CHARGEBACK DATA DICTIONARY 

FIELD NAME 

LOCATION START END 

FIELD TYPE CBSUM-REC 

NAME 

DESCRIPTION DEFINITION 

ESAFECS 

CB AGENCY KEY 1 7 NUM/7 PREFIX Department indicator and accounting 

code 

ROLLUP CODE 8 11 NUM/4 AGENCYROLLUP-CODE Chargeback agency rollup code CASE NUMBER 12 20 NUM/9 CASE-NO Unique numeric identifier for each case RECORD TYPE 21 21 NUM/1 REC TYPE Appropriate record type 1 – SUMMARY 

2 – DETAIL 

DISTRICT OFFICE 22 23 NUM/2 LAST-PYMT-DIST Owning district office LAST PAYMENT DATE 

24 31 DATE/8 LAST-PYMTDATE Date of the latest transaction YYYYMMDD 

LAST SERVICE INDICATOR 

32 32 CHAR/1 SRCE-CP-OR-BP Latest transaction’s service type. B - MEDICAL 

C - COMPENSX – CANCELL

LAST ROLL 33 33 CHAR/1 SRCE-CP-LASTROLL Latest roll type for which the claimant was last paid S - SUPPLEME

P – PERIODIC D – DEATH 

If Last Service could be either: B - NORMAL MTHE SYSTEM C - CANCELLD - CASH DEPM - MANUAL 

PAYMENT TYPE 34 34 CHAR/1 SRCE-PYMTTYPE Type of transaction for a case when it is a bill pay or compensation. This is 

dependent upon the last service indicator 

If Last Service could be either: 0 = ADJUSTM1 = DISABILIT2 = LEAVE BU3 = WEC 4 = DIRECT PA5 = INCARCER6 = DEATH EX7 = DEATH 8 = MANUAL 9 = SCHEDULA = DEATH LUB = CASH RECC = FECS PAY

SUMMARY RECORD

CASE NUMBER 35 43 NUM/9 CBSUM-CASE- Use the case type field to map the cases 
FIELD NAME 

LOCATION START END 

FIELD TYPE CBSUM-REC 

NAME 

DESCRIPTION DEFINITION 

ESAFECS 

PTR to the master case number. 

By default, if no master case number exists, then this section shall be blank. If the case type is ‘S’ or ‘M’, then this section shall indicate the master case number. 

CASE TYPE 44 44 CHAR/1 CASE-PTR-TYPE Relationship between this case and any 

other cases in the file 

I = INDEPENDM = MASTER S = SUBSIDIA

CLAIMANT NAME 

45 87 CHAR/43 CLM-NAME Claimant’s full name LAST NAME 

FIRST NAME MIDDLE NAM

SOCIAL SECURITY 

88 96 NUM/9 SSAN Claimant’s social security number 

GENDER 97 97 CHAR/1 SEX Claimant’s gender M – MALE 

F – FEMALE 

DATE OF BIRTH 98 105 DATE/8 DOB Claimant’s date of birth YYYYMMDD CLAIMANT’S ADDRESS 

106 167 CHAR/50 CLM-ADDR Claimant’s full address CLM-ADDR-S

CLM-ADDR-CCLM-ADDR-SCLM-ADDR-Z

OCCUPATIONAL CODE 

168 172 CHAR/5 OCC-CODE Claimant’s job at the time of injury 

AGENCY CODE 173 176 NUM/4 AGENCY-CODE Employing agency code BUILDING CODE 177 178 NUM/2 AGENCY-BLDG Building location code INTERNAL TO GEOGRAPHIC LOCATION 

179 187 CHAR/9 GEO-LOC Geographic location where the injury or 

death took place 

DATE OF INJURY 188 195 DATE/8 DOI Employee’s date of injury YYYYMMDD DATE OF DEATH 196 203 DATE/8 DOD Employee’s date of death YYYYMMDD INJURY OF ZIP 204 208 NUM/5 INJ-ZIP Zip code where the injury took place EXTENT OF INJURY 

209 209 CHAR/1 EXTENT-INJ Seriousness of the injury 1 = NO TIME L

2 = FIRST AID 8 = INOCULATX = NON-FAT0 = FATAL 

STATUS OF INJURY 

210 210 NUM/1 STATUS-INJ Status of injury 0 = NON-FATA

1 = FATAL 

FATAL INDICATOR 

211 211 NUM/1 FATAL-IND Relationship between the employee’s 

death and the claimed injury 

BLANK = NO 0 = DEATH NO1 = DEATH RE2 = DEATH RENOT SEVERE 

ANATOMICAL LOCATION 

212 213 CHAR/2 ANAT-LOC Anatomical location of the injury 
FIELD NAME 

LOCATION START END 

FIELD TYPE CBSUM-REC 

NAME 

DESCRIPTION DEFINITION 

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NATURE OF INJURY 

214 215 CHAR/2 NATURE Nature of injury 

CAUSE OF INJURY 

216 217 NUM/2 CAUSE Cause of injury 

PREVIOUS OWNERS 

218 224 NUM/7 CURR-PREVOWNERS NO LONGER USED BLANK 

DATE RECEIVED 225 232 DATE/8 DATE-REC Date the initial claim form was received 

(date stamped) 

YYYYMMDD 

FORMS RECEIVED 

233 234 NUM/2 FORMS-RECVD Type of claim form used at the time the 

case was created 

1 = CA-1 2 = CA-2 5 = CA-5 

DATE CASE CREATED 

235 242 DATE/8 DATE-CASECREATED Date the case was created in the district office YYYYMMDD 

ADJUDICATED STATUS 

243 244 CHAR/2 ADJUD-STATUS Case’s current adjudication status code 00 = NO STAT

A0 = ACCEPTAC = ACCEPTONLY, MED BAD = ACCEPTDAILY ROLL AUTHORIZED AF = ACCEPTFATAL, DEPENO MED BENAL = ACCEPTLEAVE ELECTAUTHORIZED AM = ACCEPTBENEFITS ONAP = ACCEPTPERIODIC ROAUTHORIZED AR = ADMINIAT = ACCEPTWAGE LOSS CAUTHORIZED DO = DENIEDD1 = DENIED; D2 = DENIED; EMPLOYEE D3 = DENIED; D4 = DENIED: DUTY D5 = DENIED; D6 = DENIED; LONGER USED7 = DENIED: D8 = DENIED; 
FIELD NAME 

LOCATION START END 

FIELD TYPE CBSUM-REC 

NAME 

DESCRIPTION DEFINITION 

ESAFECS 

D9 = DENIED; SU = SUSPENDUD = LEGACY UN = UNADJU

ADJUDICATED STATUS DATE 

245 252 DATE/8 ADJUD-STATUSDATE Date of the most recent adjudication status. YYYYMMDD 

CURRENT CASE STATUS 

253 254 ALPHNUM/2 CURR-CASESTATUS Current case pay status AR = ADMINI

C1= CLOSED, C2 = CLOSEDC3 = CLOSEDC4 = CLOSEDLOST C5 = CLOSEDCL = CLOSEDDE = DEATH RDR = DAILY RMC = MEDICAN = PERIODIC EMPLOYMENUSED)ON = OVERPACOMP OP = OVERPAROLL PI = CASE ON PR) (NO LON

PN = PERIODICAPACITY PR = PERIODIPS = SCHEDUPW = PERIODPV = PERIODIPR) (NO LONGRH = NO LONRO = REOPEN RT = CASE RERETIREMENT UD = CLAIM UUN = CLAIM UXX = DESTRO

CURRENT CASE DATE 

255 262 DATE/8 CURR-STATUSDATE Case’s current pay status date YYYYMMDD 

EARLY REFERENCE 

263 264 CHAR/2 EARLY-REF NO LONGER USED BLANK 

CMF CODE 265 265 CHAR/1 CMF-CODE NO LONGER USED BLANK REP. ACCEPTANCE 

266 300 CHAR/35 REP-ACCPTCOND NO LONGER USED BLANK 
FIELD NAME 

LOCATION START END 

FIELD TYPE CBSUM-REC 

NAME 

DESCRIPTION DEFINITION 

ESAFECS 

CONDITION SOURCE OF INJURY 

 301 304 NUM/4 SOURCE-INJURY OSHA injury site 

CA1 SIGNATURE DATE 

305 312 DATE/8 CA1-2-SIG-DATE Date the submitted claim (CA1, CA2, or 

CA5) was signed 

YYYYMMDD 

ACCEPTED CONDITION FLAG 

313 313 CHAR/1 REP-ACCPTCOND-FLAG Whether the reported diagnosis was accepted as compensable N = NOT ACC

Y = ACCEPTE

THIRD PARTY INDICATOR 

314 314 CHAR/1 3RD-PARTY-IND Latest third party insurance, if present 0 = NO 3RD PA

1 = NOT REFE2 = REFERRED 4 = CLOSED; MPURSUE 5 = CLOSED; O6 = SETTLED; 7 = SETTLED; 8 = SETTLED; CREDIT DUE 9 = SETTLED; DUE AGAINST 

REHABILITATION INDICATOR 

315 315 CHAR/1 REHAB-IND Case’s vocational rehabilitation status 1 = CLOSED O

2 = CLOSED R3 = CLOSED REMPLOYER 4 = CLOSED RREEMP 5 = CLOSED, N6 = CLOSED WSERVICES 7 = RETURNEINTERVENTIO8 = RETURNEASSISTANCE 9 = COP CLOSA = INITIAL INB = NURSE INC = RETURNED = PLAN DEVE = EXTENSIOF = WORKING G = PLACEMEH = EMPLOYEI = PLAN APPRK = NOT RTWL = LIGHT DUM = MEDICAL N = PLACEME
FIELD NAME 

LOCATION START END 

FIELD TYPE CBSUM-REC 

NAME 

DESCRIPTION DEFINITION 

ESAFECS 

O = NO RTW, P = PLACEMEQ = SCREENER = REFERRESTATUS) S = SELF-EMPT = TRAINING U = CLOSED BV = EMPLOYEW = PLACEMEW/OTHER SERX = SERVICES Y = NURSE INZ = POST EMP

REHABILITATION DATE 

316 323 DATE/8 REHAB-DATE Case’s current vocational rehabilitation 

status date 

YYYYMMDD 

PAY DISPOSITION 

324 324 CHAR/1 PYMT-DISP Whether the agency has reported to 

OWCP that pay has been terminated 

N = PAY NOT Y = PAY TERM

CONTINUATION OF PAY 

325 325 CHAR/1 COP-TYPE Whether the claimant used COP benefits N = COP BENE

Y = COP BENE

CONTROVERSION IND, 

326 326 CHAR/1 CNTRVTD-IND If the claim was controverted N = NOT CON

Y = CONTROV

COMP CLAIM IND. 

327 327 CHAR/1 CMP-CLM-IND Whether a CA-7 is on file Y = CA-7 FOR

N = CA-7 FOR

COMP CLAIM DATE 

328 335 DATE/8 CMP-CLM-DATE Latest date when the compensation claim 

was received 

YYYYMMDD 

ACTIVITY CODE 336 337 NUM/2 ACTIVITY-CODE Whether coverage was by FECA or the 

FRINGE ACTS 

01 = FEDERAL 02 = RESERVI03 = CIVIL AIR 04 = RESERVE 05 = MARITIM06 = EMERGEHAZZARD 07 = WAR – CO08 = CIVILIAN 09 = TOTAL B10 = POVERTY 11 = LAW ENF12 = COAST G13 = JOB COR14 = NEIGHBO15 = MILITAR16 = MEMBERAUXILIARY C17 = PEACE C99 = OTHER 

RESPONSIBLE 338 340 CHAR/3 RESP-EXAM Claims Examiner responsible for the 
FIELD NAME 

LOCATION START END 

FIELD TYPE CBSUM-REC 

NAME 

DESCRIPTION DEFINITION 

ESAFECS 

EXAMINER claim PRMS INDICATOR 

341 341 CHAR/1 PRMS-IND If a case is part of the Periodic Roll 

Management System (PRMS) 

N = DEFAULT NOT PART OF Y = PART OF 

TYPE INJURY 342 344 NUM/3 TYPE-INJURY The type of OSHA injury 100 = STRUCK 

110 = STRUCK 111 = STRUCK 120 = STRUCK 200 = FELL, SL210 = FELL, SA220 = FELL, D230 = SLIPPED300 = CAUGH310 = CAUGH320 = CAUGH330 = CAUGH400 = PUNCTU410 = PUNCTU420 = CUT BY 430 = STUNG 440 = BITTEN 500 = CONTAC510 = CONTAC520 = CONTAC600 = EXERTI610 = LIFTED, 620 = STRESS700 = EXPOSU710 = INHALA720 = INGEST730 = ABSORP800 = TRAVEL999 = UNCLAS

BILLABLE FLAG 345 345 CHAR/1 BILLABLE-FLAG INTERNAL USE ONLY ERROR CODE COUNTER 

346 347 NUM/2 ERROR-CODECNTR INTERNAL USE ONLY 

ERROR CODES 348 373 CHAR/26 ERRORS-CODES INTERNAL USE ONLY HBI OLI FLAG 374 374 CHAR/1 HBI-OLI-FLAG INTERNAL USE ONLY CANCELLED CHECK FLAG 

375 375 CHAR/1 CANCEL-CKFLAG Whether the compensation check has or will be cancelled Y = CANCELL

DATE) 

DUPLICATE FLAG 

376 376 CHAR/1 DUP-FLAG INTERNAL USE ONLY 

HBI/OLI ADJUSTMENTS 

377 378 NUM/2 HBI-OLI-ADJCNT INDICATES NUMBER OF HBI/OLI ADJUSTMENTS No longer valid 

CANCELLED CHECKS ADJUSTMENTS 

379 380 NUM/2 CANCEL-CKADJ-CNT Number of compensation cancelled check adjustments 
FIELD NAME 

LOCATION START END 

FIELD TYPE CBSUM-REC 

NAME 

DESCRIPTION DEFINITION 

ESAFECS 

DUPLICATE ADJUSTMENTS 

381 382 NUM/2 DUP-ADJ-CNT INDICATES NUMBER OF 

DUPLICATE ADJUSTMENTS 

No longer valid 

HBI/OLI ADJUSTMENTS 

383 392 NUM/10 HBI-OLI-ADJAMT INDICATES AMOUNT OF HBI/OLI ADJUSTMENTS No longer valid 

CANCELLED CHECKS 

393 402 NUM/10 CANCEL-CKADJ-AMT This section shall indicate the amount of cancelled checks (Compensation only) 

DUPLICATE ADJUSTMENTS 

403 412 NUM/10 DUP-ADJ-AMT INDICATES AMOUNT OF 

DUPLICATE ADJUSTMENTS 

No longer valid 

TOTAL AMOUNT PAID 

413 422 NUM/10 TOTAL-AMT Total Chargeback amount paid for bill 

pay and compensation payments 

MEDICAL BILLS 423 427 NUM/5 BPS-NO Total number of medical bills paid MEDICAL BILLS PAID 

428 437 NUM/10 BPS-AMT Total amount of medical bills paid 

COMPENSATION PAYMENTS 

438 442 NUM/5 CP-NO Total amount of compensation payments, 

fatal and non-fatal 

COMPENSATION PAYMENTS PAID 

443 451 NUM/9 CP-AMT Total amount of compensation paid, fatal 

and non-fatal 

COMPENSATION FLAG 

452 452 CHAR/1 CP-FLAG Whether the compensation payment was 

issued for a case 

Y = Compensat

DETAIL RECORD

PAYING DISTRICT 

35 36 NUM/2 PAYING-DIST District office that made the payment 

PAYMENT DATE 37 44 DATE/8 PYMT-DATE Payment date YYYYMMDD PAYMENT AMOUNT 

45 54 NUM/10 PYMT-AMT Chargeback amount paid 

PAYMENT FROM DATE 

55 62 DATE/8 PYMT-FROMDATE Starting date of the payment YYYYMMDD 

PAYMENT TO DATE 

63 70 DATE/8 PYMT-TO-DATE Ending date of the payment YYYYMMDD 

SSN 71 79 NUM/9 PAYEE-SSN-EIN Payee’s social security number or EIN 

number 

PAYEE NAME 80 114 CHAR/35 PAYEE-NAME Payee’s name PAYEE ADDRESS 115 247 CHAR/133 PAYEE-ADDR Payee’s address or the EFT/account 

routing number 

PAYEE ADDRPAYEE CITY = PAYEE STATE PAYEE ZIP = 2

PAYMENT TYPE 248 248 CHAR/1 CB-PAY-TYPE Type of transaction for a case when it is 

a bill pay or compensation 

If Service Indiccould be either: B - NORMAL MTHE SYSTEM C - CANCELLD - CASH DEPM - MANUAL 
FIELD NAME 

LOCATION START END 

FIELD TYPE CBSUM-REC 

NAME 

DESCRIPTION DEFINITION 

ESAFECS 

If Service Indiccould be either: 0 = ADJUSTM1 = DISABILIT2 = LEAVE BU3 = WEC 4 = DIRECT PA5 = INCARCER6 = BURIAL, T7 = DEATH 8 = MANUAL 9 = SCHEDULA = DEATH LUB = CASH RECC = FECS PAY

BILL PAY REIMBURSEMENT CODE 

249 249 CHAR/1 BP-REIMB-CODE If payment has been made to the 

provider or claimant (Medical payments only) 

P = PROVIDER C = CLAIMAN

ADJUSTMENT INDICATOR 

250 250 CHAR/1 ADJ-IND Whether the record is an adjustment 

record 

N = NO Y = YES 

TYPE INJURY 251 253 NUM/3 TYPE-INJURY Type of injury 100 = STRUCK 

110 = STRUCK 111 = STRUCK 120 = STRUCK 200 = FELL, SL210 = FELL, SA220 = FELL, D230 = SLIPPED300 = CAUGH310 = CAUGH320 = CAUGH330 = CAUGH400 = PUNCTU410 = PUNCTU420 = CUT BY 430 = STUNG 440 = BITTEN 500 = CONTAC510 = CONTAC520 = CONTAC600 = EXERTI610 = LIFTED, 620 = STRESS700 = EXPOSU710 = INHALA720 = INGEST730 = ABSORP
FIELD NAME 

LOCATION START END 

FIELD TYPE CBSUM-REC 

NAME 

DESCRIPTION DEFINITION 

ESAFECS 

800 = TRAVEL999 = UNCLAS

SOURCE OF INJURY 

254 257 NUM/4 SOURCE-INJURY OSHA source of the injury 

OSHA SITE CODE 258 266 CHAR/9 OSHA-SITECODE OSHA injury site PROCEDURE CODE 

267 274 CHAR/8 PROC-CODE Billed procedure code 

BILL NUMBER 275 277 NUM/3 BILL-ID-NO Sequential number of the medical bill. BILL ITEM NUMBER 

278 281 NUM/4 BILL-LINE-ITEMNO Sequential number of medical bill line item 

AGENCY CODE 282 287 NUM/6 AGENCY-CODE Agency code FILLER 288 452 CHAR/135 UNUSED-DATAAREA