Filetype Excel XLSX | Posted on 08 Aug 2022 | 3 years ago
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228x Filetype XLSX File size 0.03 MB Source: ldh.la.gov
Sheet 1: HNI DED
| Data Element | Usage Notes | Data Type | Purpose |
| ACT-UB82-HOSPITAL-DATA | GROUP(1300) | Claims activity record file extension for Acute Inpatient claims (Claim Type 01) only. | |
| HNI-TYPE-BILL | Click on this link to go to the BILL TYPE sheet in this Excel Workbook. | GROUP(3) | Bill Type Code: a NUBC (National Uniform Billing Committee) code indicating the specific type of facility, bill classification, and frequency. |
| HNI-BILL-CLASS | Click on this link to go to the BILL TYPE sheet in this Excel Workbook. | PIC XX | Bill Type Code: First two digits of the NUBC (National Uniform Billing Committee) code indicating the specific type of facility and bill classification. This code can be used to identify admissions, discharges, and interim billings. First Digit/Second Digit (Type of Facility/Bill Classification). |
| HNI-BILL-FREQUENCY | Click on this link to go to the BILL TYPE sheet in this Excel Workbook. | PIC X | Bill Type Code: Third digit of the NUBC (National Uniform Billing Committee) code indicating frequency of billing. |
| HNI-ADMIT-DATE | PIC 9(8) | CLAIM HOSPITAL ADMISSION DATE: The date a recipient was admitted to a hospital for inpatient services. | |
| HNI-ADMIT-HR | PIC 99 | The hour during which the patient was admitted for inpatient care. | |
| HNI-TYPE-ADMISN | PIC X | Type of Admission or Admission Type: a code indicating the priority of admission. | |
| HNI-SOURCE-ADMISN | PIC X | Source of Admission: a code which describes the source of the hospital admission. | |
| HNI-DISCHARGE-HR | PIC 99 | The hour the recipient was discharged from the hospital. | |
| HNI-PAT-STATUS | On UB92 (837I) claims, this code indicates the status of a recipient on the through date of claim; patient status utilizes the NUBC (National Uniform Billing Committee) code values. Click on this link to go to the PATIENT STATUS sheet in this Excel Workbook. | PIC XX | Patient Status Code. Indicates the status of a recipient on the thru date of service on the claim. |
| HNI-REVENUE-DATA | OCCURS TWENTY-EIGHT (28) TIMES | GROUP (19) | Group Element. Consists of: HNI-REV-CODE FILLER HNI-REV-UNITS HNI-REV-CHARGE HNI-NON-REV-CHARGE |
| HNI-REV-CODE | PIC XXX | A code identifying a specific accommodation, ancillary service, or billing calculation. For inpatient hospital claims, the revenue code is the NUBC code. | |
| HNI-REV-UNITS | PIC 999 | The units of service by revenue category provided for the recipient. The units include number of days of occupancy for a type of room accommodation. This is a BILLED value, not a PAID value. | |
| HNI-REV-CHARGE | PIC S9(6)V99 | The total amount charged for the related revenue code. If applicable, represents the BILLED AMOUNT for the revenue code. |
|
| HNI-NON-REV-CHARGE | PIC S9(6)V99 | Charges incurred for a revenue code that are not covered as deemed by the provider of service. | |
| HNI-REV-RATE | OCCURS TWENTY-EIGHT (28) TIMES | PIC 9(6)V99 | Daily rate for room, ICU, etc. This is a BILLED rate, NOT a paid rate. |
| HNI-MOTHER-RECIP-ID | PIC X(13) | Data Element Definition is currently under development and will be available soon. | |
| HNI-TOTAL-CHARGE | PIC S9(6)V99 | The total amount of the charges for inpatient hospital services. | |
| HNI-TOT-NON-COV-CHARGE | PIC S9(6)V99 | CLAIM HOSPITAL TOTAL NON-COVERED CHARGES:Total of any non-covered charges coded on the claim form by the provider. |
|
| HNI-COV-DAYS | PIC 999 | The number of covered days indicated by the provider of service. | |
| HNI-NON-COV-DAYS | PIC 999 | The number of days not covered determined by the provider | |
| HNI-CALC-DAYS | PIC 999 | The number of days stay as calculated by the claims system, using From and Thru dates and patient status code. | |
| HNI-PSRO | GROUP(11) | Group Element. Consists of: HNI-PSRO-CODE HNI-PSRO-FROM HNI-PSRO-THRU | |
| HNI-PSRO-CODE | PIC X | An indicator describing the determination arrived at the Utilization Review Committee or Professional Standards Review Organization Code. | |
| HNI-PSRO-FROM | PIC 9(8) | The approved from date as determined by the Utilization Review Committee or Professional Standards Review Organization Code. | |
| HNI-PSRO-THRU | PIC 9(8) | The approved Thru date as determined by the Utilization Review Committee or Professional Standards Review Organization Code. | |
| HNI-OTHER-DIAG | OCCURS THREE (3) TIMES | PIC X(5) | The third, fourth, and fifth diagnosis as coded for this hospital stay. |
| HNI-SURGICAL | OCCURS SIX (6) TIMES | GROUP(9) | Group Element. Consists of: HNI-SURGICAL-CODE HNI-SURGICAL-DATE |
| HNI-SURGICAL-CODE | PIC X(4) | Sugical Procedure Code: the ICD-9-CM surgical procedure code(s) indicated on the claim form by the provider of service. Surgical Procedure Codes: these are the S codes on the CICSLAM DIAI (Diagnosis Inquiry screen), and are the Operations Codes in the ICD-9-CM manual. Note that the "S" prefix is NOT stored on the MDW, and the period is NOT stored. | |
| HNI-SURGICAL-DATE | PIC 9(8) | Date upon which the procedure was performed. | |
| HNI-BLOOD | GROUP(6) | Group Element. Consists of: HNI-PTS-BLOOD HNI-PTS-BLOOD-REP HNI-PTS-BLOOD-NOT-REP | |
| HNI-PTS-BLOOD | PIC 99 | The amount of whole blood or its equivalent furnished to a recipient. | |
| HNI-PTS-BLOOD-REP | PIC 99 | The amount of whole blood or its equivalent furnished to a recipient and replaced. | |
| HNI-PTS-BLOOD-NOT-REP | PIC 99 | The amount of whole blood or its equivalent furnished to a recepient and not replaced. | |
| HNI-OCCURRENCE | OCCURS THREE (3) TIMES | GROUP(7) | Group Element. Consists of: HNI-OCCUR-CODE HNI-OCCUR-DATE |
| HNI-OCCUR-CODE | PIC XX | The code and associated date defining a significant event relating to this bill that may affect payor processor. | |
| HNI-OCCUR-DATE | PIC 9(8) | Date of the occurrence (see Occurrence Code) which could affect payment for this service. | |
| HNI-OCCURANCE-SPAN | GROUP(18) | Group Element. Consists of: HNI-SPAN-CODE HNI-SPAN-FROM HNI-SPAN-THRU | |
| HNI-SPAN-CODE | 70 = Qualifying Stay Dates (SNF only) 70 = Nonutilization Date (Inpatient only) 71 = Prior Stay Dates 72 = First/Last Visit 74 = Non-covered Level of Care 75 = SNF Level of Care 76 = Patient Liablity 77 = Provider Liability -- Utilization charged 78 = SNF Prior Stay Dates 79 = Payer code 80 = Leave of Absence Days |
PIC XX | A code that identifies an event that relates to the payment of the claim. |
| HNI-SPAN-FROM | PIC X(8) | The From date of an event that relates to the payment of the claim. | |
| HNI-SPAN-THRU | PIC X(8) | The Thru date of an event that relates to the payment of the claim. | |
| HNI-VALUE-DATA | OCCURS TWELVE (12) TIMES | PIC XX | Group Element. Consists of: HNI-VALUE-CODE HNI-VALUE-AMT |
| HNI-VALUE-CODE | 2 or 02 = Hosp has no Semi-Private rooms 13 = ESRD Beneficiary 14 = Automobile, No Fault, or any Liability Insurance. 15 = Worker's Comp incl Black Lung 16 = VA, PHS, or other Fed Agency 30 = Pre-Admission Testing 31 = Patient Liability Amount 37 = Pints of Blood Furnished 49 = Hematocrit Reading 61 = MSA for Hospice 80 = Covered Days 81 = Non-Covered Days 82 = Co-Insurance Days 83 = Life Time Reserve Days |
PIC S9(6)V99 | Claim Hospital Value Code: a code identifying data of a monetary nature which relates to the hospital stay. |
| HNI-VALUE-AMT | The associated value amount that relates to this hospital stay. | ||
| HNI-COND-DATA | OCCURS THREE (3) TIMES | GROUP(5) | Group Element. Consists of: HNI-CONDITION HNI-PAYOR-ID HNI-PAT-RELATED |
| HNI-CONDITION | Click on this link to go to the CONDITION CODES sheet in this Excel Workbook. | PIC XX | Claim Condition Code: the code that identifies conditions relating to the hospital stay. Relates to the Louisiana Medicaid Claim Condition Codes (NUBC). |
| HNI-PAYOR-ID | PIC X | Payor ID Code: a code identifying payors for this hospital stay. | |
| HNI-PAT-RELATED | PIC XX | Patient Related Code: a code identifying the recipient's relationship to the insured. | |
| HNI-PROGRAM-IND | PIC XX | Claim Hospital Program Indicator | |
| HNI-ATTEND-PHYS | This data element is "cleansed"; that is, invalid (non-numeric) values are replaced with 0's. | PIC X(7) | Attending Physician ID: the Provider ID Number or name of the physician treating or assuming primary responsibility for a recipient receiving inpatient services. |
| HNI-OTHER-PHYS | This data element is "cleansed"; that is, invalid (non-numeric) values are replaced with 0's. | PIC X(7) | Other Attending Physician ID: the Louisiana licensing number or name for a physician other than the attending physician, who has responsibility for care of the recipient. |
| HNI-SIGN-IND | The signature indicator must be Y or a blank | PIC X | Claim Hospital Signature Indicator |
| HNI-BENEFIT-DAYS | PIC 999 | The number of days covered or paid during claim dates of service. | |
| HNI-PAS-LOS-10 | PIC 999 | Claim Hospital PAS/LOS Days (10 percentile) The length of days stay according to PAS/LOS determination for the 10th and 90th Percentile. The number of days is determined by recipient age, single or multiple diagnoses and whether surgery was performed. These days are used in payment determination. | |
| HNI-PAS-LOS-90 | PIC 999 | The length of days stay according to PAS/LOS determination for the 10th and 90th Percentile. The number of days is determined by recipient age, single or multiple diagnoses and whether surgery was performed. These days are used in payment determination. | |
| HNI-PER-DIEM-RATE | PIC 9(4)V99 | The daily rate used in payment calculation. | |
| HNI-PERCENT-RATE | PIC 9(4)V99 | Claim Hospital Percent Rate | |
| HNI-FED-PROGRAM-IND | PIC X | CLAIM HOSPITAL FEDERAL PROGRAM CODE: A code indicating a federal mandate for certain valid attachments before payment can be approved. |
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| HNI-ATTEND-PHYS-NPI | PIC X(10) | Attending Physician NPI Number. | |
| HNI-OTHER-PHYS-NPI | PIC X(10) | Other Attending Physician NPI Number. | |
| HNI-PRESENT-ON-ADMIT | Applies to Inpatient, CT 01 only. | GROUP(5) | Group Element. Consists of HNI-DIAG-POA, HNI-SEC-DIAG-POA, HNI-OTHER-DIAG1-POA, HNI-OTHER-DIAG2-POA, HNI-OTHER-DIAG3-POA. |
| HNI-DIAG-POA | Inpatient (CT 01) Claims only. | PIC X | Indicates whether the value in A-DIAG was present on the admission of the patient. |
| HNI-SEC-DIAG-POA | Inpatient (CT 01) Claims only. | PIC X | Indicates whether the value in A-SEC-DIAG was present on the admission of the patient. |
| HNI-OTHER-DIAG1-POA | Inpatient (CT 01) Claims only. | PIC X | Indicates whether the value in HNI-OTHER-DIAG (1) was present on the admission of the patient. |
| HNI-OTHER-DIAG2-POA | Inpatient (CT 01) Claims only. | PIC X | Indicates whether the value in HNI-OTHER-DIAG(2) was present on the admission of the patient. |
| HNI-OTHER-DIAG3-POA | Inpatient (CT 01) Claims only. | PIC X | Indicates whether the value in HNI-OTHER-DIAG (3) was present on the admission of the patient. |
| Louisiana Medicaid Bill Types (Type of Bill) | ||||||||
| Click on this link to go back to the HNI SPREADSHEET | ||||||||
| Applicable to claim types 01, 02 (after 5/1/2003), 03, 06 (after 10/1/2003), 14, and 16 (after 5/1/2003). | ||||||||
| First Digit/Second Digit (Type of Facility/Bill Classification) | ||||||||
| 10 - Reserved for assignment by NUBC | ||||||||
| 11 - Hospital - Inpatient Medicaid and/or Medicare Part A or Parts A and B | ||||||||
| 12 - Hospital - Inpatient Medicaid and Medicare Part B Only | ||||||||
| 13 - Hospital - Outpatient | ||||||||
| 14 - Other Hospital (non-patient), Hospital Laboratory services provided to non-patients | ||||||||
| 15-17 - Reserved for assignment by NUBC | ||||||||
| 18 - Hospital Swing Beds | ||||||||
| 19-20 - Reserved for assignment by NUBC | ||||||||
| 21 - Skilled Nursing - Inpatient (including Medicare Part-A) | ||||||||
| 22 - Skilled Nursing - Inpatient (Medicare Part-B) | ||||||||
| 23 - Skilled Nursing - Outpatient | ||||||||
| 24 - Reserved for assignment by NUBC | ||||||||
| 25 - LTC | ||||||||
| 26 - LTC | ||||||||
| 27 - LTC | ||||||||
| 28 - Skilled Nursing - swing beds | ||||||||
| 29-31 - Reserved for assignment by NUBC | ||||||||
| 32 - Home Health - Inpatient (plan of treatment under Part B only) | ||||||||
| 33 - Home Health - Outpatient (plan of treatment under Part A, including DME under Part A) | ||||||||
| 34 - Home Health - Other (for medical and surgical services not under plan of treatment) | ||||||||
| 35-40 - Reserved for assignment by NUBC | ||||||||
| 41 - Religious non-medical Health Care Institutions - hospital inpatient | ||||||||
| 42 - Reserved for assignment by NUBC | ||||||||
| 43 - Religious non-medical Health Care Institutions - outpatient services | ||||||||
| 44-64 - Reserved for assignment by NUBC | ||||||||
| 65 - ICF-I (Intermediate Care, Level I) | ||||||||
| 66 - ICF-II (Intermediate Care, Level II) | ||||||||
| 67-70 - Reserved for assignment by NUBC | ||||||||
| 71 - Clinic - Rural Health | ||||||||
| 72 - Clinic - Hospital Based or Independent Renal Dialysis Center | ||||||||
| 73 - Clinic - Freestanding | ||||||||
| 74 - Clinic - Outpatient Rehab Facility (ORF) | ||||||||
| 75 - Clinic - Comprehensive Outpatient Rehab Facility (CORF) | ||||||||
| 76 - Clinic - Community Mental Health Center (CMHC) | ||||||||
| 77-78 - Reserved for assignment by NUBC | ||||||||
| 79 - Clinic - Other | ||||||||
| 80 - Reserved for assignment by NUBC | ||||||||
| 81 - Special Facility - Non-Hospital based Hospice Facility | ||||||||
| 82 - Special Facility - Hospital based Hospice Facility | ||||||||
| 83 - Special Facility - Ambulatory Surgical Center | ||||||||
| 84 - Special Facility - Free Standing Birthing Center | ||||||||
| 85 - Special Facility - Critical Access Hospital | ||||||||
| 86 - Special Facility - Psychiatric Residential Treatment Center | ||||||||
| 87-88 - Reserved for assignment by NUBC | ||||||||
| 89 - Special Facility - Other (HCB) | ||||||||
| 90-99 - Reserved for assignment by NUBC | ||||||||
| Third digit (Frequency of Billing) | ||||||||
| 0 - Non-Payment claim | ||||||||
| 1 - Admission thru discharge | ||||||||
| 2 - Interim - first claim | ||||||||
| 3 - Interim - continuing claim | ||||||||
| 4 - Interim - last claim | ||||||||
| 5 - late charges only (charges received after the admit thru discharge, or after the last interim) | ||||||||
| 6 - Adjustment of prior claim (pre-HIPAA); now reserved for assignment by NUBC | ||||||||
| 7 - Adjustment of prior claim (post-HIPAA); replacement of prior claim | ||||||||
| 8 - Void/cancel of prior claim. | ||||||||
| 9 - Final claim for a home health PPS episode (not used by La Medicaid). | ||||||||
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