   9022 = Clinically complex-
                                          RUGS CB2/ADL index of 12-16D
                                   9023 = Clinically complex-
                                          RUGS CC1/ADL index of 17-18
                                   9024 = Clinically complex-
                                          RUGS CC2/ADL index of 17-18D
                                   9025 = Special care-
                                          RUGS SSA/ADL index of 14
                                   9026 = Special care-
                                          RUGS SSB/ADL index of 15-16
                                   9027 = Special care-
                                          RUGS SSC/ADL index of 17-18
                                   9028 = Extensive services-
                                          RUGS SE1/ADL index 7-18/1 procedure
                                   9029 = Extensive services-
                                          RUGS SE2/ADL index 7-18/2 procedures
                                   9030 = Extensive services-
                                          RUGS SE3/ADL index 7-18/3 procedures
                                   9031 = Low rehabilitation-
                                          RUGS RLA/ADL index of 4-13
                                   9032 = Low rehabilitation-
                                          RUGS RLB/ADL index of 14-18
                                   9033 = Medium rehabilitation-
                                          RUGS RMA/ADL index of 4-7
                                   9034 = Medium rehabilitation-
                                          RUGS RMB/ADL index of 8-14
                                   9035 = Medium rehabilitation-
                                          RUGS RMC/ADL index of 15-18
                                   9036 = High rehabilitation-
                                          RUGS RHA/ADL index of 4-7
                                   9037 = High rehabilitation-
1         REV_CNTR_TB                                    Revenue Center Table
          -----------                                    --------------------

                                          RUGS RHB/ADL index of 8-12
                                   9038 = High rehabilitation-
                                          RUGS RHC/ADL index of 13-18
                                   9039 = Very High rehabilitation-
                                          RUGS RVA/ADL index of 4-8
                                   9040 = Very high rehabilitation-
                                          RUGS RVB/ADL index of 9-15
                                   9041 = Very high rehabilitation-
                                          RUGS RVC/ADL index of 16
                                   9042 = Very high rehabilitation-
                                          RUGS RUA/ADL index of 4-8
                                   9043 = Very high rehabilitation-
                                          RUGS RUB/ADL index of 9-15
                                   9044 = Ultra high rehabilitation-
                                          RUGS RUC/ADL index of 16-18
