The PS&R System Data Elements

50 – The PS&R System Data Elements (Rev. 321, Issued: 08-09-2019, Effective: 01-01-20, Implementation: 01-06-20) Maintain the following data elements from the FISS paid claim file. The PS&R system shall reflect updated FISS changes to the paid claim file fields. This section contains a crosswalk of data elements used in the FI paid claims file and the PS&R detail files. The crosswalk is presented below. It contains the current FISS paid claim record and shows how it crosswalks to the PS&R detail file. Cross Walk of Data Elements in FI Paid Claims file and PS&R Detail File FI Paid Claim File PS&R Detail Record File Comments FSSCPDCL-NO C-DETL-HICAN FSSCPDCL-NO C-DETL2-HICAN Via C-DETL-HICAN FSSCPDCL-PAT-LAST-NM C-DETL-BENE-LNAME FSSCPDCL-PAT-FIRST-NM C-DETL-BENE-INIT1 FSSCPDCL-PAT-FIRST-INIT C-DETL-BENE-INIT1 FSSCPDCL-PAT-MIDL-INIT C-DETL-BENE-INIT2 FSSCPDCL-PAT-LAST-NM C-2DETL-BENE-LNAME Via C-BENE-LNAME FSSCPDCL-PAT-FIRST-NM C-2DETL-BENE-INIT1 Via C-BENE-INIT1 FSSCPDCL-PAT-FIRST-INIT C-2DETL-BENE-INIT1 Via C-BENE-INIT1 FSSCPDCL-PAT-MIDL-INIT C-2DETL-BENE-INIT2 Via C-BENE-INIT2 FSSCPDCL-DCN C-DETL-ICN C-DETL-KEY FSSCPDCL-DCN-PLAN-CD C-DETL-ICN C-DETL-KEY FSSCPDCL-DCN-JULIAN C-DETL-ICN C-DETL-KEY FSSCPDCL-DCN-YR C-DETL-ICN C-DETL-KEY FSSCPDCL-DCN-JUL-DT C-DETL-ICN C-DETL-KEY FSSCPDCL-DCN-BTCH-NBR-X C-DETL-ICN C-DETL-KEY FSSCPDCL-DCN-BTCH-NBR C-DETL-ICN C-DETL-KEY FSSCPDCL-DCN-CLM-SEQ-NBR C-DETL-ICN C-DETL-KEY FSSCPDCL-DCN-SPLIT-CD C-DETL-ICN C-DETL-KEY FSSCPDCL-DCN-ORIG-CD C-DETL-ICN C-DETL-KEY FSSCPDCL-DCN-FUTURE C-DETL-ICN C-DETL-KEY FSSCPDCL-DCN-FUTURE2 C-DETL-ICN C-DETL-KEY FSSCPDCL-DCN-SITE-ID C-DETL-ICN C-DETL-KEY FSSCPDCL-DCN C-DETL2-ICN C-DETL2-KEY via C-DETL-KEY FSSCPDCL-DCN-PLAN-CD C-DETL2-ICN C-DETL2-KEY via C-DETL-KEY FSSCPDCL-DCN-JULIAN C-DETL2-ICN C-DETL2-KEY via C-DETL-KEY FSSCPDCL-DCN-YR C-DETL2-ICN C-DETL2-KEY via C-DETL-KEY FI Paid Claim File PS&R Detail Record File Comments FSSCPDCL-DCN-JUL-DT C-DETL2-ICN C-DETL2-KEY via C-DETL-KEY FSSCPDCL-DCN-BTCH-NBR-X C-DETL2-ICN C-DETL2-KEY via C-DETL-KEY FSSCPDCL-DCN-BTCH-NBR C-DETL2-ICN C-DETL2-KEY via C-DETL-KEY FSSCPDCL-DCN-CLM-SEQ-NBR C-DETL2-ICN C-DETL2-KEY via C-DETL-KEY FSSCPDCL-DCN-SPLIT-CD C-DETL2-ICN C-DETL2-KEY via C-DETL-KEY FSSCPDCL-DCN-ORIG-CD C-DETL2-ICN C-DETL2-KEY via C-DETL-KEY FSSCPDCL-DCN-FUTURE C-DETL2-ICN C-DETL2-KEY via C-DETL-KEY FSSCPDCL-DCN-FUTURE2 C-DETL2-ICN C-DETL2-KEY via C-DETL-KEY FSSCPDCL-DCN-SITE-ID C-DETL2-ICN C-DETL2-KEY via C-DETL-KEY FSSCPDCL-MEDA-PROV-ID C-DETL-PROV C-DETL-KEY FSSCPDCL-PROV-STATE-CD C-DETL-PROV C-DETL-KEY FSSCPDCL-PROV-ID C-DETL-PROV C-DETL-KEY FSSCPDCL-PROV-TYP-FACIL-CD C-DETL-PROV C-DETL-KEY FSSCPDCL-PROV-2 C-DETL-PROV C-DETL-KEY FSSCPDCL-PROV-EMER-IND C-DETL-PROV C-DETL-KEY FSSCPDCL-PROV-DEPT-ID C-DETL-PROV C-DETL-KEY FSSCPDCL-MEDA-PROV-FILLER C-DETL-PROV C-DETL-KEY FSSCPDCL-MEDA-PROV-ID C-DETL2-PROV C-DETL2-KEY via C-DETL-KEY FSSCPDCL-PROV-STATE-CD C-DETL2-PROV C-DETL2-KEY via C-DETL-KEY FSSCPDCL-PROV-ID C-DETL2-PROV C-DETL2-KEY via C-DETL-KEY FSSCPDCL-PROV-TYP-FACIL-CD C-DETL2-PROV C-DETL2-KEY via C-DETL-KEY FSSCPDCL-PROV-2 C-DETL2-PROV C-DETL2-KEY via C-DETL-KEY FSSCPDCL-PROV-EMER-IND C-DETL2-PROV C-DETL2-KEY via C-DETL-KEY FSSCPDCL-PROV-DEPT-ID C-DETL2-PROV C-DETL2-KEY via C-DETL-KEY FSSCPDCL-MEDA-PROV-FILLER C-DETL2-PROV C-DETL2-KEY via C-DETL-KEY FSSCPDCL-OTHER-SUMMARY- DATA C-DETL2-PROV C-DETL2-KEY via C-DETL-KEY FSSCPDCL-BILL-TYP-CD C-DETL2-PROV C-DETL2-KEY via C-DETL-KEY FSSCPDCL-BILL-CATEGORY C-DETL-RPT-TYPE C-DETL-KEY FSSCPDCL-LOB-CD C-DETL-RPT-TYPE C-DETL-KEY FSSCPDCL-SERV-TYP-CD C-DETL-RPT-TYPE C-DETL-KEY 88 PDCL-INP-CLAIM VALUES '11' '18' '21' '28' '33' '32' '41' '51' '81' '82' C-DETL-RPT-TYPE C-DETL-KEY; COBOL condition name 88 PDCL-HH-CLAIM VALUES '32' '81' '82' C-DETL-RPT-TYPE C-DETL-KEY; COBOL condition name 88 PDCL-HH-PPS-CLAIM VALUES '32' '33' C-DETL-RPT-TYPE C-DETL-KEY; COBOL condition name 88 PDCL-SNF-CLAIM VALUES '18' '21' '28' C-DETL-RPT-TYPE C-DETL-KEY; COBOL condition name 88 PDCL-OUTP-CLAIM VALUES '12 '13' '14''22' '23' '24' '34' '42' '43' '44' '52' '53' '54' '71' '72' '73' '74' '75' '76' '83' '85' C-DETL-RPT-TYPE C-DETL-KEY; COBOL condition name FSSCPDCL-FREQ-CD C-DETL-FREQ-CD C-DETL-KEY (If I or P, make 7) FSSCPDCL-BILL-TYP-CD C-DETL2-PROV C-DETL2-KEY via C-DETL-KEY FSSCPDCL-BILL-CATEGORY C-DETL2-PROV C-DETL2-KEY via C-DETL-KEY FSSCPDCL-LOB-CD C-DETL2-PROV C-DETL2-KEY via C-DETL-KEY FSSCPDCL-SERV-TYP-CD C-DETL2-PROV C-DETL2-KEY via C-DETL-KEY 88 PDCL-INP-CLAIM VALUES '11' '18' '21' '28' '33' '32' '41' '51' '81' '82' C-DETL2-PROV C-DETL2-KEY; COBOL condition name 88 PDCL-HH-CLAIM VALUES '32' '81' '82' C-DETL2-PROV C-DETL2-KEY; COBOL condition name 88 PDCL-HH-PPS-CLAIM VALUES C-DETL2-PROV C-DETL2-KEY; COBOL condition name FI Paid Claim File PS&R Detail Record File Comments '32' '33' 88 PDCL-SNF-CLAIM VALUES '18' '21' '28' C-DETL2-PROV C-DETL2-KEY; COBOL condition name 88 PDCL-OUTP-CLAIM VALUES '12 '13' '14''22' '23' '24' '34' '42' '43' '44' '52' '53' '54' '71' '72' '73' '74' '75' '76' '83' '85' C-DETL2-PROV C-DETL2-KEY; COBOL condition name FSSCPDCL-FREQ-CD C-DETL2-PROV C-DETL2-KEY (If I or P, make 7.) via C- DETL-KEY FSSCPDCL-FREQ-CD C-DETL-RPT-TYPE VIA W- RPT-CLASS C-DETL-KEY 88 PDCL-FINAL-BILL VALUES '1' '4 '5' '9' C-DETL-RPT-TYPE VIA W- RPT-CLASS C-DETL-KEY; COBOL condition name 88 PDCL-INTERIM-BILL VALUES '2 '3' C-DETL-RPT-TYPE VIA W- RPT-CLASS C-DETL-KEY; COBOL condition name 88 PDCL-NO-PAY-BILL VALUE '0' C-DETL-RPT-TYPE VIA W- RPT-CLASS C-DETL-KEY; COBOL condition name 88 PDCL-DEBIT-ADJ VALUE '7' C-DETL-RPT-TYPE VIA W- RPT-CLASS C-DETL-KEY; COBOL condition name 88 PDCL-CREDIT-ADJ VALUE '8' C-DETL-RPT-TYPE VIA W- RPT-CLASS C-DETL-KEY; COBOL condition name 88 PDCL-CANCEL-BILL VALUE '8' 'F' 'G' 'H' 'I' 'J' 'K' 'M' C-DETL-RPT-TYPE VIA W- RPT-CLASS C-DETL-KEY; COBOL condition name FSSCPDCL-RECD-DT-CYMD C-DETL-RECEIPT-DT FSSCPDCL-PAID-DT-CYMD C-DETL-RMT-DATE C-DETL-KEY FSSCPDCL-PAID-DT-CC C-DETL-RMT-DATE C-DETL-KEY FSSCPDCL-PAID-DT C-DETL-RMT-DATE C-DETL-KEY FSSCPDCL-PAID-YR C-DETL-RMT-DATE C-DETL-KEY via C-DETL-KEY FSSCPDCL-PAID-MO C-DETL-RMT-DATE C-DETL-KEY FSSCPDCL-PAID-DY C-DETL-RMT-DATE C-DETL-KEY FSSCPDCL-PAID-DT-CYMD C-DETL2-RMT-DATE C-DETL2-KEY via C-DETL-KEY FSSCPDCL-PAID-DT-CC C-DETL2-RMT-DATE C-DETL2-KEY via C-DETL-KEY FSSCPDCL-PAID-DT C-DETL2-RMT-DATE C-DETL2-KEY via C-DETL-KEY FSSCPDCL-PAID-YR C-DETL2-RMT-DATE C-DETL2-KEY via C-DETL-KEY FSSCPDCL-PAID-MO C-DETL2-RMT-DATE C-DETL2-KEY via C-DETL-KEY FSSCPDCL-PAID-DY C-DETL2-RMT-DATE C-DETL2-KEY via C-DETL-KEY FSSCPDCL-PAID-DT-CYMD C-DETL-FILE-DATE C-DETL-KEY; MD400500 FSSCPDCL-PAID-DT-CC C-DETL-FILE-DATE C-DETL-KEY; MD400500 FSSCPDCL-PAID-DT C-DETL-FILE-DATE C-DETL-KEY; MD400500 FSSCPDCL-PAID-YR C-DETL-FILE-DATE C-DETL-KEY; MD400500 FSSCPDCL-PAID-MO C-DETL-FILE-DATE C-DETL-KEY; MD400500 FSSCPDCL-PAID-DY C-DETL-FILE-DATE C-DETL-KEY; MD400500 FSSCPDCL-STMT-COV-FROM-DT- CYMD C-DETL-FROM-DATE FSSCPDCL-STMT-COV-FROM-DT- CC C-DETL-FROM-DATE FSSCPDCL-STMT-COV-FROM-DT C-DETL-FROM-DATE FSSCPDCL-STMT-COV-FROM-YR C-DETL-FROM-DATE FSSCPDCL-STMT-COV-FROM-MO C-DETL-FROM-DATE FSSCPDCL-STMT-COV-FROM-DY C-DETL-FROM-DATE FSSCPDCL-STMT-COV-FROM-DT- CYMD C-DETL2-FROM-DATE Via C-DETL-FROM-DATE FSSCPDCL-STMT-COV-FROM-DT- C-DETL2-FROM-DATE Via C-DETL-FROM-DATE FI Paid Claim File PS&R Detail Record File Comments CC FSSCPDCL-STMT-COV-FROM-DT C-DETL2-FROM-DATE Via C-DETL-FROM-DATE FSSCPDCL-STMT-COV-FROM-YR C-DETL2-FROM-DATE Via C-DETL-FROM-DATE FSSCPDCL-STMT-COV-FROM-MO C-DETL2-FROM-DATE Via C-DETL-FROM-DATE FSSCPDCL-STMT-COV-FROM-DY C-DETL2-FROM-DATE Via C-DETL-FROM-DATE FSSCPDCL-STMT-COV-TO-DT- CYMD C-DETL-THRU-DATE C-DETL-KEY FSSCPDCL-STMT-COV-TO-DT-CC C-DETL-THRU-DATE C-DETL-KEY FSSCPDCL-STMT-COV-TO-DT C-DETL-THRU-DATE C-DETL-KEY FSSCPDCL-STMT-COV-TO-YR C-DETL-THRU-DATE C-DETL-KEY FSSCPDCL-STMT-COV-TO-MO C-DETL-THRU-DATE C-DETL-KEY FSSCPDCL-STMT-COV-TO-DY C-DETL-THRU-DATE C-DETL-KEY FSSCPDCL-STMT-COV-TO-DT- CYMD C-DETL2-THRU-DATE C-DETL2-KEY via C-DETL-KEY FSSCPDCL-STMT-COV-TO-DT-CC C-DETL2-THRU-DATE C-DETL2-KEY via C-DETL-KEY FSSCPDCL-STMT-COV-TO-DT C-DETL2-THRU-DATE C-DETL2-KEY via C-DETL-KEY FSSCPDCL-STMT-COV-TO-YR C-DETL2-THRU-DATE C-DETL2-KEY via C-DETL-KEY FSSCPDCL-STMT-COV-TO-MO C-DETL2-THRU-DATE C-DETL2-KEY via C-DETL-KEY FSSCPDCL-STMT-COV-TO-DY C-DETL2-THRU-DATE C-DETL2-KEY via C-DETL-KEY FSSCPDCL-PAT-MED-REC-NO C-DETL-PCN FSSCPDCL-DRG-CD C-DETL-DRG-CODE FSSCPDCL-CANC-ADJ-CD C-DETL-CANCEL-ADJ FSSCPDCL-MEDICAL-RECORD-NO C-DETL-PCN FSSCPDCL-PIP-IND C-DETL-PIP-IND In MD400600: IF FSSCPDCL-PIP-IND = 'Y' MOVE 'Y' TO C-DETL-PIP-IND FSSCPDCL-HH-SPLIT-IND C-DETL-HH-SPLIT-IND FSSCPDCL-PATIENT-STATUS C-DETL-PAT-STATUS FSSCPDCL-PATIENT-STATUS C-DETL2-PAT-STATUS Via C-DETL-PAT-STATUS FSSCPDCL-PATIENT-STATUS C-DETL-PATIENT-ST FSSCPDCL-COV-DY-CNT C-DETL-TRANS-DAYS FSSCPDCL-FED-PORTION C-DETL-FED-SPEC-PMT FSSCPDCL-PPS-PAYMENT C-DETL2-PPS-PAYMENT FSSCPDCL-DRG-WEIGHT C-DETL-CAP-DRG-WT FSSCPDCL-DSCHG-FRCTN C-DETL-CAP-DSCHG-FR FSSCPDCL-DRG-WT-FRCTN C-DETL-DRGWT-FR FSSCPDCL-CAP-TOT-PAY C-DETL-CAPTL-PMT C-DETL-CAPTL-PMT redefines C-DETL- ESRD-NETWORK FSSCPDCL-CAP-FSP C-DETL-CAP-FSP FSSCPDCL-CAP-DSH-ADJ C-DETL-CAP-DSH-ADJ FSSCPDCL-CAP2-B-FSP C-DETL-CAP-B-FSP FSSCPDCL-CAP-HSP C-DETL-CAP-HSP FSSCPDCL-CAP-OLD-HARM C-DETL-CAP-OLD-HARM FSSCPDCL-CAP-IME-ADJ C-DETL-CAP-IME-ADJ FSSCPDCL-PPS-RTC C-DETL-PRICER-RTC FSSCPDCL-COIN-DAYS-1ST-YR C-DETL-COIN-DAYS FSSCPDCL-CAP-OUTLIER C-DETL-CAP-OUTLIER FSSCPDCL-CAP2-B-OUTLIER C-DETL-CAP-B-OUTLIE FSSCPDCL-OUTLIER-DYS C-DETL-OUTLIER-DAYS FSSCPDCL-HOSP-PORTION C-DETL-HOS-SPEC-PMT FSSCPDCL-CAPI-EXCEPTIONS C-DETL-CAP-EXCPTONS FI Paid Claim File PS&R Detail Record File Comments FSSCPDCL-VAL-AMT C-DETL-CASH-DEDUCT Via W-VALUE-AMT-9 in MD400600 FSSCPDCL-VAL-AMT C-DETL-CASH-DEDUCT Via W-0-CASH-DEDUCT in MD400700 FSSCPDCL-VAL-AMT C-DETL-CASH-DEDUCT Via W-0-CASH-DEDUCT in MD400701 FSSCPDCL-VAL-AMT C-DETL-CASH-DEDUCT Via W-0-CASH-DEDUCT in MD400710 FSSCPDCL-VAL-AMT C-DETL-CASH-DEDUCT Via W-DEDUCTIBLE via W-O-CASH- DEDUCT in MD400700 FSSCPDCL-VAL-AMT C-DETL-CASH-DEDUCT Via W-DEDUCTIBLE via W-O-CASH- DEDUCT in MD400701 FSSCPDCL-VAL-AMT C-DETL-CASH-DEDUCT Via W-DEDUCTIBLE via W-O-CASH- DEDUCT in MD400710 FSSCPDCL-VAL-AMT C-DETL-SRVC-MSAE Field is set in this portion of MD400600: MSAE-RTN IF W-VALUE-AMT (3:3) = '099' MOVE W-VALUE-AMT (6:2) TO C- DETL-SRVC-MSAE (3:2) ELSE IF W-VALUE-AMT (3:2) = '99' MOVE W-VALUE-AMT (5:3) TO C- DETL-SRVC-MSAE (3:3) ELSE IF W-VALUE-AMT (7:1) > '5' MOVE W-VALUE-AMT (3:5) TO C DETL-SRVC-MSAE ELSE MOVE W-VALUE-AMT (4:4) TO C DETL-SRVC-MSAE. MSAE-RTN-EXIT EXIT FSSCPDCL-REIMB-PROV-AMT C-DETL-NET-REIMB FSSCPDCL-REIMB-PROV-AMT C-DETL-TRANS-PMT C-DETL-TRANS-PMT = FSSCPDCL- REIMB-PROV-AMT - W-OUT-EIMB-AMT FSSCPDCL-HCPC-CD-X C-DETL-HCPCS-CD Via W-DETL-HCPCS-TRL.W-DETL- HCPCS-CD via W-HCPCS-CD in MD400600 FSSCPDCL-HCPC-MODIFIERS C-DETL-ASC-HCPCMODS Via W-DETL-HCPCS-MODS via W- HCPCS-MODIFIERS in MD400600 FSSCPDCL-HCPC-MODIFIER C-DETL-ASC-HCPCMODS Via W-DETL-HCPCS-MODS via W- HCPCS-MODIFIERS in MD400600 FSSCPDCL-HCPC-MODIFIER2 C-DETL-ASC-HCPCMODS Via W-DETL-HCPCS-MODS via W- HCPCS-MODIFIERS in MD400600 FSSCPDCL-HCPC-MODIFIER3 C-DETL-ASC-HCPCMODS Via W-DETL-HCPCS-MODS via W- HCPCS-MODIFIERS in MD400600 FSSCPDCL-HCPC-MODIFIER4 C-DETL-ASC-HCPCMODS Via W-DETL-HCPCS-MODS via W- HCPCS-MODIFIERS in MD400600 FSSCPDCL-HCPC-MODIFIER5 C-DETL-ASC-HCPCMODS Via W-DETL-HCPCS-MODS via W- HCPCS-MODIFIERS in MD400600 FSSCPDCL-ASC-PERCENT C-DETL-ASC-PCT-IND Via W-ASC-TRL.WAT-PCT-IND via W- ASCC-PERCENT in MD400600 FSSCPDCL-ASC-GRP C-DETL-ASC-GRP-CD Via W-ASC-TRL.WAT-GRP-CD via W- ASC-GROUP in MD400600 FSSCPDCL-PRICER-IND C-DETL2-PRICER-IND FSSCPDCL-OPPS-PRICR-LINE-RTC C-DETL2-PRICER-LINE-RT C FSSCPDCL-REV-CD C-DETL-HCPCS-REV Via W-HCPCS-TRL.W-DETL-HCPCS-REV FI Paid Claim File PS&R Detail Record File Comments via W-REVENUE-CD in MD400600 FSSCPDCL-REV-CD C-DETL-REV-CD Via W-DETL-REV-CD via W-REVENUE- CD in MD400600. 88 FSSCPDCL-FEE-SCHEDULE- REV-CD VALUES 0274, 0300 THRU 0319, 0403 C-DETL-REV-CD COBOL condition name 88 PDCL-FEE-SCHEDULE-REV-CD VALUES 0274, 0300 THRU 0319, 0403 C-DETL-REV-CD COBOL condition name FSSCPDCL-REV-CD-X redefines FSSCPDCL-REV-CD C-DETL-REV-CD FSSCPDCL-REV-SERV-UNIT-CNT PIC 9(07) C-DETL-HCPCS-UNITS Via W-HCPCS-TRL.W-DETL-HCPCS- UNITS via W-UNITS in MD400600 FSSCPDCL-REV-SERV-UNIT-CNT PIC 9(07) C-DETL-REV-UNITS Via W-DETL-REV-UNITS via W-UNITS in MD400600 FSSCPDCL-REV-SERV-RATE C-DETL-HCPCS-REIMB Via W-RATE in MD400600 FSSCPDCL-RAD-PRICER-AMT-X FSSCPDCL-RAD-PRICER-AMT C-DETL-HCPCS-REIMB Via W-RATE via W-RAD-PRICER-AMT in MD400600 FSSCPDCL-RAD-PRICER-AMT C-DETL2-APC-GROSS-PMT Via W-RATE via W-RAD-PRICER-AMT in MD400600 FSSCPDCL-REV-TOT-CHRG-AMT C-DETL-REV-CHG Via W-DETL-REV-CHG via W-SERV- CHARGES in MD400600 FSSCPDCL-REV-TOT-CHRG-AMT C-DETL-TOT-COV-CHG Via W-DETL-REV-CHRG via W-SERV- CHARGES FSSCPDCL-REV-COV-CHRG-AMT C-DETL-HCPCS-REIMB Via W-RATE in MD400600 FSSCPDCL-REV-COV-CHRG-AMT C-DETL2-REV-COV-CHG- AMT FSSCPDCL-REV-TOT-CHRG-AMT C-DETL-TOT-COV-CHG Via W-DETL-REV-CHRG via W-SERV- CHARGES FSSCPDCL-REV-COV-CHRG-AMT C-DETL-REV-CHG Via W-DETL-REV-CHG via W-SERV- CHARGES in MD400600 FSSCPDCL-REV-NCOV-CHRG-AM T C-DETL-REV-CHG Via W-RATE via W-I-SERV-NCOV- CHARGES in MD400600 FSSCPDCL-REV-NCOV-CHRG-AM T C-DETL-HCPCS-REIMB Via W-RATE via W-I-SERV-NCOV- CHARGES in MD400600 FSSCPDCL-REV-TOT-CHRG-AMT C-DETL-HCPCS-BLDCHG Via W-DETL-REV-CHG via W-SERV- CHARGES in MD400600 FSSCPDCL-REV-COV-CHRG-AMT C-DETL-HCPCS-BLDCHG Via W-DETL-REV-CHG via W-SERV- CHARGES in MD400600 FSSCPDCL-REV-NCOV-CHRG-AM T C-DETL-HCPCS-BLDCHG Via W-RATE via W-I-SERV-NCOV- CHARGES in MD400600 FSSCPDCL-WAGE-ADJ-COIN-LINE C-DETL2-WGE-ADJ- COIN-LINE FSSCPDCL-REDUCED-COIN-LINE C-DETL2-REDU-COIN-LINE FSSCPDCL-PROV-REIMB-LINE C-DETL2-PROV-REIMB- LINE FSSCPDCL-PAT-CASH-DED-LINE C-DETL2-PAT-CASH-DED- LINE FSSCPDCL-PSY-ESRD-BLD-HEMO C-DETL2-PSY-ESRD-BLD- HEMO FSSCPDCL-APC-HCPCS-PROC C-DETL2-APC-HCPCS-PRO C FSSCPDCL-APC-SERV-IND C-DETL-APC-SERV-IND Via W-DETL-REV-TRL.W-DETL-APC- FI Paid Claim File PS&R Detail Record File Comments SERV-IND via W-APC-SERV-IND in MD400600 FSSCPDCL-APC-SERV-IND C-DETL2-APC-SERV-IND Via W-DETL-REV-TRL.W-DETL-APC- SERV-IND via W-APC-SERV-IND in MD400600 FSSCPDCL-SITE-OF-SERV-INC- FLAG redefines FSSCPDCL-APC- SERV-IND C-DETL-APC-SERV-IND Via W-DETL-REV-TRL.W-DETL-APC- SERV-IND via W-APC-SERV-IND in MD400600 FSSCPDCL-APC-PAYMENT-IND C-DETL2-APC-PMT-IND FSSCPDCL-APC-DISC-FCTR C-DETL2-APC-DISC-FCTR FSSCPDCL-APC-DEN-REJ C-DETL2-APC-DEN-REJ FSSCPDCL-APC-PKG-FLAG C-DETL2-APC-PKG-FLAG FSSCPDCL-APC-PAY-ADJ-FLAG C-DETL2-APC-PAY-ADJ- FLG FSSCPDCL-APC-TOB-INCL C-DETL2-APC-TOB-INCL FSSCPDCL-APC-ACTION-FLAG C-DETL2-APC-ACTION- FLAG FSSCPDCL-ORIG-HCPC-CD C-DETL2-ORIG-HCPC-CD FSSCPDCL-ORIG-HCPC-IND C-DETL2-ORIG-HCPC-IND FSSCPDCL-HH-HRG-WGTS C-DETL-HIPPS-WGT Via W-DETL-REV-TRL.W-DETL-HIPPS- WGT via W-HIPPS-WGT in MD400600 FSSCPDCL-LINES-FUTURE3 PIC X(22) C-DETL-HIPPS-APC Via W-DETL-REV-TRL.W-DETL-HIPPS- APC via W-HIPPS-APC via WS-HOLD- HIPPS via WS-FUTURE.W-HCPC in MD400600 NO IDENTIFIABLE FIELD IN PCR C-DETL-SORT-BYTE 1 or 2; set in MD400600 FSSCPDCL-VAL-AMT C-DETL-IND-MDED-PMT Via W-MED-ED-PMT FSSCPDCL-DRG-REIMB-AMT C-DETL-ASCPRICE-AMT Via W-ASC-PRICE-AMT in MD400700 NO IDENTIFIABLE FIELD IN PCR C-DETL-SEC-LIAB-PMT Computed in MD400600 NO IDENTIFIABLE FIELD IN PCR C-DETL-SEC-LIAB-PMT Computed in MD400502 NO IDENTIFIABLE FIELD IN PCR C-DETL-MSP-RED-IND Via W-MSP-REDUCED-IND set in REDUCE-MSP procedure in MD400700 C-DETL-BLOOD-DEDUCT Via W-VALUE-AMT-9 C-DETL-VAL62 Via W-VALUE-AMT-9 C-DETL-VAL63 Via W-VALUE-AMT-9 C-DETL-VAL64 Via W-VALUE-AMT-9 C-DETL-VAL65 Via W-VALUE-AMT-9 C-DETL-DSH-PMT Via W-VALUE-AMT-9 C-DETL-INTEREST-PMT Via W-VALUE-AMT-9 C-DETL-ESRD-NETWORK Via W-VALUE-AMT-9 C-DETL-SEQ-AMT Via W-VALUE-AMT-9 C-DETL-FEE-MSP Via W-VALUE-AMT-9 C-DETL-FEE-SEQ Via W-VALUE-AMT-9 NO IDENTIFIABLE FIELD IN PCR C-DETL-NPI Field is not referenced by any programs NO IDENTIFIABLE FIELD IN PCR C-DETL2-NPI C-DETL2-KEY via C-DETL-KEY C-DETL-LIFE-DAYS Via W-LR-DAY-TOT in MD400600; see W- LR-DAY-TOT in this crosswalk. C-DETL-COINSURANCE Via W-O-COINSURANCE FSSCPDCL-PATIENT-STATUS C-DETL-BNFT-EXH-IND In MD400600: IF FSSCPDCL-PATIENT-STATUS = '30' MOVE 'S' TO C-DETL-BNFT-EXH-IND FI Paid Claim File PS&R Detail Record File Comments C-DETL-TOT-COV-CHG C-DETL-OUT-DAYS-PMT Via W-OUT-REIMB-AMT W-OUT-REIMB-AMT Via W-OUT-REIMB-AMT NO IDENTIFIABLE FIELD IN PCR C-DETL-TRANS-PMT IF W-OUT-REIMB = 'Y' AND W-OUT- TYPE = 'C' COMPUTE C-DETL-TRANS-PMT = FSSCPDCL-REIMB-PROV-AMT - W-OUT-REIMB-AMT ELSE COMPUTE C-DETL-TRANS-PMT = FSSCPDCL-REIMB-PROV-AMT. NO IDENTIFIABLE FIELD IN PCR C-DETL-HCPC-TOTREIM C-DETL-HCPC-TOT-CHG ADD W-DETL-HCPCS-BLDCHG TO C- DETL-HCPC-TOT-CHG C-DETL-HH-DME-COINS Redefines C-DETL-ASCPRICE-AMT and is not used in MD400600. Used in MD400502 and MD400501 NO IDENTIFIABLE FIELD IN PCR C-DETL-ICN-IND MOVE 'I' TO C-DETL-ICN-IND appears to be the only reference to this field in MD400600 NO IDENTIFIABLE FIELD IN PCR C-DETL-GROSSUP-IND IF (C-DETL-THRU-DATE (1:4) = '1992' OR '1993') AND (C-DETL-GROSSUP-IND NOT = 'G') AND (C-DETL-RPT-TYPE = '136' OR '137' OR '138' OR '139') PERFORM GROSSUP-CHECK MOVE 'G' TO C-DETL-GROSSUP-IND. NO IDENTIFIABLE FIELD IN PCR C-DETL-FEE-RED-IND C-DETL-FEE-RED-IND is not referenced in MD400600. Set to 'Y' in M400502. NO IDENTIFIABLE FIELD IN PCR C-DETL-ORIG-THRU-CT The only reference to this field in MD400600 is this statement: IF C-DETL-THRU-DATE = C-PDTE- START (W-SUB) MOVE 1 TO C-DETL-ORIG-THRU-CT MOVE C-DETL-THRU-DATE TO C- DETL-ORIG-THRU-DATE (1) SUBTRACT 1 FROM W-SUB MOVE C-PROV-PD-END (W-SUB) TO C-DETL-THRU-DATE MOVE 2 TO W-SUB. NO IDENTIFIABLE FIELD IN PCR C-DETL-SPLIT-CT The sole apparent use of this field in MD400600 occurs here: SPLIT-RTN. IF W-SPLIT-TYPE (W-SUB) NOT = SPACES ADD 1 TO C-DETL-SPLIT-CT MOVE W-SPLIT-TYPE (W-SUB) TO C-DETL-SPLIT-IND (C-DETL- SPLIT-CT) SPLIT-RTN-EXIT. EXIT. FI Paid Claim File PS&R Detail Record File Comments NO IDENTIFIABLE FIELD IN PCR C-DETL-REV-TRL-CT C-DETL-REV-TRL-CT is an index, used in the context of this statement in MD400600: MOVE W-DETL-REV-TRL TO C-DETL- REV-TRL (C-DETL-REV-TRL-CT) NO IDENTIFIABLE FIELD IN PCR C-DETL-HCPCS-TRL-CT IF W-ASC-PRICE-AMT > MOVE W-DETL-HCPCS-TRL TO C-DETL-HCPCS-TRL (C-DETL-HCPCS- TRL-CT) NO IDENTIFIABLE FIELD IN PCR C-DETL-OPPS-GEN-IND Field is set in this portion of MD400600: IF W-OPPS-CLAIM = 'Y' OR W-OCEFLG1 N = 'Y' OR (FSSCPDCL-STMT-COV-FROM-DT- CYMD > '20000731' AND (PDCL-OUTP-CLAIM AND (W-BILL- TYPE72X-SW NOT = 'Y') AND (FSSCPDCL-PAID-DT-CYMD > '20000611'))) MOVE 'Y' TO C-DETL-OPPS-GEN- IND. NO IDENTIFIABLE FIELD IN PCR C-DETL-ORIG-THRU-DATE Field is set in this portion of MD400600: ORIG-THRU-RTN. IF C-DETL-THRU-DATE = C-PDTE- START (W-SUB) MOVE 1 TO C-DETL-ORIG-THRU-CT MOVE C-DETL-THRU-DATE TO C- DETL-ORIG-THRU-DATE (1) SUBTRACT 1 FROM W-SUB MOVE C-PROV-PD-END (W-SUB) TO C-DETL-THRU-DATE MOVE 2 TO W-SUB. ORIG-THRU-RTN-EXIT. EXIT. NO IDENTIFIABLE FIELD IN PCR C-DETL-SPLIT-IND Field is set in this portion of MD400600: SPLIT-RTN. IF W-SPLIT-TYPE (W-SUB) NOT = SPACES ADD 1 TO C-DETL-SPLIT-CT MOVE W-SPLIT-TYPE (W-SUB) TO C-DETL-SPLIT-IND (C-DETL-SPLIT- CT) SPLIT-RTN-EXIT. EXIT. NO IDENTIFIABLE FIELD IN PCR W-NCOV-UNITS IF W-UNITS > 0 COMPUTE W-UNIT-CHG = W-SERV- CHARGES / W-UNITS COMPUTE W-COV-UNITS = W-COV- CHG / W-UNIT-CHG COMPUTE W-NCOV-UNITS = W-I- SERV-NCOV-CHARGES / W-UNIT-CHG. NO IDENTIFIABLE FIELD IN PCR C-DETL-REV-NCV-IND Set via W-DETL-REV-NCV-IND via program logic. FI Paid Claim File PS&R Detail Record File Comments NO IDENTIFIABLE FIELD IN PCR W-LR-DAYS-TOT COMPUTE W-LR-DAYS-TOT = (FSSCPDCL-LIFE-DY-CNT + FSSCPDCL-LTR-DAYS-2ND-YR). NO IDENTIFIABLE FIELD IN PCR C-DETL-FULL-DAYS IF FSSCPDCL-CST-REP-DYS > 0 OR (W- SEC-LIAB = 'R' OR 'Y') COMPUTE C-DETL-FULL-DAYS = FSSCPDCL-CST-REP-DYS - FSSCPDCL-COIN-DAYS-1ST-YR - W- LR-DAYS-TOT ELSE COMPUTE C-DETL-FULL-DAYS = FSSCPDCL-COV-DY-CNT - FSSCPDCL-COIN-DAYS-1ST-YR – W- LR-DAYS-TOT. W-ASC-TRL C-DETL-ASC-TRL See the 2 constituent fields in this structure: C DETL-ASC-GRP-CD and C-DELT-ASC- PCT-IND C-DETL-CAP-TRL See the 13 constituent fields in this structure NO IDENTIFIABLE FIELD IN PCR C-DETL-FREE-BYTES NO IDENTIFIABLE FIELD IN PCR C-DETL-FREE-BYTE NO IDENTIFIABLE FIELD IN PCR C-DETL-FREE-BYTE-CT NO IDENTIFIABLE FIELD IN PCR C-DETL-CAP-TRL-CT Set to zero and incremented in MD400600 C-DETL-OUT-COST-PMT Via W-OUT-REIMB-AMT in MD400600 NO IDENTIFIABLE FIELD IN PCR C-DETL-ASC-TRL-CT Set to zero and incremented in MD400600 NO IDENTIFIABLE FIELD IN PCR C-DETL-VAL-AMT Via W-VALUE-AMT-9 in MD400600 NO IDENTIFIABLE FIELD IN PCR C-DETL-VAL-CNT Set to zero and incremented in MD400600 NO IDENTIFIABLE FIELD IN PCR C-DETL-CLM-NCV-IND NO IDENTIFIABLE FIELD IN PCR C-DETL-GROSS-APC Set to zero only in MD400600 C-DETL-VAL64 Via W-VALUE-AMT-9 C-DETL-VAL65 Via W-VALUE-AMT-9 C-DETL2-FREQ-CD C-DETL2-KEY via C-DETL-KEY NO IDENTIFIABLE FIELD IN PCR C-DETL2-SORT-BYTE C-DETL2-KEY via C-DETL-KEY; then set to '2 NO IDENTIFIABLE FIELD IN PCR C-DETL2-OPPS-TRL-CT Via C-DETL-HCPCS-TRL-CT NO IDENTIFIABLE FIELD IN PCR C-DETL2-OPPS-TRL Container of recurring structures containing: C-DETL2-APC-HCPCS-PROC C-DETL2-APC-PMT-APC C-DETL2-PRICER-LINE-RTC C-DETL2-PRICER-IND C-DETL2-APC-ACTION-FLAG C-DETL2-APC-GROSS-PMT C-DETL2-PROV-REIMB-LINE C-DETL2-APC-SERV-IND C-DETL2-APC-TOB-INCL C-DETL2-APC-PMT-IND C-DETL2-APC-DISC-FCTR C-DETL2-APC-DEN-REJ C-DETL2-APC-PKG-FLAG C-DETL2-APC-PAY-ADJ-FLG C-DETL2-REV-COV-CHG-AMT C-DETL2-REDU-COIN-LINE C-DETL2-WGE-ADJ-COIN-LINE C-DETL2-PSY-ESRD-BLD-HEMO FI Paid Claim File PS&R Detail Record File Comments C-DETL2-PAT-CASH-DED-LINE C-DETL2-ORIG-HCPC-CD C-DETL2-ORIG-HCPC-IND