stack/dev/seeds/bcda_v3_cclf_crosswalk.csv at main

Files

kert 7e53d9360a chore(bcda): vendor CMSgov/bcda-app + bcda.cms.gov v3 artefacts sparsely, flatten the v3 data dictionary into crosswalk seeds, weekly drift workflow

dev/vendor/MANIFEST.toml pins bcda-app@7decdcc (v3 handler + tests, request
validation middleware, OperationOutcome writer, v3 Postman collection, gzip
fixtures, sandbox config, LICENSE) and the bcda.cms.gov v3 data dictionary,
v2 dictionary and official v3 sample ndjson. vendor_bcda_app.py --verify |
--check | --sync (stdlib only); the bcda-vendor workflow runs --check weekly
and files an issue on drift — nothing auto-commits, a payload change upstream
is something a human reads before the flattener is re-pointed.

gen_bcda_v3_crosswalk.py writes dev/seeds/bcda_v3_data_dictionary.csv
(fhirPath, IDR sourceColumn, ccwMapping, cclfMapping per v3 field),
bcda_v3_cclf_crosswalk.csv (293 CCLF elements -> v3 field) and
bcda_v3_cclf_absent.csv (52 CCLF fields v3 does not carry); the CCLF sheet
has label/name swapped on data rows and is normalised. Tests assert the
committed seeds match the vendored workbook.

refs #1139

2026-10-25 13:08:05 -04:00

110 KiB

Raw Permalink Blame History

1	cclf_file	element	field_label	field_name	start_position	end_position	data_length	format	field_description	bcda_v3_field	fhir_path
2	CCLF0	1	File Number Label	Title	1	13	13	X(13)	“File Number” This field will be left-justified and right-padded with spaces.
3	CCLF0	2	Delimiter	Delimiter	14	14	1	X(1)	“\|”
4	CCLF0	3	File Description Label	Title	15	34	20	X(20)	“File Description” This field will be left-justified and right-padded with spaces.
5	CCLF0	4	Delimiter	Delimiter	35	35	1	X(1)	“\|”
6	CCLF0	5	Total Records Count Label	Title	36	55	20	X(20)	“Total Records Count” This field will be left-justified and right-padded with spaces.
7	CCLF0	6	Delimiter	Delimiter	56	56	1	X(1)	“\|”
8	CCLF0	7	Record Length Label	Title	57	69	13	X(13)	“Record Length” This field will be left-justified and right-padded with spaces.
9	CCLF1	1	Current Claim Unique Identifier	CUR_CLM_UNIQ_ID	1	13	13	9(13)	A unique identification number assigned to the claim. I H	The claim unique ID is a unique ID for the claim within the source system.	ExplanationOfBenefit.identifier.where(type.coding.system = 'http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBIdentifierType' and type.coding.code = 'uc' ).value
10	CCLF1	2	Provider OSCAR Number	PRVDR_OSCAR_NUM	14	19	6	X(06)	A facility’s Medicare/Medicaid identification number. It is also known as a Medicare/Medicaid Provider Number, or CCN. This number verifies that a provider has been Medicare certified for a particular type of service. H	Provider Number (OSCAR/CCN)	ExplanationOfBenefit.contained.where(id = %root.provider.reference.substring(1)).identifier.where(system='http://terminology.hl7.org/NamingSystem/CCN').value
11	CCLF1	3	Medicare Beneficiary Identifier	BENE_MBI_ID	20	30	11	X(11)	A Medicare Beneficiary Identifier assigned to a beneficiary I H	Medicare Beneficiary Identifier	Patient.identifier.where(system='http://hl7.org/fhir/sid/us-mbi').value
12	CCLF1	4	Beneficiary HIC Number	BENE_HIC_NUM	31	41	11	X(11)	Legacy Beneficiary HICN field I Note: To comply with MACRA of 2015, after the end of the New Medicare Card Transition Period in December 2019, only the MBI will be accepted on claims, and the HICN value will no longer be displayed. The Beneficiary HIC Number will be blank in CCLFs generated effective January 1, 2020, onwards.
13	CCLF1	5	Claim Type Code	CLM_TYPE_CD	42	43	2	9(02)	Signifies the type of claim being submitted through the Medicare or Medicaid programs. H Claim type code include: 10 = HHA claim 20 = Non swing bed SNF claim 30 = Swing bed SNF claim 40 = Outpatient claim 50 = Hospice claim 60 = Inpatient claim 61 = Inpatient “Full-Encounter” claim	Claim Type Code	ExplanationOfBenefit.type.coding.where(system = 'https://bluebutton.cms.gov/fhir/CodeSystem/CLM-TYPE-CD').code
14	CCLF1	6	Claim From Date	CLM_FROM_DT	44	53	10	YYYY-MM-DD	The first day on the billing statement that covers services rendered to the beneficiary. H Also known as “Statement Covers From Date.”	Claim From Date	ExplanationOfBenefit.billablePeriod.start
15	CCLF1	7	Claim Thru Date	CLM_THRU_DT	54	63	10	YYYY-MM-DD	The last day on the billing statement that covers services rendered to the beneficiary. H Also known as the “Statement Covers Through Date.”	Claim Thru Date	ExplanationOfBenefit.billablePeriod.end
16	CCLF1	8	Claim Bill Facility Type Code	CLM_BILL_FAC_TYPE_CD	64	64	1	X(01)	The first digit of the type of bill (TOB1) is used to identify the type of facility that provided care to the beneficiary (e.g., hospital or SNF). H Claim Facility Type Code include: 1 = Hospital 2 = SNF 3 = HHA 4 = Religious non-medical (hospital) 5 = Religious non-medical (extended care) 6 = Intermediate care 7 = Clinic or hospital-based renal dialysis facility 8 = Specialty facility or Ambulatory Surgical Center (ASC) surgery 9 = Reserved	Bill Facility Type Code	ExplanationOfBenefit.supportingInfo.where(category.coding.system='http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType' and category.coding.code='typeofbill').code.coding.where(system='https://bluebutton.cms.gov/fhir/CodeSystem/CLM-BILL-FAC-TYPE-CD').code
17	CCLF1	9	Claim Bill Classificatio n Code	CLM_BILL_CLSFCTN_CD	65	65	1	X(01)	The second digit of the type of bill (TOB2) is used to indicate with greater specificity where the service was provided (e.g., a department within a hospital). H Find Claim Service Classification Code at the ResDAC website.	Claim Bill Classification Code	ExplanationOfBenefit.supportingInfo.where(category.coding.system='http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType' and category.coding.code='typeofbill').code.coding.where(system='https://bluebutton.cms.gov/fhir/CodeSystem/CLM-BILL-CLSFCTN-CD').code
18	CCLF1	10	Principal Diagnosis Code	PRNCPL_DGNS_CD	66	72	7	X(07)	The ICD-9/10 diagnosis code identifies the beneficiary’s principal illness or disability. H	Claim Diagnosis Code	ExplanationOfBenefit.diagnosis.diagnosis.coding.code
19	CCLF1	11	Admitting Diagnosis Code	ADMTG_DGNS_CD	73	79	7	X(07)	The ICD-9/10 diagnosis code identifies the illness or disability for which the beneficiary was admitted. H	Claim Diagnosis Code	ExplanationOfBenefit.diagnosis.diagnosis.coding.code
20	CCLF1	12	Claim Medicare Non-Payment Reason Code	CLM_MDCR_NPMT_RSN_CD	80	81	2	X(02)	Indicates the reason payment on an institutional claim is denied. Find Medicare Non-Payment Reason Code at the ResDAC website.	Claim Non Payment Reason Code	ExplanationOfBenefit.supportingInfo.where(category.coding.where(system='https://bluebutton.cms.gov/fhir/CodeSystem/Supporting-Information').exists() and category.coding.where(code='CLM_MDCR_NPMT_RSN_CD').exists()).code.coding.code
21	CCLF1	13	Claim Payment Amount	CLM_PMT_AMT	82	98	17	-9(13).99	Amount that Medicare paid on the claim. H	Payment Amount	ExplanationOfBenefit.payment.amount.value
22	CCLF1	14	Claim NCH Primary Payer Code	CLM_NCH_PRMRY_PYR_CD	99	99	1	X(01)	If a payer other than Medicare has primary responsibility for payment of the beneficiary’s health insurance bills, this code indicates the responsible primary payer. H If this field is blank, Medicare is the primary payer for the beneficiary. Find NCH Primary Payer Code at the ResDAC website.	The code outlining the primary payer.	ExplanationOfBenefit.supportingInfo.where(category.coding.where(system='https://bluebutton.cms.gov/fhir/CodeSystem/Supporting-Information').exists() and category.coding.where(code='CLM_NCH_PRMRY_PYR_CD').exists()).code.coding.where(system='https://bluebutton.cms.gov/fhir/CodeSystem/CLM-PRMRY-PYR-CD').code
23	CCLF1	15	Federal Information Processing Standards (FIPS) State Code	PRVDR_FAC_FIPS_ST_CD	100	101	2	X(02)	Identifies the state where the facility providing services is located.	State FIPS Code	ExplanationOfBenefit.supportingInfo.where(category.coding.where(system='https://bluebutton.cms.gov/fhir/CodeSystem/Supporting-Information').exists() and category.coding.where(code='PRVDR_FAC_FIPS_ST_CD').exists()).code
24	CCLF1	16	Beneficiary Patient Status Code	BENE_PTNT_STUS_CD	102	103	2	X(02)	Indicates the patient's discharge status as of the Claim Through Date. For example, it may indicate where a patient was discharged to (e.g., home, another facility) or the circumstances of a discharge (e.g., against medical advice, or patient death). I H Find Patient Discharge Status Code at the ResDAC website.	Patient Discharge Status Code	ExplanationOfBenefit.supportingInfo.where(category.coding.system='http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType' and category.coding.code='discharge-status').code.coding.where(system='https://bluebutton.cms.gov/fhir/CodeSystem/BENE-PTNT-STUS-CD').code
25	CCLF1	17	Diagnosis Related Group Code	DGNS_DRG_CD	104	107	4	X(04)	Indicates the diagnostic related group to which a hospital claim belongs for prospective payment purposes. I H	Claim Diagnosis Related Group Code	ExplanationOfBenefit.supportingInfo.where(category.coding.system='http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType' and category.coding.code='drg').code.coding.where(system='https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/MS-DRG-Classifications-and-Software').code
26	CCLF1	18	Claim Outpatient Service Type Code	CLM_OP_SRVC_TYPE_CD	108	108	1	X(01)	A code reported by the provider that indicates the specific type of claim (Inpatient, Outpatient, etc.). I H Claim Outpatient Service Type Code include: 0 = Blank 1 = Emergency (The patient required immediate medical intervention because 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 available and suitable accommodation) 3 = Elective (The patient's condition permitted adequate time to schedule the availability of suitable accommodations) 5 = Reserved 6 = Reserved 7 = Reserved 8 = Reserved 9 = Unknown (Information not available)	Claim Outpatient Service Type Code	ExplanationOfBenefit.supportingInfo.where(code.coding.system='https://bluebutton.cms.gov/fhir/CodeSystem/CLM-OP-SRVC-TYPE-CD').code.coding.code
27	CCLF1	19	Facility Provider NPI Number	FAC_PRVDR_NPI_NUM	109	118	10	X(10)	Identifies the facility associated with the claim. Each facility is assigned its own unique NPI.	Provider billing NPI number	ExplanationOfBenefit.contained.where(id = %root.provider.reference.substring(1)).identifier.where(system='http://hl7.org/fhir/sid/us-npi').value
28	CCLF1	20	Operating Provider NPI Number	OPRTG_PRVDR_NPI_NUM	119	128	10	X(10)	Identifies the operating provider associated with the claim. Each provider is assigned its own unique NPI.	Operating Physician NPI	ExplanationOfBenefit.careTeam.where(role.coding.where(code = 'otheroperating').exists()).provider.identifier.value
29	CCLF1	21	Attending Provider NPI Number	ATNDG_PRVDR_NPI_NUM	129	138	10	X(10)	Identifies the attending provider associated with the claim. Each provider is assigned its own unique NPI.	Attending Physician NPI	ExplanationOfBenefit.careTeam.where(role.coding.where(code = 'attending').exists()).provider.identifier.value
30	CCLF1	22	Other Provider NPI Number	OTHR_PRVDR_NPI_NUM	139	148	10	X(10)	Identifies the other providers associated with the claim. Each provider is assigned its own unique NPI.	Other Physician NPI	ExplanationOfBenefit.careTeam.where(role.coding.where(code = 'otheroperating').exists()).provider.identifier.value or ExplanationOfBenefit.careTeam.where(role.coding.where(code = 'supervisor').exists()).provider.identifier.value
31	CCLF1	23	Claim Adjustment Type Code	CLM_ADJSMT_TYPE_CD	149	150	2	X(02)	Indicates whether the claim is an original, cancellation, or adjustment claim. Claim Adjustment Type Code include: 0 = Original Claim 1 = Cancellation Claim 2 = Adjustment claim	Claim Adjustment Type Code	ExplanationOfBenefit.supportingInfo.where(category.coding.where(system='https://bluebutton.cms.gov/fhir/CodeSystem/Supporting-Information').exists() and category.coding.where(code='CLM_ADJSTMT_TYPE_CD').exists()).code.coding.code
32	CCLF1	24	Claim Effective Date	CLM_EFCTV_DT	151	160	10	YYYY-MM-DD	Date the claim was processed and added to the NCH. Also referred to as the NCH Weekly Processing Date. H	Claim Effective Date	ExplanationOfBenefit.created
33	CCLF1	25	Claim IDR Load Date	CLM_IDR_LD_DT	161	170	10	YYYY-MM-DD	When the claim was loaded into the IDR.	Claim IDR Load Date	ExplanationOfBenefit.supportingInfo.where(category.coding.where(system='https://bluebutton.cms.gov/fhir/CodeSystem/Supporting-Information').exists() and category.coding.where(code='CLM_IDR_LD_DT').exists()).timing
34	CCLF1	26	Beneficiary Equitable BIC HICN Number	BENE_EQTBL_BIC_HICN_NUM	171	181	11	X(11)	Legacy Beneficiary Equitable BIC HICN Number. Note: To comply with MACRA of 2015, after the end of the New Medicare Card Transition Period in December 2019, MBI will be accepted on claims, and the HICN value/ Beneficiary Equitable BIC HICN Number will no longer be displayed. The Beneficiary Equitable BIC HICN Number will be blank in CCLFs generated effective January 1, 2020, onwards.
35	CCLF1	27	Claim Admission Type Code	CLM_ADMSN_TYPE_CD	182	183	2	X(2)	Indicates the type and priority of inpatient services. I H Claim Admission Type Code include: 0 = Blank 1 = Emergency 2 = Urgent 3 = Elective 4 = Newborn 5 = Trauma Center 6-8 = Reserved 9 = Unknown	Claim Admission Type Code	ExplanationOfBenefit.supportingInfo.where(category.coding.system='http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType' and category.coding.code='admtype').code.coding.where(system='https://bluebutton.cms.gov/fhir/CodeSystem/CLM-ADMSN-TYPE-CD').code
36	CCLF1	28	Claim Admission Source Code	CLM_ADMSN_SRC_CD	184	185	2	X(2)	Indicates the source of the beneficiary’s referral for admission or visit (e.g., a physician or another facility). Find Admission Source Code at the ResDAC website.	Source Admission Code	ExplanationOfBenefit.supportingInfo.where(category.coding.system='http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType' and category.coding.code='pointoforigin').code.coding.where(system='https://bluebutton.cms.gov/fhir/CodeSystem/CLM-ADMSN-SRC-CD').code
37	CCLF1	29	Claim Bill Frequency Code	CLM_BILL_FREQ_CD	186	186	1	X(1)	The third digit of the type of bill (TOB3) code. It indicates the sequence of the claim in the beneficiary's current episode of care (e.g., interim or voided). Find Claim Frequency Code at the ResDAC website.	Bill Frequency Code	ExplanationOfBenefit.supportingInfo.where(category.coding.system='http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType' and category.coding.code='typeofbill').code.coding.where(system='https://bluebutton.cms.gov/fhir/CodeSystem/CLM-BILL-FREQ-CD').code
38	CCLF1	30	Claim Query Code	CLM_QUERY_CD	187	187	1	X(1)	Indicates the type of claim record being processed with respect to payment (e.g., debit/credit indicator or interim/final indicator). Claim Query Code include: 0 = Credit adjustment 1 = Interim bill 2 = HHA benefits exhausted 3 = Final bill 4 = Discharge notice 5 = Debit adjustment	Claim Query Code	ExplanationOfBenefit.supportingInfo.where(category.coding.where(system='https://bluebutton.cms.gov/fhir/CodeSystem/Supporting-Information').exists() and category.coding.where(code='CLM_QUERY_CD').exists()).code.coding.code
39	CCLF1	31	ICD Version Indicator	DGNS_PRCDR_ICD_IND	188	188	1	X(1)	9 = ICD-9 0 = ICD-10 U = any value other than “9” or “0” in the source data.	Diagnosis Procedure ICD indicator	ExplanationOfBenefit.diagnosis.diagnosis.coding.system
40	CCLF1	32	Total Claim Charge Amount	CLM_MDCR_INSTNL_TOT_CHRG_AMT	189	203	15	-9(11).99	Effective with NCH Version G, the total charges for all services included on the institutional claim. This field is redundant with revenue center code 0001/total charges.	Total Charge Amount	ExplanationOfBenefit.total.where(category.coding.where(system='https://bluebutton.cms.gov/fhir/CodeSystem/Adjudication').exists() and category.coding.where(code='CLM_SBMT_CHRG_AMT').exists() ).amount.value
41	CCLF1	33	Claim Capital Indirect Medical Education Amount	CLM_MDCR_IP_PPS_CPTL_IME_AMT	204	218	15	-9(11).99	The amount of the indirect medical education (IME) (reimbursable amount for teaching hospitals only; an added amount passed by Congress to augment normal Prospective Payment System [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. Note: Applicable for claim type = 60 and total calculated based on debit credit methodology.	Claim PPS Capital IME Amount	ExplanationOfBenefit.adjudication.where(category.coding.where(system='https://bluebutton.cms.gov/fhir/CodeSystem/Adjudication' and code='CLM_MDCR_IP_PPS_CPTL_IME_AMT').exists()).amount.value
42	CCLF1	34	Claim Operational Indirect Medical Education Amount	CLM_OPRTNL_IME_AMT	219	240	22	-9(18).99	The indirect medical education amount applicable to the bill. (Do not include PPS capital IME adjustment in this entry). Note: Applicable for claim type = 60 and total calculated based on debit credit methodology.	Operating Indirect Medical Education Amount	ExplanationOfBenefit.adjudication.where(category.coding.where(system='https://bluebutton.cms.gov/fhir/CodeSystem/Adjudication' and code='CLM_OPRTNL_IME_AMT').exists()).amount.value
43	CCLF1	35	Claim Capital Disproportionate Amount	CLM_MDCR_IP_PPS_DSPRPRTNT_AMT	241	255	15	-9(11).99	Effective 3/2/92, the amount of disproportionate share (rate reflecting indigent population served) portion of the PPS payment for capital. [NCH] Note: Applicable for claim type = 60 and total calculated based on debit credit methodology.	Claim PPS Capital Disproportionate Share Amount	ExplanationOfBenefit.adjudication.where(category.coding.where(system='https://bluebutton.cms.gov/fhir/CodeSystem/Adjudication' and code='CLM_MDCR_IP_PPS_DSPRPRTNT_AMT').exists()).amount.value
44	CCLF1	36	Claim Health Insurance Prospective Payment System Uncompens ated Care Amount	CLM_HIPPS_UNCOMPD_CARE_AMT	256	270	15	-9(11).99	This is a payment for DSH hospitals as part of Section 3133 of ACA. It represents the uncompensated care amount of the payment. Note: Applicable for claim types = (10, 20, 30, 40, 50, 60) and total calculated based on debit credit methodology.	Claim Uncompensated Care Payment Amount	ExplanationOfBenefit.adjudication.where(category.coding.where(system='https://bluebutton.cms.gov/fhir/CodeSystem/Adjudication' and code='CLM_HIPPS_UNCOMPD_CARE_AMT').exists()).amount.value
45	CCLF1	37	Claim Operational disproportionate Amount	CLM_OPRTNL_DSPRPRTNT_AMT	271	292	22	-9(18).99	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 adjustment in this entry). Note: Applicable for claim type = 60 and total calculated based on debit credit methodology.	Operating Disproportionate Share Amount	ExplanationOfBenefit.adjudication.where(category.coding.where(system='https://bluebutton.cms.gov/fhir/CodeSystem/Adjudication' and code='CLM_OPRTNL_DSPRTNT_AMT').exists()).amount.value
46	CCLF1	38	Claim Provider OSCAR Number	CLM_BLG_PRVDR_OSCAR_NUM	293	312	20	x(20)	A facility’s Medicare/Medicaid identification number. It is also known as a Medicare/Medicaid Provider Number, or CCN. This number verifies that a provider has been Medicare certified for a particular type of service. Notes:  From January 2022 onward, for Shared Savings Program, ACO REACH, KCC, VTAPM, and PCF models, this value is sourced from the Medicare claims processing system.  This field is included in addition to the Element 2 “Provider OSCAR Number” sourced from Provider Enrollment Change of Ownership System (PECOS).	Provider Number (OSCAR/CCN)	ExplanationOfBenefit.contained.where(id = %root.provider.reference.substring(1)).identifier.where(system='http://terminology.hl7.org/NamingSystem/CCN').value
47	CCLF1	39	Claim Facility Provider NPI Number	CLM_BLG_PRVDR_NPI_NUM	313	322	10	x(10)	Identifies the facility associated with the claim. Each facility is assigned its own unique NPI. Notes:  From January 2022 onward, for Shared Savings Program, ACO REACH, KCC, VTAPM, and PCF models, this value is sourced from the Medicare claims processing system.  This field is included in addition to the Element 19 “Facility Provider NPI Number” sourced from PECOS.	Provider billing NPI number	ExplanationOfBenefit.contained.where(id = %root.provider.reference.substring(1)).identifier.where(system='http://hl7.org/fhir/sid/us-npi').value
48	CCLF1	40	Claim Operating Provider NPI Number	CLM_OPRTG_PRVDR_NPI_NUM	323	332	10	x(10)	Identifies the operating provider associated with the claim. Each provider is assigned its own unique NPI. Notes:  From January 2022 onward, for Shared Savings Program, ACO REACH, KCC, VTAPM, and PCF models, this value is sourced from the Medicare claims processing system.  This field is included in addition to the Element 20 “Operating Provider NPI Number” sourced from PECOS.	Operating Physician NPI	ExplanationOfBenefit.careTeam.where(role.coding.where(code = 'otheroperating').exists()).provider.identifier.value
49	CCLF1	41	Claim Attending Provider NPI Number	CLM_ATNDG_PRVDR_NPI_NUM	333	342	10	x(10)	Identifies the attending provider associated with the claim. Each provider is assigned its own unique NPI. Notes:  From January 2022 onward, for Shared Savings Program, ACO REACH, KCC, VTAPM, and PCF models, this value is sourced from the Medicare claims processing system.  This field is included in addition to the Element 21 “Attending Provider NPI Number” sourced from PECOS.	Attending Physician NPI	ExplanationOfBenefit.careTeam.where(role.coding.where(code = 'attending').exists()).provider.identifier.value
50	CCLF1	42	Claim Other Provider NPI Number	CLM_OTHR_PRVDR_NPI_NUM	343	352	10	x(10)	Identifies the other providers associated with the claim. Each provider is assigned its own unique NPI. Notes:  From January 2022 onward, for Shared Savings Program, ACO REACH, KCC, VTAPM, and PCF models, this value is sourced from the Medicare claims processing system.  This field is included in addition to the Element 22 “Other Provider NPI Number” sourced from PECOS.	Other Physician NPI	ExplanationOfBenefit.careTeam.where(role.coding.where(code = 'otheroperating').exists()).provider.identifier.value or ExplanationOfBenefit.careTeam.where(role.coding.where(code = 'supervisor').exists()).provider.identifier.value
51	CCLF1	43	Claim Control Number	CLM_CNTL_NUM	353	392	40	x(40)	An identifier assigned by the claim processor (i.e., MAC, Part D Plan, or Encounter Data Processing Contractor) to a claim.	Claim Control Number	ExplanationOfBenefit.identifier.where(system = 'https://bluebutton.cms.gov/identifiers/CLM-CNTL-NUM').value
52	CCLF1	44	Claim Original Control Number	CLM_ORG_CNTL_NUM	393	432	40	x(40)	A unique number assigned by the state’s payment system that identifies an original claim.	This field is the original identification value assigned.	ExplanationOfBenefit.related.where(relationship.coding.system = 'http://terminology.hl7.org/CodeSystem/ex-relatedclaimrelationship').reference.where(system='https://bluebutton.cms.gov/identifiers/CLM-CNTL-NUM').value
53	CCLF1	45	Claim Contractor Number	CLM_CNTRCTR_NUM	433	437	5	x(5)	A number assigned by CMS identifying a MAC authorized to process Medicare claims.	FI Number	ExplanationOfBenefit.supportingInfo.where(category.coding.where(system='https://bluebutton.cms.gov/fhir/CodeSystem/Supporting-Information').exists() and category.coding.where(code='CLM_CNTRCTR_NUM').exists()).code.coding.code
54	CCLF2	1	Current Claim Unique Identifier	CUR_CLM_UNIQ_ID	1	13	13	9(13)	A unique identification number assigned to the claim. I H	The claim unique ID is a unique ID for the claim within the source system.	ExplanationOfBenefit.identifier.where(type.coding.system = 'http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBIdentifierType' and type.coding.code = 'uc' ).value
55	CCLF2	2	Claim Line Number	CLM_LINE_NUM	14	23	10	9(10)	A sequential number that identifies a specific claim line.	Line Item Sequence Number	ExplanationOfBenefit.item.sequence
56	CCLF2	3	Medicare Beneficiary Identifier	BENE_MBI_ID	24	34	11	X(11)	A Medicare Beneficiary Identifier assigned to a beneficiary. I H	Medicare Beneficiary Identifier	Patient.identifier.where(system='http://hl7.org/fhir/sid/us-mbi').value
57	CCLF2	4	Beneficiary HIC Number	BENE_HIC_NUM	35	45	11	X(11)	Legacy Beneficiary HICN field. Note: To comply with MACRA of 2015, after the end of the New Medicare Card Transition Period in December 2019, only the MBI will be accepted on claims and the HICN value will no longer be displayed. The Beneficiary HIC Number will be blank in CCLFs generated effective January 1, 2020, onwards.
58	CCLF2	5	Claim Type Code	CLM_TYPE_CD	46	47	2	9(02)	Signifies the type of claim being submitted through the Medicare or Medicaid programs. H Claim type code include: 10 = HHA claim 20 = Non swing bed SNF claim 30 = Swing bed SNF claim 40 = Outpatient claim 50 = Hospice claim 60 = Inpatient claim 61 = Inpatient “Full- Encounter” claim	Claim Type Code	ExplanationOfBenefit.type.coding.where(system = 'https://bluebutton.cms.gov/fhir/CodeSystem/CLM-TYPE-CD').code
59	CCLF2	6	Claim Line From Date	CLM_LINE_FROM_DT	48	57	10	YYYY-MM-DD	The date the service associated with the line item began. H	Line Item From Date	ExplanationOfBenefit.item.serviced.start
60	CCLF2	7	Claim Line Thru Date	CLM_LINE_THRU_DT	58	67	10	YYYY-MM-DD	The date the service associated with the line item ended. H	Last Expense Date	ExplanationOfBenefit.item.serviced.end
61	CCLF2	8	Product Revenue Center Code	CLM_LINE_PROD_REV_CTR_CD	68	71	4	X(04)	The number a provider assigns to the cost center to which a particular charge is billed (e.g., accommodations or supplies). A cost center is a division or unit within a hospital (e.g., radiology, emergency room, pathology). Find Revenue Center Code at the ResDAC website. Revenue center code 0001 represents the total of all revenue centers included on the claim.	Line Item Revenue Center Code	ExplanationOfBenefit.item.revenue.coding.where(system='https://bluebutton.cms.gov/fhir/CodeSystem/CLM-REV-CNTR-CD').code
62	CCLF2	9	Claim Line Institutional Revenue Center Date	CLM_LINE_INSTNL_REV_CTR_DT	72	81	10	YYYY-MM-DD	The date that applies to the service associated with the Revenue Center code.	Revenue Center Date	ExplanationOfBenefit.item.servicedDate
63	CCLF2	10	HCPCS Code	CLM_LINE_HCPCS_CD	82	86	5	X(05)	The HCPCS code representing the procedure, supply, product, and/or service provided to the beneficiary. Note: Health Insurance Prospective Payment System (HIPPS) code may be available when the Product Revenue Center Code is “0022” (SNF Prospective Payment System).	Line Item HCPCS Code	ExplanationOfBenefit.item.productOrService.where(coding.system='http://www.ama-assn.org/go/cpt' or coding.system='https://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets' or coding.system='http://terminology.hl7.org/CodeSystem/data-absent-reason').coding.code
64	CCLF2	11	Beneficiary Equitable BIC HICN Number	BENE_EQTBL_BIC_HICN_NUM	87	97	11	X(11)	Legacy Beneficiary Equitable BIC HICN Number. Note: To comply with MACRA of 2015, after the end of the New Medicare Card Transition Period in December 2019, only the MBI will be accepted on claims, and the HICN value/ Beneficiary Equitable BIC HICN Number will no longer be displayed. The Beneficiary Equitable BIC HICN Number will be blank in CCLFs generated effective January 1, 2020, onwards.
65	CCLF2	12	Provider OSCAR Number	PRVDR_OSCAR_NUM	98	103	6	X(6)	A facility’s Medicare/Medicaid identification number, also known as a Medicare/Medicaid Provider Number, or CCN. This number verifies that a provider has been Medicare certified for a particular type of services. H	Provider Number (OSCAR/CCN)	ExplanationOfBenefit.contained.where(id = %root.provider.reference.substring(1)).identifier.where(system='http://terminology.hl7.org/NamingSystem/CCN').value
66	CCLF2	13	Claim From Date	CLM_FROM_DT	104	113	10	YYYY-MM-DD	The first day on the billing statement that covers services rendered to the beneficiary. H Also known as the “Statement Covers From Date.”	Claim From Date	ExplanationOfBenefit.billablePeriod.start
67	CCLF2	14	Claim Thru Date	CLM_THRU_DT	114	123	10	YYYY-MM-DD	The last day on the billing statement that covers services rendered to the beneficiary. H Also known as the “Statement Covers Through Date.”	Claim Thru Date	ExplanationOfBenefit.billablePeriod.end
68	CCLF2	15	Claim Line Service Unit Quantity	CLM_LINE_SRVC_UNIT_QTY	124	147	24	-9(18).9999	Count of total units, at the line-item level, associated with services needing unit reporting (e.g., anesthesia time units and blood units). H	Line Item Service Unit Quantity	ExplanationOfBenefit.item.quantity.value
69	CCLF2	16	Claim Line Covered Paid Amount	CLM_LINE_CVRD_PD_AMT	148	164	17	-9(13).99	The amount Medicare reimbursed the provider for covered services associated with the claim-line. H	Claim Line Covered Paid Amount	ExplanationOfBenefit.item.adjudication.where(category.coding.where(system='https://bluebutton.cms.gov/fhir/CodeSystem/Adjudication') and category.coding.where(code='CLM_LINE_CVRD_PD_AMT')).amount.value
70	CCLF2	17	HCPCS First Modifier Code	HCPCS_1_MDFR_CD	165	166	2	X(2)	The first code to modify the HCPCS procedure code associated with the claim-line. This provides more specific procedure identification for the line- item service. H	HCPCS Modifier Code 1	ExplanationOfBenefit.item.modifier[0].coding.code
71	CCLF2	18	HCPCS Second Modifier Code	HCPCS_2_MDFR_CD	167	168	2	X(2)	The second code to modify the HCPCS procedure code associated with the claim-line. This provides more specific procedure identification for the line- item service. H	HCPCS Modifier Code 2	ExplanationOfBenefit.item.modifier[1].coding.code
72	CCLF2	19	HCPCS Third Modifier Code	HCPCS_3_MDFR_CD	169	170	2	X(2)	The third code to modify the HCPCS procedure code associated with the claim-line. This provides more specific procedure identification for the line- item service. H	HCPCS Modifier Code 3	ExplanationOfBenefit.item.modifier[2].coding.code
73	CCLF2	20	HCPCS Fourth Modifier Code	HCPCS_4_MDFR_CD	171	172	2	X(2)	The fourth code to modify the HCPCS procedure code associated with the claim-line. This provides more specific procedure identification for the line- item service. H	HCPCS Modifier Code 4	ExplanationOfBenefit.item.modifier[3].coding.code
74	CCLF2	21	HCPCS Fifth Modifier Code	HCPCS_5_MDFR_CD	173	174	2	X(2)	The fifth code to modify the HCPCS procedure code associated with the claim-line. This provides more specific procedure identification for the line- item service. H	HCPCS Modifier Code 5	ExplanationOfBenefit.item.modifier[4].coding.code
75	CCLF2	22	Claim Revenue APC HIPPS Code	CLM_REV_APC_HIPPS_CD	175	179	5	X(5)	APC group for outpatient claim type	Line Item APC / HIPPS Code	ExplanationOfBenefit.item.productOrService.coding.where(system='https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ProspMedicareFeeSvcPmtGen/HIPPSCodes').code
76	CCLF2	23	Claim Facility Provider OSCAR Number	CLM_FAC_PRVDR_OSCAR_NUM	180	199	20	X(20)	A facility’s Medicare/Medicaid identification number, also known as a Medicare/Medicaid Provider Number, or CCN. This number verifies that a provider has been Medicare certified for a particular type of services. Notes:  From January 2022 onward, for Shared Savings Program, ACO REACH, KCC, VTAPM, and PCF models, this value is sourced from the Medicare claims processing system.  This field is included in addition to the Element 12 “Provider OSCAR Number” sourced from PECOS.	Provider Number (OSCAR/CCN)	ExplanationOfBenefit.contained.where(id = %root.provider.reference.substring(1)).identifier.where(system='http://terminology.hl7.org/NamingSystem/CCN').value
77	CCLF3	1	Current Claim Unique Identifier	CUR_CLM_UNIQ_ID	1	13	13	9(13)	A unique identification number assigned to the claim. I H	The claim unique ID is a unique ID for the claim within the source system.	ExplanationOfBenefit.identifier.where(type.coding.system = 'http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBIdentifierType' and type.coding.code = 'uc' ).value
78	CCLF3	2	Medicare Beneficiary Identifier	BENE_MBI_ID	14	24	11	X(11)	A Medicare Beneficiary Identifier assigned to a beneficiary. I H	Medicare Beneficiary Identifier	Patient.identifier.where(system='http://hl7.org/fhir/sid/us-mbi').value
79	CCLF3	3	Beneficiary HIC Number	BENE_HIC_NUM	25	35	11	X(11)	Legacy Beneficiary HICN field. Note: To comply with MACRA of 2015, after the end of the New Medicare Card Transition Period in December 2019, only the MBI will be accepted on claims, and the HICN value will no longer be displayed. The Beneficiary HIC Number will be blank in CCLFs generated effective January 1, 2020, onwards.
80	CCLF3	4	Claim Type Code	CLM_TYPE_CD	36	37	2	9(02)	Signifies the type of claim being submitted through the Medicare or Medicaid programs. H Claim type code are: 10 = HHA claim 20 = Non swing bed SNF claim 30 = Swing bed SNF claim 40 = Outpatient claim 50 = Hospice claim 60 = Inpatient claim 61 = Inpatient “Full- Encounter” claim	Claim Type Code	ExplanationOfBenefit.type.coding.where(system = 'https://bluebutton.cms.gov/fhir/CodeSystem/CLM-TYPE-CD').code
81	CCLF3	5	Claim Value Sequence Number	CLM_VAL_SQNC_NUM	38	39	2	9(2)	An arbitrary sequential number that uniquely identifies a procedure code record within the claim.
82	CCLF3	6	Procedure Code	CLM_PRCDR_CD	40	46	7	X(07)	The ICD-9/10 code that indicates the procedure performed during the period covered by the claim. H	Claim Procedure Code	ExplanationOfBenefit.procedure.procedure.coding.code
83	CCLF3	7	Procedure Performed Date	CLM_PRCDR_PRFRM_DT	47	56	10	YYYY-MM-DD	The date the indicated procedure was performed. H	Procedure Performed Date	ExplanationOfBenefit.procedure.date
84	CCLF3	8	Beneficiary Equitable BIC HICN Number	BENE_EQTBL_BIC_HICN_NUM	57	67	11	X(11)	Legacy Beneficiary Equitable BIC HICN Number. Note: To comply with MACRA of 2015, after the end of the New Medicare Card Transition Period in December 2019, only the MBI will be accepted on claims, and the HICN value/ Beneficiary Equitable BIC HICN Number will no longer be displayed. The Beneficiary Equitable BIC HICN Number will be blank in CCLFs generated effective January 1, 2020, onwards.
85	CCLF3	9	Provider OSCAR Number	PRVDR_OSCAR_NUM	68	73	6	X(6)	A facility’s Medicare/Medicaid identification number. It is also known as a Medicare/Medicaid Provider Number, or CCN. This number verifies that a provider has been Medicare certified for a particular type of services. H	Provider Number (OSCAR/CCN)	ExplanationOfBenefit.contained.where(id = %root.provider.reference.substring(1)).identifier.where(system='http://terminology.hl7.org/NamingSystem/CCN').value
86	CCLF3	10	Claim From Date	CLM_FROM_DT	74	83	10	YYYY-MM-DD	The first day on the billing statement that covers services rendered to the beneficiary. H Also known as “Statement Covers From Date.”	Claim From Date	ExplanationOfBenefit.billablePeriod.start
87	CCLF3	11	Claim Thru Date	CLM_THRU_DT	84	93	10	YYYY-MM-DD	The last day on the billing statement that covers services rendered to the beneficiary. H Also known as the “Statement Covers Through Date.”	Claim Thru Date	ExplanationOfBenefit.billablePeriod.end
88	CCLF3	12	ICD Version Indicator	DGNS_PRCDR_ICD_IND	94	94	1	X(1)	9 = ICD-9 0 = ICD-10 U = any value other than “9” or “0” in the source data.	Diagnosis Procedure ICD indicator	ExplanationOfBenefit.procedure.procedure.coding.system
89	CCLF3	13	Claim Provider OSCAR Number	CLM_BLG_PRVDR_OSCAR_NUM	95	114	20	X(20)	A facility’s Medicare/Medicaid identification number, also known as a Medicare/Medicaid Provider Number, or CCN. This number verifies that a provider has been Medicare certified for a particular type of services. Notes:  From January 2022 onward, for Shared Savings Program, ACO REACH, KCC, VTAPM, and PCF models, this value is sourced from the Medicare claims processing system.  This field is included in addition to the Element 9 “Provider OSCAR Number” sourced from PECOS.	Provider Number (OSCAR/CCN)	ExplanationOfBenefit.contained.where(id = %root.provider.reference.substring(1)).identifier.where(system='http://terminology.hl7.org/NamingSystem/CCN').value
90	CCLF4	1	Current Claim Unique Identifier	CUR_CLM_UNIQ_ID	1	13	13	9(13)	A unique identification number assigned to the claim. I H	The claim unique ID is a unique ID for the claim within the source system.	ExplanationOfBenefit.identifier.where(type.coding.system = 'http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBIdentifierType' and type.coding.code = 'uc' ).value
91	CCLF4	2	Medicare Beneficiary Identifier	BENE_MBI_ID	14	24	11	X(11)	A Medicare Beneficiary Identifier assigned to a beneficiary. I H	Medicare Beneficiary Identifier	Patient.identifier.where(system='http://hl7.org/fhir/sid/us-mbi').value
92	CCLF4	3	Beneficiary HIC Number	BENE_HIC_NUM	25	35	11	X(11)	Legacy Beneficiary HICN field. Note: To comply with MACRA of 2015, after the end of the New Medicare Card Transition Period in December 2019, only the MBI will be accepted on claims, and the HICN value will no longer be displayed. The Beneficiary HIC Number will be blank in CCLFs generated effective January 1, 2020, onwards.
93	CCLF4	4	Claim Type Code	CLM_TYPE_CD	36	37	2	9(02)	Signifies the type of claim being submitted through the Medicare or Medicaid programs. H Claim type code include: 10 = HHA claim 20 = Non swing bed SNF claim 30 = Swing bed SNF claim 40 = Outpatient claim 50 = Hospice claim 60 = Inpatient claim 61 = Inpatient “Full- Encounter” claim	Claim Type Code	ExplanationOfBenefit.type.coding.where(system = 'https://bluebutton.cms.gov/fhir/CodeSystem/CLM-TYPE-CD').code
94	CCLF4	5	Claim Product Type Code	CLM_PROD_TYPE_CD	38	38	1	X(01)	Code classifying the diagnosis category. H Category codes include: E = Accident diagnosis code 1 = First diagnosis E code D = Other diagnosis code	Diagnosis Prod Type Code	ExplanationOfBenefit.diagnosis.type.coding
95	CCLF4	6	Claim Value Sequence Number	CLM_VAL_SQNC_NUM	39	40	2	9(2)	An arbitrary sequential number that uniquely identifies a procedure code record within the claim.
96	CCLF4	7	Diagnosis Code	CLM_DGNS_CD	41	47	7	X(07)	The ICD-9/10 diagnosis code identifying the beneficiary’s illness or disability. I H	Claim Diagnosis Code	ExplanationOfBenefit.diagnosis.diagnosis.coding.code
97	CCLF4	8	Beneficiary Equitable BIC HICN Number	BENE_EQTBL_BIC_HICN_NUM	48	58	11	X(11)	Legacy Beneficiary Equitable BIC HICN Number. Note: To comply with MACRA of 2015, after the end of the New Medicare Card Transition Period in December 2019, only the MBI will be accepted on claims and the HICN value/ Beneficiary Equitable BIC HICN Number will no longer be displayed. The Beneficiary Equitable BIC HICN Number will be blank effective January 1, 2020.
98	CCLF4	9	Provider OSCAR Number	PRVDR_OSCAR_NUM	59	64	6	X(6)	The OSCAR is a facility’s Medicare/Medicaid identification number. It is also known as a Medicare/Medicaid Provider Number, or CCN. This number verifies that a provider has been Medicare certified for a particular type of services. H	Provider Number (OSCAR/CCN)	ExplanationOfBenefit.contained.where(id = %root.provider.reference.substring(1)).identifier.where(system='http://terminology.hl7.org/NamingSystem/CCN').value
99	CCLF4	10	Claim From Date	CLM_FROM_DT	65	74	10	YYYY-MM-DD	The first day on the billing statement that covers services rendered to the beneficiary. H Also known as the “Statement Covers From Date.”	Claim From Date	ExplanationOfBenefit.billablePeriod.start
100	CCLF4	11	Claim Thru Date	CLM_THRU_DT	75	84	10	YYYY-MM-DD	The last day on the billing statement that covers services rendered to the beneficiary. H Also known as the “Statement Covers Through Date.”	Claim Thru Date	ExplanationOfBenefit.billablePeriod.end
101	CCLF4	12	Claim Present- on-Admission Indicator	CLM_POA_IND	85	91	7	X(7)	Indicates whether a patient had the condition listed on the claim line at the time of admission to the facility. I H Find Present-on-Admission values at the ResDAC website.	Claim Present on Admission Indicator	ExplanationOfBenefit.diagnosis.onAdmission.coding
102	CCLF4	13	ICD Version Indicator	DGNS_PRCDR_ICD_IND	92	92	1	X(1)	9 = ICD-9 0 = ICD-10 U = any value other than “9” or “0” in the source data.	Diagnosis Procedure ICD indicator	ExplanationOfBenefit.diagnosis.diagnosis.coding.system
103	CCLF4	14	Claim Provider OSCAR Number	CLM_BLG_PRVDR_OSCAR_NUM	93	112	20	X(20)	A facility’s Medicare/Medicaid identification number, also known as a Medicare/Medicaid Provider Number, or CCN. This number verifies that a provider has been Medicare certified for a particular type of services. Notes:  From January 2022 onward, for Shared Savings Program, ACO REACH, KCC, VTAPM, and PCF models, this value is sourced from the Medicare claims processing system.  This field is included in addition to the Element 9 “Provider OSCAR Number” sourced from PECOS.	Provider Number (OSCAR/CCN)	ExplanationOfBenefit.contained.where(id = %root.provider.reference.substring(1)).identifier.where(system='http://terminology.hl7.org/NamingSystem/CCN').value
104	CCLF5	1	Current Claim Unique Identifier	CUR_CLM_UNIQ_ID	1	13	13	9(13)	A unique identification number assigned to the claim. I H	The claim unique ID is a unique ID for the claim within the source system.	ExplanationOfBenefit.identifier.where(type.coding.system = 'http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBIdentifierType' and type.coding.code = 'uc' ).value
105	CCLF5	2	Claim Line Number	CLM_LINE_NUM	14	23	10	9(10)	A sequential number that identifies a specific claim line within a given claim.	Line Item Sequence Number	ExplanationOfBenefit.item.sequence
106	CCLF5	3	Medicare Beneficiary Identifier	BENE_MBI_ID	24	34	11	X(11)	A Medicare Beneficiary Identifier assigned to a beneficiary. I H	Medicare Beneficiary Identifier	Patient.identifier.where(system='http://hl7.org/fhir/sid/us-mbi').value
107	CCLF5	4	Beneficiary HIC Number	BENE_HIC_NUM	35	45	11	X(11)	Legacy Beneficiary HICN field. Note: To comply with MACRA of 2015, after the end of the New Medicare Card Transition Period in December 2019, only the MBI will be accepted on claims, and the HICN value will no longer be displayed. The HICN field will be blank effective January 1, 2020.
108	CCLF5	5	Claim Type Code	CLM_TYPE_CD	46	47	2	9(02)	Signifies the type of claim being submitted through the Medicare or Medicaid programs. H Claim type code include: 71 = RIC O local carrier non-DMEPOS claim 72 = RIC O local carrier DMEPOS claim	Claim Type Code	ExplanationOfBenefit.type.coding.where(system = 'https://bluebutton.cms.gov/fhir/CodeSystem/CLM-TYPE-CD').code
109	CCLF5	6	Claim From Date	CLM_FROM_DT	48	57	10	YYYY-MM-DD	The first day on the billing statement that covers services rendered to the beneficiary. H Also known as the “Statement Covers From Date.”	Claim From Date	ExplanationOfBenefit.billablePeriod.start
110	CCLF5	7	Claim Thru Date	CLM_THRU_DT	58	67	10	YYYY-MM-DD	The last day on the billing statement that covers services rendered to the beneficiary. H Also known as the “Statement Covers Through Date.”	Claim Thru Date	ExplanationOfBenefit.billablePeriod.end
111	CCLF5	8	Rendering Provider Type Code	RNDRG_PRVDR_TYPE_CD	68	70	3	X(03)	Indicates the type of provider who provided the service associated with this line item on the claim. Provider Type Code include: 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 8 = Family Practice UI = UPIN Identification N2 = National Council for Prescription Drug Programs D = National Supplier Clearinghouse BP = PIN Individual BG = PIN Group A = Online Survey, Certification and Reporting
112	CCLF5	9	Rendering Provider FIPS State Code	RNDRG_PRVDR_FIPS_ST_CD	71	72	2	X(02)	Identifies the state that the provider providing the service is located in.	State FIPS Code	ExplanationOfBenefit.supportingInfo.where(category.coding.where(system='https://bluebutton.cms.gov/fhir/CodeSystem/Supporting-Information').exists() and category.coding.where(code='RNDRG_PRVDR_FIPS_ST_CD').exists()).code
113	CCLF5	10	Claim-Line Provider Specialty Code	CLM_PRVDR_SPCLTY_CD	73	74	2	X(02)	Indicates the CMS specialty code associated with the provider of services. CMS used this number to price the service on the line-item. Find Provider Specialty Code at CMS.gov or the Research Data Assistance Center.	Provider Speciality Code	ExplanationOfBenefit.item.extension.where(url='https://bluebutton.cms.gov/fhir/StructureDefinition/CLM-PRVDR-SPCLTY-CD').value.code
114	CCLF5	11	Claim Federal Type Service Code	CLM_FED_TYPE_SRVC_CD	75	75	1	X(01)	Indicates the type of service (e.g., consultation, surgery) provided to the beneficiary. Types of Service Code are defined in the Medicare Carrier Manual. Find Types of Service Code at the ResDAC website.	CMS Service Type Code	ExplanationOfBenefit.item.extension.where(url='https://bluebutton.cms.gov/fhir/StructureDefinition/CLM-FED-TYPE-SRVC-CD').value.code
115	CCLF5	12	Claim Place of Service Code	CLM_POS_CD	76	77	2	X(02)	Indicates the place where the indicated service was provided (e.g., ambulance, school). Places of service are defined in the Medicare Carrier Manual. Find Place of Service Code at the ResDAC website.	Place Of Service Code	ExplanationOfBenefit.item.location.coding.where(system='https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set').code
116	CCLF5	13	Claim Line From Date	CLM_LINE_FROM_DT	78	87	10	YYYY-MM-DD	The date the service associated with the line item began.	Line Item From Date	ExplanationOfBenefit.item.serviced.start
117	CCLF5	14	Claim Line Thru Date	CLM_LINE_THRU_DT	88	97	10	YYYY-MM-DD	The date the service associated with the line item ended.	Last Expense Date	ExplanationOfBenefit.item.serviced.end
118	CCLF5	15	HCPCS Code	CLM_LINE_HCPCS_CD	98	102	5	X(05)	The HCPCS code representing the procedure, supply, product, and/or service provided to the beneficiary. I H	Line Item HCPCS Code	ExplanationOfBenefit.item.productOrService.where(coding.system='http://www.ama-assn.org/go/cpt' or coding.system='https://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets' or coding.system='http://terminology.hl7.org/CodeSystem/data-absent-reason').coding.code
119	CCLF5	16	Claim Line NCH Payment Amount	CLM_LINE_CVRD_PD_AMT	103	117	15	X(15)	The amount of payment made by Medicare on behalf of the beneficiary for the indicated service after deductible and coinsurance amounts have been paid.	Claim Line Covered Paid Amount	ExplanationOfBenefit.item.adjudication.where(category.coding.where(system='https://bluebutton.cms.gov/fhir/CodeSystem/Adjudication') and category.coding.where(code='CLM_LINE_CVRD_PD_AMT')).amount.value
120	CCLF5	17	Claim Primary Payer Code	CLM_LINE_PRMRY_PYR_CD	118	118	1	X(01)	If a payer other than Medicare has primary responsibility for payment of the service indicated on the claim line, this code indicates the primary payer. This field is also known as the Line Beneficiary Primary Payer Code. I H If this field is blank, Medicare is the primary payer for the beneficiary. Find Primary Payer Code at the ResDAC website.	Line Primary Payer Code	ExplanationOfBenefit.item.extension.where(url='https://bluebutton.cms.gov/fhir/StructureDefinition/CLM-PRMRY-PYR-CD').value.code
121	CCLF5	18	Diagnosis Code	CLM_LINE_DGNS_CD	119	125	7	X(07)	The ICD-9/10 diagnosis code identifying the beneficiary’s principal illness or disability. I H	Line Item Diagnosis Code	ExplanationOfBenefit.item.select(%root.diagnosis[diagnosisSequence-1].diagnosis.coding.code)
122	CCLF5	19	Claim Provider Tax Number	CLM_RNDRG_PRVDR_TAX_NUM	126	135	10	X(10)	The SSN or Employee Identification Number (EIN) of the provider of the indicated service. This number identifies who receives payment for the indicated service. I	Provider Tax Number	ExplanationOfBenefit.item.extension.where(url='https://bluebutton.cms.gov/fhir/StructureDefinition/CLM-PRVDR-TAX-NUM').value
123	CCLF5	20	Rendering Provider NPI Number	RNDRG_PRVDR_NPI_NUM	136	145	10	X(10)	A number that identifies the provider rendering the indicated service on the claim line. Each provider is assigned its own unique NPI.	Rendering Provider NPI Number - Line Level	ExplanationOfBenefit.careTeam.where(role.coding.where(code = 'rendering').exists()).provider.identifier.value
124	CCLF5	21	Claim Carrier Payment Denial Code	CLM_CARR_PMT_DNL_CD	146	147	2	X(02)	Indicates to whom payment was made (e.g., physician, beneficiary), or if the claim was denied. Find Carrier Payment Denial Code at the ResDAC website. Additionally, the following code may be available: G = MSP Cost Avoided - Secondary Claims Investigation H = MSP Cost Avoided - Self Reports J = MSP Cost Avoided - 411.25 T = MSP Cost Avoided - IEQ contractor (eff. 7/96) X = MSP Cost Avoided - generic Y = MSP Cost Avoided - IRS/SSA data match project	Claim Payment Denial Code	ExplanationOfBenefit.supportingInfo.where(category.coding.where(system='https://bluebutton.cms.gov/fhir/CodeSystem/Supporting-Information').exists() and category.coding.where(code='CLM_CARR_PMT_DNL_CD').exists()).code.coding.code
125	CCLF5	22	Claim-Line Processing Indicator Code	CLM_PRCSG_IND_CD	148	149	2	X(02)	Indicates if the service indicated on the claim line was allowed or the reason it was denied. Find Processing Indicator Code at the ResDAC website. Additionally, the following code may be available: G = MSP Cost Avoided - Secondary Claims Investigation H = MSP Cost Avoided - Self Reports J = MSP Cost Avoided - 411.25 19 = MSP Cost Avoided - Worker's Compensation Set Aside 41 = MSP Cost Avoided - Next Generation Desktop	Processing Indicator Code	ExplanationOfBenefit.item.extension.where(url='https://bluebutton.cms.gov/fhir/StructureDefinition/CLM-PRCSG-IND-CD').value.code
126	CCLF5	23	Claim Adjustment Type Code	CLM_ADJSMT_TYPE_CD	150	151	2	X(02)	Indicates whether the claim is an original, cancellation, or adjustment claim. Claim Adjustment Type Code include: 0 = Original Claim 1 = Cancellation Claim 2 = Adjustment claim	Claim Adjustment Type Code	ExplanationOfBenefit.supportingInfo.where(category.coding.where(system='https://bluebutton.cms.gov/fhir/CodeSystem/Supporting-Information').exists() and category.coding.where(code='CLM_ADJSTMT_TYPE_CD').exists()).code.coding.code
127	CCLF5	24	Claim Effective Date	CLM_EFCTV_DT	152	161	10	YYYY-MM-DD	The date the claim was processed and added to the NCH. This is also referred to as the NCH Weekly Processing Date.	Claim Effective Date	ExplanationOfBenefit.created
128	CCLF5	25	Claim IDR Load Date	CLM_IDR_LD_DT	162	171	10	YYYY-MM-DD	When the claim was loaded into the IDR.	Claim IDR Load Date	ExplanationOfBenefit.supportingInfo.where(category.coding.where(system='https://bluebutton.cms.gov/fhir/CodeSystem/Supporting-Information').exists() and category.coding.where(code='CLM_IDR_LD_DT').exists()).timing
129	CCLF5	26	Claim Control Number	CLM_CNTL_NUM	172	211	40	X(40)	A unique number assigned to a claim by the Medicare carrier. This number allows CMS to associate each line item with its respective claim.	Claim Control Number	ExplanationOfBenefit.identifier.where(system = 'https://bluebutton.cms.gov/identifiers/CLM-CNTL-NUM').value
130	CCLF5	27	Beneficiary Equitable BIC HICN Number	BENE_EQTBL_BIC_HICN_NUM	212	222	11	X(11)	Legacy Beneficiary Equitable BIC HICN Number. Note: To comply with MACRA of 2015, after the end of the New Medicare Card Transition Period in December 2019, only the MBI will be accepted on claims, and the HICN value/ Beneficiary Equitable BIC HICN Number will no longer be displayed. The Beneficiary Equitable BIC HICN Number will be blank effective January 1, 2020.
131	CCLF5	28	Claim Line Allowed Charges Amount	CLM_LINE_ALOWD_CHRG_AMT	223	239	17	X(17)	The amount Medicare approved for payment to the provider.	Line Item Allowed Charge Amount	ExplanationOfBenefit.item.adjudication.where(category.coding.where(system='https://bluebutton.cms.gov/fhir/CodeSystem/Adjudication') and category.coding.where(code='CLM_LINE_ALOWD_CHRG_AMT')).amount.value
132	CCLF5	29	Claim Line Service Unit Quantity	CLM_LINE_SRVC_UNIT_QTY	240	263	24	-9(18).9999	Count of total units, at the line-item level, associated with services needing unit reporting (e.g., anesthesia time units and blood units).	Line Item Service Unit Quantity	ExplanationOfBenefit.item.quantity.value
133	CCLF5	30	HCPCS First Modifier Code	HCPCS_1_MDFR_CD	264	265	2	X(2)	The first code to modify the HCPCS procedure code associated with the claim- line. This provides more specific procedure identification for the line- item service. H	HCPCS Modifier Code 1	ExplanationOfBenefit.item.modifier[0].coding.code
134	CCLF5	31	HCPCS Second Modifier Code	HCPCS_2_MDFR_CD	266	267	2	X(2)	The second code to modify the HCPCS procedure code associated with the claim- line. This provides more specific procedure identification for the line- item service. H	HCPCS Modifier Code 2	ExplanationOfBenefit.item.modifier[1].coding.code
135	CCLF5	32	HCPCS Third Modifier Code	HCPCS_3_MDFR_CD	268	269	2	X(2)	The third code to modify the HCPCS procedure code associated with the claim- line. This provides more specific procedure identification for the line- item service. H	HCPCS Modifier Code 3	ExplanationOfBenefit.item.modifier[2].coding.code
136	CCLF5	33	HCPCS Fourth Modifier Code	HCPCS_4_MDFR_CD	270	271	2	X(2)	The fourth code to modify the HCPCS procedure code associated with the claim- line. This provides more specific procedure identification for the line- item service. H	HCPCS Modifier Code 4	ExplanationOfBenefit.item.modifier[3].coding.code
137	CCLF5	34	HCPCS Fifth Modifier Code	HCPCS_5_MDFR_CD	272	273	2	X(2)	The fifth code to modify the HCPCS procedure code associated with the claim- line. This provides more specific procedure identification for the line- item service. H	HCPCS Modifier Code 5	ExplanationOfBenefit.item.modifier[4].coding.code
138	CCLF5	35	Claim Disposition Code	CLM_DISP_CD	274	275	2	X(2)	Information regarding payment actions on the claim. Claim Disposition Code include: 01 = Debit accepted 02 = Debit accepted (automatic adjustment) 03 = Cancel accepted	Claim Disposition Code	ExplanationOfBenefit.supportingInfo.where(category.coding.where(system='https://bluebutton.cms.gov/fhir/CodeSystem/Supporting-Information').exists() and category.coding.where(code='CLM_DISP_CD').exists()).code.coding.code
139	CCLF5	36	Claim Diagnosis First Code	CLM_DGNS_1_CD	276	282	7	X(7)	The first of 12 allowable ICD-9/10 diagnosis code identifying the beneficiary’s illness or disability. I H	Claim Diagnosis Code	ExplanationOfBenefit.diagnosis.diagnosis.coding.code
140	CCLF5	37	Claim Diagnosis Second Code	CLM_DGNS_2_CD	283	289	7	X(7)	The second of 12 allowable ICD-9/10 diagnosis code identifying the beneficiary’s illness or disability. I H	Claim Diagnosis Code	ExplanationOfBenefit.diagnosis.diagnosis.coding.code
141	CCLF5	38	Claim Diagnosis Third Code	CLM_DGNS_3_CD	290	296	7	X(7)	The third of 12 allowable ICD-9/10 diagnosis code identifying the beneficiary’s illness or disability. I H	Claim Diagnosis Code	ExplanationOfBenefit.diagnosis.diagnosis.coding.code
142	CCLF5	39	Claim Diagnosis Fourth Code	CLM_DGNS_4_CD	297	303	7	X(7)	The fourth of 12 allowable ICD-9/10 diagnosis code identifying the beneficiary’s illness or disability. I H	Claim Diagnosis Code	ExplanationOfBenefit.diagnosis.diagnosis.coding.code
143	CCLF5	40	Claim Diagnosis Fifth Code	CLM_DGNS_5_CD	304	310	7	X(7)	The fifth of 12 allowable ICD-9/10 diagnosis code identifying the beneficiary’s illness or disability. I H	Claim Diagnosis Code	ExplanationOfBenefit.diagnosis.diagnosis.coding.code
144	CCLF5	41	Claim Diagnosis Sixth Code	CLM_DGNS_6_CD	311	317	7	X(7)	The sixth of 12allowable ICD-9/10 diagnosis code identifying the beneficiary’s illness or disability. I H	Claim Diagnosis Code	ExplanationOfBenefit.diagnosis.diagnosis.coding.code
145	CCLF5	42	Claim Diagnosis Seventh Code	CLM_DGNS_7_CD	318	324	7	X(7)	The seventh of 12 allowable ICD-9/10 diagnosis code identifying the beneficiary’s illness or disability. I H	Claim Diagnosis Code	ExplanationOfBenefit.diagnosis.diagnosis.coding.code
146	CCLF5	43	Claim Diagnosis Eighth Code	CLM_DGNS_8_CD	325	331	7	X(7)	The eighth of 12 allowable ICD-9/10 diagnosis code identifying the beneficiary’s illness or disability. I H	Claim Diagnosis Code	ExplanationOfBenefit.diagnosis.diagnosis.coding.code
147	CCLF5	44	ICD Version Indicator	DGNS_PRCDR_ICD_IND	332	332	1	X(1)	9 = ICD-9 0 = ICD-10 U = any value other than “9” or “0” in the source data.	Diagnosis Procedure ICD indicator	ExplanationOfBenefit.diagnosis.diagnosis.coding.system
148	CCLF5	45	Claim Diagnosis Ninth Code	CLM_DGNS_9_CD	333	339	7	X(7)	The ninth of 12 allowable ICD-9/10 diagnosis code identifying the beneficiary’s illness or disability. I H	Claim Diagnosis Code	ExplanationOfBenefit.diagnosis.diagnosis.coding.code
149	CCLF5	46	Claim Diagnosis Tenth Code	CLM_DGNS_10_CD	340	346	7	X(7)	The tenth of 12 allowable ICD-9/10 diagnosis code identifying the beneficiary’s illness or disability. I H	Claim Diagnosis Code	ExplanationOfBenefit.diagnosis.diagnosis.coding.code
150	CCLF5	47	Claim Diagnosis Eleventh Code	CLM_DGNS_11_CD	347	353	7	X(7)	The eleventh of 12 allowable ICD-9/10 diagnosis code identifying the beneficiary’s illness or disability. I H	Claim Diagnosis Code	ExplanationOfBenefit.diagnosis.diagnosis.coding.code
151	CCLF5	48	Claim Diagnosis Twelfth Code	CLM_DGNS_12_CD	354	360	7	X(7)	The twelfth of 12 allowable ICD-9/10 diagnosis code identifying the beneficiary’s illness or disability. I H	Claim Diagnosis Code	ExplanationOfBenefit.diagnosis.diagnosis.coding.code
152	CCLF5	49	HCPCS BETOS Code	HCPCS_BETOS_CD	361	363	3	X(3)	A code representing a clinical category. The Berenson-Eggers Type of Service (BETOS) code.
153	CCLF5	50	Claim Rendering Provider NPI Number	CLM_RNDRG_PRVDR_NPI_NUM	364	373	10	X(10)	A number that identifies the provider rendering the indicated service on the claim line. Each provider is assigned its own unique NPI. Notes:  From January 2022 onward, for Shared Savings Program, ACO REACH, KCC, VTAPM, and PCF models, this value is sourced from the Medicare claims processing system.  This field is included in addition to the Element 20 “Rendering Provider NPI Number” sourced from PECOS.	Rendering Provider NPI Number - Line Level	ExplanationOfBenefit.careTeam.where(role.coding.where(code = 'rendering').exists()).provider.identifier.value
154	CCLF5	51	Claim Referring Provider NPI Number	CLM_RFRG_PRVDR_NPI_NUM	374	383	10	X(10)	A number that identifies the provider that referred the service on the claim line. Each provider is assigned its own unique NPI.	Referring Provider NPI Number	ExplanationOfBenefit.careTeam.where(role.coding.where(code = 'referring').exists()).provider.identifier.value
155	CCLF5	52	Claim contractor number	CLM_CNTRCTR_NUM	384	388	5	X(5)	A number assigned by CMS identifying a MAC authorized to process Medicare claims.	FI Number	ExplanationOfBenefit.supportingInfo.where(category.coding.where(system='https://bluebutton.cms.gov/fhir/CodeSystem/Supporting-Information').exists() and category.coding.where(code='CLM_CNTRCTR_NUM').exists()).code.coding.code
156	CCLF6	1	Current Claim Unique Identifier	CUR_CLM_UNIQ_ID	1	13	13	9(13)	A unique identification number assigned to the claim. I H	The claim unique ID is a unique ID for the claim within the source system.	ExplanationOfBenefit.identifier.where(type.coding.system = 'http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBIdentifierType' and type.coding.code = 'uc' ).value
157	CCLF6	2	Claim Line Number	CLM_LINE_NUM	14	23	10	9(10)	A sequential number that identifies a specific claim line.	Line Item Sequence Number	ExplanationOfBenefit.item.sequence
158	CCLF6	3	Medicare Beneficiary Identifier	BENE_MBI_ID	24	34	11	X(11)	A Medicare Beneficiary Identifier assigned to a beneficiary. I H	Medicare Beneficiary Identifier	Patient.identifier.where(system='http://hl7.org/fhir/sid/us-mbi').value
159	CCLF6	4	Beneficiary HIC Number	BENE_HIC_NUM	35	45	11	X(11)	Legacy Beneficiary HICN field. Note: To comply with MACRA of 2015, after the end of the New Medicare Card Transition Period in December 2019, only the MBI will be accepted on claims, and the HICN value will no longer be displayed. The Beneficiary HIC Number will be blank in CCLFs generated effective January 1, 2020, onwards.
160	CCLF6	5	Claim Type Code	CLM_TYPE_CD	46	47	2	9(02)	Signifies the type of claim being submitted through the Medicare or Medicaid programs. H Claim type code include: 81 = RIC M DMERC non-DMEPOS claim 82 = RIC M DMERC DMEPOS claim	Claim Type Code	ExplanationOfBenefit.type.coding.where(system = 'https://bluebutton.cms.gov/fhir/CodeSystem/CLM-TYPE-CD').code
161	CCLF6	6	Claim From Date	CLM_FROM_DT	48	57	10	YYYY-MM-DD	The first day on the billing statement that covers services rendered to the beneficiary. H Also known as the “Statement Covers From Date.”	Claim From Date	ExplanationOfBenefit.billablePeriod.start
162	CCLF6	7	Claim Thru Date	CLM_THRU_DT	58	67	10	YYYY-MM-DD	The last day on the billing statement that covers services rendered to the beneficiary. H Also known as the “Statement Covers Through Date.”	Claim Thru Date	ExplanationOfBenefit.billablePeriod.end
163	CCLF6	8	Claim Federal Type Service Code	CLM_FED_TYPE_SRVC_CD	68	68	1	X(01)	Indicates the type of service (e.g., consultation, surgery), provided to the beneficiary. Types of Service Code are defined in the Medicare Carrier Manual. H Find Types of Service Code at the ResDAC website.	CMS Service Type Code	ExplanationOfBenefit.item.extension.where(url='https://bluebutton.cms.gov/fhir/StructureDefinition/CLM-FED-TYPE-SRVC-CD').value.code
164	CCLF6	9	Claim Place of Service Code	CLM_POS_CD	69	70	2	X(02)	Indicates place where the indicated service was provided (e.g., ambulance, school). H Find Place of Service Code at the ResDAC website.	Place Of Service Code	ExplanationOfBenefit.item.location.coding.where(system='https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set').code
165	CCLF6	10	Claim Line From Date	CLM_LINE_FROM_DT	71	80	10	YYYY-MM-DD	The date the service associated with the line item began. H	Line Item From Date	ExplanationOfBenefit.item.serviced.start
166	CCLF6	11	Claim Line Thru Date	CLM_LINE_THRU_DT	81	90	10	YYYY-MM-DD	The date the service associated with the line item ended. H	Last Expense Date	ExplanationOfBenefit.item.serviced.end
167	CCLF6	12	HCPCS Code	CLM_LINE_HCPCS_CD	91	95	5	X(05)	The HCPCS code representing the procedure, supply, product, and/or service provided to the beneficiary. H	Line Item HCPCS Code	ExplanationOfBenefit.item.productOrService.where(coding.system='http://www.ama-assn.org/go/cpt' or coding.system='https://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets' or coding.system='http://terminology.hl7.org/CodeSystem/data-absent-reason').coding.code
168	CCLF6	13	Claim Line NCH Payment Amount	CLM_LINE_CVRD_PD_AMT	96	110	15	-9(11).99	The amount of payment made by Medicare on behalf of the beneficiary for the indicated service after deductible and coinsurance amounts have been paid. H	Claim Line Covered Paid Amount	ExplanationOfBenefit.item.adjudication.where(category.coding.where(system='https://bluebutton.cms.gov/fhir/CodeSystem/Adjudication') and category.coding.where(code='CLM_LINE_CVRD_PD_AMT')).amount.value
169	CCLF6	14	Claim Primary Payer Code	CLM_PRMRY_PYR_CD	111	111	1	X(01)	If a payer other than Medicare has primary responsibility for payment of the service indicated on the claim line, this code indicates the primary payer. This field is also known as the Line Beneficiary Primary Payer Code. If this field is blank, Medicare is the primary payer for the beneficiary. Find Primary Payer Code at the ResDAC website.	Line Primary Payer Code	ExplanationOfBenefit.item.extension.where(url='https://bluebutton.cms.gov/fhir/StructureDefinition/CLM-PRMRY-PYR-CD').value.code
170	CCLF6	15	Pay-to Provider NPI Number	PAYTO_PRVDR_NPI_NUM	112	121	10	X(10)	A number that identifies the provider billing for the indicated service on the claim line. Each provider is assigned its own unique NPI.	Provider billing NPI number	ExplanationOfBenefit.contained.where(id = %root.provider.reference.substring(1)).identifier.where(system='http://hl7.org/fhir/sid/us-npi').value
171	CCLF6	16	Ordering Provider NPI Number	ORDRG_PRVDR_NPI_NUM	122	131	10	X(10)	A number that identifies the provider ordering the indicated service on the claim line. Each provider is assigned its own unique NPI.	Referring Provider NPI Number	ExplanationOfBenefit.careTeam.where(role.coding.where(code = 'referring').exists()).provider.identifier.value
172	CCLF6	17	Claim Carrier Payment Denial Code	CLM_CARR_PMT_DNL_CD	132	133	2	X(02)	Indicates to whom payment was made (e.g., physician, beneficiary) or if the claim was denied Find Carrier Payment Denial Code at the ResDAC website. Additionally, the following code may be available: G = Secondary Claims Investigation H = Self Reports J = 411.25 T = MSP Cost Avoided - IEQ contractor (eff. 7/96) X = MSP Cost Avoided - generic Y = MSP Cost Avoided - IRS/SSA data match project	Claim Payment Denial Code	ExplanationOfBenefit.supportingInfo.where(category.coding.where(system='https://bluebutton.cms.gov/fhir/CodeSystem/Supporting-Information').exists() and category.coding.where(code='CLM_CARR_PMT_DNL_CD').exists()).code.coding.code
173	CCLF6	18	Claim Processing Indicator Code	CLM_PRCSG_IND_CD	134	135	2	X(02)	Indicates if the service indicated on the claim line was allowed or the reason it was denied. Find Processing Indicator Code at the ResDAC website. Additionally, the following code may be available: G = MSP Cost Avoided - Secondary Claims Investigation H = MSP Cost Avoided - Self Reports J = MSP Cost Avoided - 411.25 19 = MSP Cost Avoided - Worker's Compensation Set Aside 41 = MSP Cost Avoided - Next Generation Desktop	Processing Indicator Code	ExplanationOfBenefit.item.extension.where(url='https://bluebutton.cms.gov/fhir/StructureDefinition/CLM-PRCSG-IND-CD').value.code
174	CCLF6	19	Claim Adjustment Type Code	CLM_ADJSMT_TYPE_CD	136	137	2	X(02)	Indicates whether the claim is an original, cancellation, or adjustment claim. Claim Adjustment Type Code include: 0 = Original Claim 1 = Cancellation Claim 2 = Adjustment claim	Claim Adjustment Type Code	ExplanationOfBenefit.supportingInfo.where(category.coding.where(system='https://bluebutton.cms.gov/fhir/CodeSystem/Supporting-Information').exists() and category.coding.where(code='CLM_ADJSTMT_TYPE_CD').exists()).code.coding.code
175	CCLF6	20	Claim Effective Date	CLM_EFCTV_DT	138	147	10	YYYY-MM-DD	The date the claim was processed and added to the NCH. This is also referred to as the NCH Weekly Processing Date. H	Claim Effective Date	ExplanationOfBenefit.created
176	CCLF6	21	Claim IDR Load Date	CLM_IDR_LD_DT	148	157	10	YYYY-MM-DD	When the claim was loaded into the IDR.	Claim IDR Load Date	ExplanationOfBenefit.supportingInfo.where(category.coding.where(system='https://bluebutton.cms.gov/fhir/CodeSystem/Supporting-Information').exists() and category.coding.where(code='CLM_IDR_LD_DT').exists()).timing
177	CCLF6	22	Claim Control Number	CLM_CNTL_NUM	158	197	40	X(40)	A unique number assigned to a claim by the Medicare carrier. This number allows CMS to associate each line item with its respective claim.	Claim Control Number	ExplanationOfBenefit.identifier.where(system = 'https://bluebutton.cms.gov/identifiers/CLM-CNTL-NUM').value
178	CCLF6	23	Beneficiary Equitable BIC HICN Number	BENE_EQTBL_BIC_HICN_NUM	198	208	11	X(11)	Legacy Beneficiary Equitable BIC HICN Number. Note: To comply with MACRA of 2015, after the end of the New Medicare Card Transition Period in December 2019, only the MBI will be accepted on claims, and the HICN value/ Beneficiary Equitable BIC HICN Number will no longer be displayed. The Beneficiary Equitable BIC HICN Number will be blank in CCLFs generated effective January 1, 2020, onwards.
179	CCLF6	24	Claim Line Allowed Charges Amount	CLM_LINE_ALOWD_CHRG_AMT	209	225	17	-9(14).99	The amount Medicare approved for payment to the provider.	Line Item Allowed Charge Amount	ExplanationOfBenefit.item.adjudication.where(category.coding.where(system='https://bluebutton.cms.gov/fhir/CodeSystem/Adjudication') and category.coding.where(code='CLM_LINE_ALOWD_CHRG_AMT')).amount.value
180	CCLF6	25	Claim Disposition Code	CLM_DISP_CD	226	227	2	X(2)	Contains information regarding payment actions on the claim. Claim Disposition Code include: 01 = Debit accepted 02 = Debit accepted (automatic adjustment) 03 = Cancel accepted	Claim Disposition Code	ExplanationOfBenefit.supportingInfo.where(category.coding.where(system='https://bluebutton.cms.gov/fhir/CodeSystem/Supporting-Information').exists() and category.coding.where(code='CLM_DISP_CD').exists()).code.coding.code
181	CCLF6	26	Claim Pay-to Provider NPI Number	CLM_BLG_PRVDR_NPI_NUM	228	237	10	X(10)	A number that identifies the provider billing for the indicated service on the claim line. Each provider is assigned its own unique NPI. Notes:  From January 2022 onward, for Shared Savings Program, ACO REACH, KCC, VTAPM, and PCF models, this value is sourced from the Medicare claims processing system.  This field is included in addition to the Element 15 “Pay-to Provider NPI Number” sourced from PECOS.	Provider billing NPI number	ExplanationOfBenefit.contained.where(id = %root.provider.reference.substring(1)).identifier.where(system='http://hl7.org/fhir/sid/us-npi').value
182	CCLF6	27	Claim Ordering Provider NPI Number	CLM_RFRG_PRVDR_NPI_NUM	238	247	10	X(10)	A number that identifies the provider ordering the indicated service on the claim line. Each provider is assigned its own unique NPI. Notes:  From January 2022 onward, for Shared Savings Program, ACO REACH, KCC, VTAPM, and PCF models, this value is sourced from the Medicare claims processing system.  This field is included in addition to the Element 16 “Ordering Provider NPI Number” sourced from PECOS.	Referring Provider NPI Number	ExplanationOfBenefit.careTeam.where(role.coding.where(code = 'referring').exists()).provider.identifier.value
183	CCLF7	1	Current Claim Unique Identifier	CUR_CLM_UNIQ_ID	1	13	13	9(13)	A unique identification number assigned to the claim. I H	Claim Unique ID	ExplanationOfBenefit.identifier.where(type.coding.system = 'http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBIdentifierType' and type.coding.code = 'uc' ).value
184	CCLF7	2	Medicare Beneficiary Identifier	BENE_MBI_ID	14	24	11	X(11)	A Medicare Beneficiary Identifier assigned to a beneficiary. I H	Medicare Beneficiary Identifier	Patient.identifier.where(system='http://hl7.org/fhir/sid/us-mbi').value
185	CCLF7	3	Beneficiary HIC Number	BENE_HIC_NUM	25	35	11	X(11)	Legacy Beneficiary HICN field. Note: To comply with MACRA of 2015, after the end of the New Medicare Card Transition Period in December 2019, only the MBI will be accepted on claims, and the HICN value will no longer be displayed. The Beneficiary HIC Number will be blank in CCLFs generated effective January 1, 2020, onwards.
186	CCLF7	4	NDC Code	CLM_LINE_NDC_CD	36	46	11	X(11)	A universal unique product identifier for human drugs. H	National Drug Code	(ExplanationOfBenefit.item.productOrService.coding\|ExplanationOfBenefit.item.detail.productOrService.coding).where(system = 'http://hl7.org/fhir/sid/ndc').code
187	CCLF7	5	Claim Type Code	CLM_TYPE_CD	47	48	2	9(02)	Signifies the type of claim being submitted through the Medicare or Medicaid programs. H Claim type code include: 01 = Part D - Original without resubmitted PDE 02 = Part D - Adjusted PDE 03 = Part D - Deleted Claims 04 = Part D - Resubmitted PDE	Claim Type Code	ExplanationOfBenefit.type.coding.where(system = 'https://bluebutton.cms.gov/fhir/CodeSystem/CLM-TYPE-CD').code
188	CCLF7	6	Claim Line From Date	CLM_LINE_FROM_DT	49	58	10	YYYY-MM-DD	The date the service associated with the line item began (i.e., the date upon which the prescription was filled).	Line Item From Date	ExplanationOfBenefit.item.serviced
189	CCLF7	7	Provider Service Identifier Qualifier Code	PRVDR_SRVC_ID_QLFYR_CD	59	60	2	X(02)	Indicates the type of number used to identify the pharmacy providing the services: 01 = NPI Number 06 = Unique Physician Identification Number (UPIN) 07 = National Council for Prescription Drug Programs (NCPDP) Number 08 = State License Number 11 = TIN 99 = Other mandatory for Standard Data Format	Provider Service Identifier Qualifier Code	ExplanationOfBenefit.contained.where(id = %context.provider.reference.substring(1)).identifier.type.where(system='http://bluebutton.cms.gov/fhir/CodeSystem/PRVDR-ID-QLFYR-CD').code
190	CCLF7	8	Claim Service Provider Generic ID Number	CLM_SRVC_PRVDR_GNRC_ID_NUM	61	80	20	X(20)	The number associated with the indicated code in the Provider Service Identification Qualifier Code field.	Service Provider Generic ID Number	ExplanationOfBenefit.contained.where(id = %context.provider.reference.substring(1)).identifier.where(system='http://bluebutton.cms.gov/fhir/identifiers/GenericIdNum').value
191	CCLF7	9	Claim Dispensing Status Code	CLM_DSPNSNG_STUS_CD	81	81	1	X(01)	Indicates the status of prescription fulfillment. Dispensing Code include: P = Partially filled C = Completely filled	Dispensing Status Code	ExplanationOfBenefit.supportingInfo.code.coding.where(system='https://bluebutton.cms.gov/fhir/CodeSystem/CLM-DSPNSNG-STUS-CD').code
192	CCLF7	10	Claim Dispense as Written (DAW) Product Selection Code	CLM_DAW_PROD_SLCTN_CD	82	82	1	X(01)	Indicates the prescriber's instructions regarding generic substitution or how those instructions were followed. DAW Product Selection Code include: 0 = No product selection indicated 1 = Substitution not allowed by prescriber 2 = Substitution allowed – Patient requested that brand be dispensed 3 = Substitution allowed – Pharmacist selected product dispensed 4 = Substitution allowed – Generic not in stock 5 = Substitution allowed – Brand drug dispensed as generic 6 = Override 7 = Substitution not allowed – Brand drug mandated by law 8 = Substitution allowed – Generic drug not available in marketplace 9 = Other	DAW Product Selection Code	ExplanationOfBenefit.supportingInfo.code.coding.where(system='http://terminology.hl7.org/CodeSystem/NCPDPDispensedAsWrittenOrProductSelectionCode').code
193	CCLF7	11	Claim Line Service Unit Quantity	CLM_LINE_SRVC_UNIT_QTY	83	106	24	-9(18).9999	Count of total units, at the line-item level, associated with services needing unit reporting (e.g., anesthesia time units and blood units).	Line Item NDC Quantity	(ExplanationOfBenefit.item.quantity\|ExplanationOfBenefit.item.detail.quantity).value
194	CCLF7	12	Claim Line Days’ Supply Quantity	CLM_LINE_DAYS_SUPLY_QTY	107	115	9	9(09)	The number of days the supply of medication dispensed by the pharmacy will cover.	Days Supply Quantity	ExplanationOfBenefit.supportingInfo.where(category.coding.where(system='http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType' and code='dayssupply').exists()).valueQuantity.value
195	CCLF7	13	Provider Prescribing ID Qualifier Code	PRVDR_PRSBNG_ID_QLFYR_CD	116	117	2	X(02)	Indicates the type of number used to identify the prescribing provider: 01 = NPI Number 06 = UPIN 07 = NCPDP Number 08 = State License Number 11 = TIN 12 = DEA 99 = Other mandatory for Standard Data Format	Provider Prescribing Identifier Qualifier Code	ExplanationOfBenefit.careTeam.where(role.coding.where(code = 'prescribing').exists()).provider.identifier.type.coding.where(system='http://bluebutton.cms.gov/fhir/CodeSystem/PRVDR-ID-QLFYR-CD').code
196	CCLF7	14	Claim Prescribing Provider Generic ID Number	CLM_PRSBNG_PRVDR_GNRC_ID_NUM	118	137	20	X(20)	The number associated with the indicated code in the Provider Prescribing Service Identification Qualifier Code field.	Prescribing Provider Generic ID Number	ExplanationOfBenefit.careTeam.where(role.coding.where(code='prescribing').exists()).provider.identifier.where(system='http://bluebutton.cms.gov/fhir/identifiers/GenericIdNum').value
197	CCLF7	15	Claim Line Beneficiary Payment Amount	CLM_LINE_BENE_PMT_AMT	138	150	13	-9(9).99	The dollar amount paid by the beneficiary that is not reimbursed by a third party (e.g., copayments, coinsurance, deductible, or other patient pay amounts). H	Patient Responsibility Payment Amount	ExplanationOfBenefit.item.adjudication.where(category.coding.where(system='http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication' and code='paidbypatient').exists() and category.coding.where(system='https://bluebutton.cms.gov/fhir/CodeSystem/Adjudication' and code='CLM_LINE_BENE_PMT_AMT').exists()).amount.value
198	CCLF7	16	Claim Adjustment Type Code	CLM_ADJSMT_TYPE_CD	151	152	2	X(02)	Indicates whether the claim an original, cancellation, or adjustment claim. Claim Adjustment Type Code include: 0 = Original Claim 1 = Cancellation Claim 2 = Adjustment claim	Claim Adjustment Type Code	ExplanationOfBenefit.supportingInfo.where(category.coding.where(system='https://bluebutton.cms.gov/fhir/CodeSystem/Supporting-Information').exists() and category.coding.where(code='CLM_ADJSTMT_TYPE_CD').exists()).code.coding.code
199	CCLF7	17	Claim Effective Date	CLM_EFCTV_DT	153	162	10	YYYY-MM-DD	The date the claim was processed and added to the NCH. This is also referred to as the NCH Weekly Processing Date. H	Claim Effective Date	ExplanationOfBenefit.created
200	CCLF7	18	Claim IDR Load Date	CLM_IDR_LD_DT	163	172	10	YYYY-MM-DD	When the claim was loaded into the IDR.	Claim IDR Load Date	ExplanationOfBenefit.supportingInfo.where(category.coding.where(system='https://bluebutton.cms.gov/fhir/CodeSystem/Supporting-Information').exists() and category.coding.where(code='CLM_IDR_LD_DT').exists()).timing
201	CCLF7	19	Claim Line Prescription Service Reference Number	CLM_LINE_RX_SRVC_RFRNC_NUM	173	184	12	9(12)	Identifies a prescription dispensed by a particular service provider on a particular service date.	RX Number	ExplanationOfBenefit.supportingInfo.where(category.coding.where(system='https://bluebutton.cms.gov/fhir/CodeSystem/Supporting-Information' and code='CLM_LINE_RX_NUM').exists()).value
202	CCLF7	20	Claim Line Prescription Fill Number	CLM_LINE_RX_FILL_NUM	185	193	9	X(09)	Assigned to the current dispensed supply by the pharmacy. It designates the sequential order of the original fill or subsequent refills of a prescription.	RX Fill Number	ExplanationOfBenefit.supportingInfo.where(category.coding.where(system='http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType' and code='refillnum').exists()).valueQuantity.value
203	CCLF7	21	Claim Pharmacy Service Type Code	CLM_PHRMCY_SRVC_TYPE_CD	194	195	2	X(02)	A unique identifier of a type of service being performed by a pharmacy when different contractual terms exist between a payer and the pharmacy or when benefits are based upon the type of service performed. 1 = Community/Retail Pharmacy Services 2 = Compounding Pharmacy Services 3 = Home Infusion Therapy Provider Services 4 = Institutional Pharmacy Services 5 = Long Term Care Pharmacy Services 6 = Mail Order Pharmacy Services 7 = Managed Care Organization Pharmacy Services 8 = Specialty Care Pharmacy Services 99 = Other	Pharmacy Service Type Code	ExplanationOfBenefit.supportingInfo.where(category.coding.where(system='https://bluebutton.cms.gov/fhir/CodeSystem/Supporting-Information' and code='CLM_PHRMCY_SRVC_TYPE_CD').exists()).code.coding.where(system='https://bluebutton.cms.gov/fhir/CodeSystem/CLM-PHRMCY-SRVC-TYPE-CD').code
204	CCLF8	1	Medicare Beneficiary Identifier	BENE_MBI_ID	1	11	11	X(11)	A Medicare Beneficiary Identifier assigned to a beneficiary. I H	Medicare Beneficiary Identifier	Patient.identifier.where(system='http://hl7.org/fhir/sid/us-mbi').value
205	CCLF8	2	Beneficiary HIC Number	BENE_HIC_NUM	12	22	11	X(11)	Legacy Beneficiary HICN field. Note: To comply with MACRA of 2015, after the end of the New Medicare Card Transition Period in December 2019, only the MBI will be accepted on claims, and the HICN value will no longer be displayed. The Beneficiary HIC Number will be blank in CCLFs generated effective January 1, 2020, onwards.
206	CCLF8	3	Beneficiary FIPS State Code	BENE_FIPS_STATE_CD	23	24	2	9(02)	Identifies the state where the beneficiary receiving services resides. I H
207	CCLF8	4	Beneficiary FIPS County Code	BENE_FIPS_CNTY_CD	25	27	3	9(03)	Identifies the county where the beneficiary receiving services resides. I H
208	CCLF8	5	Beneficiary ZIP Code	BENE_ZIP_CD	28	32	5	X(05)	The beneficiary’s ZIP code as indicated in their Medicare enrollment record. I H
209	CCLF8	6	Beneficiary Date of Birth	BENE_DOB	33	42	10	YYYY-MM-DD	The month, day, and year of the beneficiary’s birth. I H	Beneficiary Date of Birth	Patient.birthDate
210	CCLF8	7	Beneficiary Sex Code	BENE_SEX_CD	43	43	1	X(01)	The beneficiary’s sex. I H Code includes: 1 = Male 2 = Female 0 = Unknown	Beneficiary Sex Code	Patient.extension.where(url='http://hl7.org/fhir/us/core/StructureDefinition/us-core-sex').value
211	CCLF8	8	Beneficiary Race Code	BENE_RACE_CD	44	44	1	X(01)	The beneficiary's race. I H Code includes: 0 = Unknown 1 = White 2 = Black 3 = Other 4 = Asian 5 = Hispanic 6 = North American Native	Beneficiary Race Code	Patient.extension.where(url='http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity' or url='http://hl7.org/fhir/us/core/StructureDefinition/us-core-race').extension.valueCoding
212	CCLF8	9	Beneficiary Age	BENE_AGE	45	47	3	9(03)	The beneficiary’s current age, as calculated by subtracting the beneficiary’s date of birth from the current date. I H
213	CCLF8	10	Beneficiary Medicare Status Code	BENE_MDCR_STUS_CD	48	49	2	X(02)	Indicates the reason for a beneficiary's entitlement to Medicare benefits as of a particular date, broken down by the following categories: I H Old Age & Survivors Insurance (OASI), Disabled, and ESRD, and by appropriate combinations of these categories: 10 = Aged without ESRD 11 = Aged with ESRD 20 = Disabled without ESRD 21 = Disabled with ESRD 31 = ESRD only	Medicare Status Code	Coverage.extension.where(url='https://bluebutton.cms.gov/fhir/StructureDefinition/BENE-MDCR-STUS-CD').value.code
214	CCLF8	11	Beneficiary Dual Status Code	BENE_DUAL_STUS_CD	50	51	2	X(02)	Identifies the most recent entitlement status of beneficiaries eligible for a program(s) in addition to Medicare (e.g., Medicaid). I H Find Dual Status Code at the ResDAC website.	Beneficiary Dual Status Code	Coverage.extension.where(url='https://bluebutton.cms.gov/fhir/StructureDefinition/BENE-DUAL-STUS-CD').value.code
215	CCLF8	12	Beneficiary Death Date	BENE_DEATH_DT	52	61	10	YYYY-MM-DD	The month, day, and year of a beneficiary’s death. I H	Beneficiary Date of Death	Patient.deceasedDateTime
216	CCLF8	13	Date beneficiary enrolled in Hospice	BENE_RNG_BGN_DT	62	71	10	YYYY-MM-DD	The date the beneficiary enrolled in Hospice. I H
217	CCLF8	14	Date beneficiary ended Hospice	BENE_RNG_END_DT	72	81	10	YYYY-MM-DD	The date the beneficiary is- enrolled in hospice. I H
218	CCLF8	15	Beneficiary First Name	BENE_1ST_NAME	82	111	30	X(30)	The first name of the beneficiary. I H	Beneficiary First Name	Patient.name.given[0]
219	CCLF8	16	Beneficiary Middle Name	BENE_MIDL_NAME	112	126	15	X(15)	The middle name of the beneficiary. I H	Beneficiary Middle Name	Patient.name.given[1]
220	CCLF8	17	Beneficiary Last Name	BENE_LAST_NAME	127	166	40	X(40)	The last name of the beneficiary. I H	Beneficiary Last Name	Patient.name.family
221	CCLF8	18	Beneficiary Original Entitlement Reason Code	BENE_ORGNL_ENTLMT_RSN_CD	167	167	1	X(01)	The reason for the beneficiary's original entitlement to Medicare benefits. I H 0 = Old Age and Survivors Insurance (OASI) 1 = Disability Insurance Benefits (DIB) 2 = ESRD 3 = Both DIB and ESRD 4 = Unknown	Beneficiary Entitlement Reason Code	Coverage.extension.where(url='https://bluebutton.cms.gov/fhir/StructureDefinition/BENE-MDCR-ENTLMT-RSN-CD').value.code
222	CCLF8	19	Beneficiary Entitlement Buy- in Indicator	BENE_ENTLMT_BUYIN_IND	168	168	1	X(01)	Indicates for each month of the denominator reference year, the entitlement of the beneficiary to Medicare Part A, Medicare Part B, or Medicare Parts A and B both, as well as whether or not the beneficiary’s state of residence was liable and paid for the beneficiary’s Medicare Part B monthly premiums. I H 0 = Not Entitled 1 = Part A Only 2 = Part B Only 3 = Part A and Part B A = Part A, State Buy-In B = Part B, State Buy-In C = Parts A and B, State Buy- In	Buy-in Code	Coverage.extension.where(url='https://bluebutton.cms.gov/fhir/StructureDefinition/BENE-BUYIN-CD').value.code
223	CCLF8	20	Bene Entitlement Part A Begin Date	BENE_PART_A_ENRLMT_BGN_DT	169	178	10	YYYY-MM-DD	The date that a beneficiary is entitled for Medicare Part A benefits.	Beneficiary Range Begin Date	Coverage.period.start
224	CCLF8	21	Bene Entitlement Part B Begin Date	BENE_PART_B_ENRLMT_BGN_DT	179	188	10	YYYY-MM-DD	The date that a beneficiary is entitled for Medicare Part B benefits.	Beneficiary Range Begin Date	Coverage.period.start
225	CCLF8	22	Beneficiary Derived Mailing Line One Address	BENE_LINE_1_ADR	189	233	45	X(45)	The first line of the street address. I
226	CCLF8	23	Beneficiary Derived Mailing Line Two Address	BENE_LINE_2_ADR	234	278	45	X(45)	The second line of the street address. I
227	CCLF8	24	Beneficiary Derived Mailing Line Three Address	BENE_LINE_3_ADR	279	318	40	X(40)	The third line of the street address. I
228	CCLF8	25	Beneficiary Derived Mailing Line Four Address	BENE_LINE_4_ADR	319	358	40	X(40)	The fourth line of the street address. I
229	CCLF8	26	Beneficiary Derived Mailing Line Five Address	BENE_LINE_5_ADR	359	398	40	X(40)	The fifth line of the street address. I
230	CCLF8	27	Beneficiary Derived Mailing Line Six Address	BENE_LINE_6_ADR	399	438	40	X(40)	The sixth line of the street address. I
231	CCLF8	28	Beneficiary City	GEO_ZIP_PLC_NAME	439	538	100	X(100)	The name of the city. I	City Name	Patient.address.city
232	CCLF8	29	Beneficiary State	GEO_USPS_STATE_CD	539	540	2	X(2)	State code used by the United States Postal Service to identify a state. I	USPS State Code	Patient.address.state
233	CCLF8	30	Beneficiary Zip Code	GEO_ZIP5_CD	541	545	5	X(5)	The US Postal Service code that is associated with a geographical area. I	Beneficiary Zip Code - First 5	Patient.address.postalCode
234	CCLF8	31	Beneficiary Zip Code Ext.	GEO_ZIP4_CD	546	549	4	X(4)	A four-digit extension to a ZIP Code that represents a subdivision for mailing purposes of the ZIP Code. I
235	CCLF9	1	HICN_MBI_XREF_IND…	HICN/MBI XREF Indicator…	1	1	1	X(1)	M = MBI Note: To comply with MACRA of 2015, after the end of the New Medicare Card Transition Period in December 2019, only the MBI will be accepted on claims, and the HICN value will no longer be displayed. The Beneficiary HIC Number will be blank in CCLFs generated effective January 1, 2020, onwards.
236	CCLF9	2	Current Beneficiary Identifier	CRNT_NUM	2	12	11	X(11)	Current Beneficiary MBI will denote the MBI. Note: To comply with MACRA of 2015, after the end of the New Medicare Card Transition Period in December 2019, only the MBI will be accepted on claims, and the HICN value will no longer be displayed. The Beneficiary HIC Number will be blank in CCLFs generated effective January 1, 2020, onwards.	Medicare Beneficiary Identifier	Patient.identifier.where(system='http://hl7.org/fhir/sid/us-mbi').value
237	CCLF9	3	Previous Beneficiary Identifier	PRVS_NUM	13	23	11	X(11)	Previous Beneficiary MBI. Note: To comply with MACRA of 2015, after the end of the New Medicare Card Transition Period in December 2019, only the MBI will be accepted on claims, and the HICN value will no longer be displayed. The HICN field will be blank in CCLFs generated effective January 1, 2020, onwards.	Medicare Beneficiary Identifier	Patient.identifier.where(system='http://hl7.org/fhir/sid/us-mbi').value
238	CCLF9	4	Previous Identifier Effective Date	PRVS_ID_EFCTV_DT	24	33	10	YYYY-MM-DD	The date the previous identifier became active.	MBI Effective Date	Patient.identifier.where(system='http://hl7.org/fhir/sid/us-mbi').period.start
239	CCLF9	5	Previous Identifier Obsolete Date	PRVS_ID_OBSLT_DT	34	43	10	YYYY-MM-DD	The date the previous identifier ceased to be active.	MBI Obsolete Date	Patient.identifier.where(system='http://hl7.org/fhir/sid/us-mbi').period.end
240	CCLF9	6	Beneficiary Railroad Board Number	BENE_RRB_NUM	44	55	12	X(12)	Legacy RRB number. Note: To comply with MACRA of 2015, after the end of the New Medicare Card Transition Period in December 2019, only the Medicare Beneficiary Identifier (MBI) will be accepted on claims, and the HICN and RRB will no longer be displayed. These fields will be blank effective January 1, 2020, in CCLF files.
241	CCLFA	1	Current Claim Unique Identifier	CUR_CLM_UNIQ_ID	1	13	13	9(13)	A unique identification number assigned to the claim. I H	The claim unique ID is a unique ID for the claim within the source system.	ExplanationOfBenefit.identifier.where(type.coding.system = 'http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBIdentifierType' and type.coding.code = 'uc' ).value
242	CCLFA	2	Medicare Beneficiary Identifier	BENE_MBI_ID	14	24	11	X(11)	A Medicare Beneficiary Identifier assigned to a beneficiary. I H	Medicare Beneficiary Identifier	Patient.identifier.where(system='http://hl7.org/fhir/sid/us-mbi').value
243	CCLFA	3	Beneficiary HIC Number	BENE_HIC_NUM	25	35	11	X(11)	Legacy Beneficiary HICN field. Note: To comply with MACRA of 2015, after the end of the New Medicare Card Transition Period in December 2019, only the MBI will be accepted on claims, and the HICN value will no longer be displayed. The Beneficiary HIC Number will be blank in CCLFs generated effective January 1, 2020, onwards.
244	CCLFA	4	Claim Type Code	CLM_TYPE_CD	36	37	2	9(02)	Signifies the type of claim being submitted through the Medicare or Medicaid programs. H Claim type code include: 10 = HHA claim 20 = Non swing bed SNF claim 30 = Swing bed SNF claim 40 = Outpatient claim 50 = Hospice claim 60 = Inpatient claim 61 = Inpatient “Full- Encounter” claim	Claim Type Code	ExplanationOfBenefit.type.coding.where(system = 'https://bluebutton.cms.gov/fhir/CodeSystem/CLM-TYPE-CD').code
245	CCLFA	5	Claim Admission Date	CLM_ACTV_CARE_FROM_DT	38	47	10	YYYY-MM-DD	On an institutional claim, the date the beneficiary was admitted to the hospital, skilled nursing facility, or Christian science sanatorium. I H	Claim Active Care From Date	ExplanationOfBenefit.supportingInfo.where(category.coding.system='http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType' and category.coding.code='admissionperiod').timing.start
246	CCLFA	6	PBP Benefit Enhancement Indicator	CLM_NGACO_PBPMT_SW	48	48	1	X(1)	A single character code of “Y” or “N” that indicates whether a particular claim is tied to a PBP benefit enhancement. Blank if no data are available. Note: This field was created for both NGACO and VTAPM models. NGACO sunset in 2022 but this field will continue to be used for the VTAPM model.	Claim NGACO PBPMT Switch	ExplanationOfBenefit.supportingInfo.where(category.coding.where(system='https://bluebutton.cms.gov/fhir/CodeSystem/Supporting-Information').exists() and category.coding.where(code='CLM_NGACO_PBPMT_SW').exists()).value
247	CCLFA	7	Post Discharge Home Visit Benefit Enhancement Indicator	CLM_NGACO_PDSCHRG_HCBS_SW	49	49	1	X(1)	A single character code of “Y” or “N” that indicates whether a particular claim is tied to a Post Discharge Home Visit benefit enhancement. Blank if no data are available. Note: This field was created for both NGACO and VTAPM models. NGACO sunset in 2022 but this field will continue to be used for the VTAPM model.	Claim NGACO Post Discharge HCBS Switch	ExplanationOfBenefit.supportingInfo.where(category.coding.where(system='https://bluebutton.cms.gov/fhir/CodeSystem/Supporting-Information').exists() and category.coding.where(code='CLM_NGACO_PDSCHRG_HCBS_SW').exists()).value
248	CCLFA	8	SNF 3-Day Waiver Benefit Enhancement Indicator	CLM_NGACO_SNF_WVR_SW	50	50	1	X(1)	A single character code of “Y” or “N” that indicates whether a particular claim is tied to a SNF 3-Day Waiver benefit enhancement. Blank if no data are available. Note: This field was created for both NGACO and VTAPM models. NGACO sunset in 2022 but this field will continue to be used for the VTAPM model.	Claim NGACO SNF Waiver Switch	ExplanationOfBenefit.supportingInfo.where(category.coding.where(system='https://bluebutton.cms.gov/fhir/CodeSystem/Supporting-Information').exists() and category.coding.where(code='CLM_NGACO_SNF_WVR_SW').exists()).value
249	CCLFA	9	Telehealth Benefit Enhancement Indicator	CLM_NGACO_TLHLTH_SW	51	51	1	X(1)	A single character code of “Y” or “N” that indicates whether a particular claim is tied to a Telehealth benefit enhancement. Blank if no data are available. Note: This field was created for both NGACO and VTAPM models. NGACO sunset in 2022 but this field will continue to be used for the VTAPM model.	Claim NGACO Telehealth Switch	ExplanationOfBenefit.supportingInfo.where(category.coding.where(system='https://bluebutton.cms.gov/fhir/CodeSystem/Supporting-Information').exists() and category.coding.where(code='CLM_NGACO_TLHLTH_SW').exists()).value
250	CCLFA	10	AIPBP Benefit Enhancement Indicator	CLM_NGACO_CPTATN_SW	52	52	1	X(1)	A single character code of “Y” or “N” that indicates whether a particular claim is tied to an AIPBP benefit enhancement. Blank if no data are available. Note: This field was created for both NGACO and VTAPM models. NGACO sunset in 2022 but this field will continue to be used for the VTAPM model.	Claim NGACO Capitation Switch	ExplanationOfBenefit.supportingInfo.where(category.coding.where(system='https://bluebutton.cms.gov/fhir/CodeSystem/Supporting-Information').exists() and category.coding.where(code='CLM_NGACO_CPTATN_SW').exists()).value
251	CCLFA	11	First Program Demonstration Number	CLM_DEMO_1ST_NUM	53	54	2	X(2)	Medicare Demonstration Special Processing Number (SPN). This is a first demonstration number. This field will be used to hold the 2-byte number for future use with the Bundled Payments for Care Improvement initiative.	Claim Benefit Enhancement Code 1	ExplanationOfBenefit.supportingInfo.where(category.coding.where(system='https://bluebutton.cms.gov/fhir/CodeSystem/Supporting-Information').exists() and category.coding.where(code='CLM_BNFT_ENHNCMT_CD').exists()).value
252	CCLFA	12	Second Program Demonstration Number	CLM_DEMO_2ND_NUM	55	56	2	X(2)	Medicare Demonstration Special Processing Number (SPN). This is a second demonstration number. This field will be used to hold the 2-byte number for future use with the Bundled Payments for Care Improvement initiative.	Claim Benefit Enhancement Code 2	ExplanationOfBenefit.supportingInfo.where(category.coding.where(system='https://bluebutton.cms.gov/fhir/CodeSystem/Supporting-Information').exists() and category.coding.where(code='CLM_BNFT_ENHNCMT_CD').exists()).value
253	CCLFA	13	Third Program Demonstration Number	CLM_DEMO_3RD_NUM	57	58	2	X(2)	Medicare Demonstration Special Processing Number (SPN). This is a third demonstration number. This field will be used to hold the 2-byte number for future use with the Bundled Payments for Care Improvement initiative.	Claim Benefit Enhancement Code 3	ExplanationOfBenefit.supportingInfo.where(category.coding.where(system='https://bluebutton.cms.gov/fhir/CodeSystem/Supporting-Information').exists() and category.coding.where(code='CLM_BNFT_ENHNCMT_CD').exists()).value
254	CCLFA	14	Fourth Program Demonstration Number	CLM_DEMO_4TH_NUM	59	60	2	X(2)	Medicare Demonstration Special Processing Number (SPN). This is a fourth demonstration number. This field will be used to hold the 2-byte number for future use with the Bundled Payments for Care Improvement initiative.	Claim Benefit Enhancement Code 4	ExplanationOfBenefit.supportingInfo.where(category.coding.where(system='https://bluebutton.cms.gov/fhir/CodeSystem/Supporting-Information').exists() and category.coding.where(code='CLM_BNFT_ENHNCMT_CD').exists()).value
255	CCLFA	15	Fifth Program Demonstration Number	CLM_DEMO_5TH_NUM	61	62	2	X(2)	Medicare Demonstration Special Processing Number (SPN). This is a fifth demonstration number. This field will be used to hold the 2-byte number for future use with the Bundled Payments for Care Improvement initiative.	Claim Benefit Enhancement Code 5	ExplanationOfBenefit.supportingInfo.where(category.coding.where(system='https://bluebutton.cms.gov/fhir/CodeSystem/Supporting-Information').exists() and category.coding.where(code='CLM_BNFT_ENHNCMT_CD').exists()).value
256	CCLFA	16	PBP/AIPBP Inclusion Amount	CLM_PBP_INCLSN_AMT	63	81	19	-9(15).99	The amount that would have been paid in the absence of PBP/ AIPBP Reduction. The value for the PBP/AIPBP Inclusion Amount is derived from the table and column called “CMS_VIEW_CLM_PRD.CLM_VAL_AMT” when the value code within the field called “CLM_VAL_CD” equals “Q0.”
257	CCLFA	17	PBP/AIPBP Reduction Amount	CLM_PBP_RDCTN_AMT	82	100	19	-9(15).99	The PBP/AIPBP Reduction Amount withheld from payment to the Provider. The value for the PBP/AIPBP Reduction Amount is derived from the table and column called “CMS_VIEW_CLM_PRD.CLM_VAL_AMT” when the value code within the field called “CLM_VAL_CD” equals “Q1.”
258	CCLFA	18	Care Management Home Visits	CLM_NGACO_CMG_WVR_SW	101	101	1	X(1)	A single character code of “Y” or “N” that indicates whether a particular claim is tied to a Care Management Home Visits benefit enhancement. Blank if no data are available. Note: This field was created for both NGACO and VTAPM models. NGACO sunset in 2022 but this field will continue to be used for the VTAPM model.	Claim ACO Care Management HCBS Switch	ExplanationOfBenefit.supportingInfo.where(category.coding.where(system='https://bluebutton.cms.gov/fhir/CodeSystem/Supporting-Information').exists() and category.coding.where(code='CLM_ACO_CARE_MGMT_HCBS_SW').exists()).value
259	CCLFA	19	Claim Institutional Per Diem Amount	CLM_INSTNL_PER_DIEM_AMT	102	120	19	-9(15).99	The maximum amount a provider can be paid for each day of care.	Pass Through Per Diem Amount	ExplanationOfBenefit.adjudication.where(category.coding.where(system='https://bluebutton.cms.gov/fhir/CodeSystem/Adjudication' and code='CLM_INSTNL_PER_DIEM_AMT').exists()).amount.value
260	CCLFA	20	Claim Medicare Inpatient Beneficiary Deductible Amount	CLM_MDCR_IP_BENE_DDCTBL_AMT	121	135	15	-9(11).99	The amount of the deductible the beneficiary paid for inpatient services, as originally submitted on the institutional claim.	Deductible Amount	ExplanationOfBenefit.adjudication.where(category.coding.where(system='https://bluebutton.cms.gov/fhir/CodeSystem/Adjudication' and code='CLM_MDCR_IP_BENE_DDCTBL_AMT').exists()).amount.value
261	CCLFA	21	Claim Medicare Coinsurance Amount	CLM_MDCR_COINSRNC_AMT	136	154	19	-9(15).99	An amount identifying the portion applied toward the coinsurance a beneficiary is responsible for.	Part A/B Coinsurance Liability Amount	ExplanationOfBenefit.total.where(category.coding.where(system='http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication' and code='coinsurance').exists() and category.coding.where(system='https://bluebutton.cms.gov/fhir/CodeSystem/Adjudication' and code='CLM_MDCR_COINSRNC_AMT').exists()).amount.value
262	CCLFA	22	Claim Blood Liability Amount	CLM_BLOOD_LBLTY_AMT	155	169	15	-9(11).99	An amount identifying the portion of the blood deductible a beneficiary is liable for.	Blood Deductible Liability Amount	ExplanationOfBenefit.adjudication.where(category.coding.where(system='https://bluebutton.cms.gov/fhir/CodeSystem/Adjudication' and code='CLM_BLOOD_LBLTY_AMT').exists()).amount.value
263	CCLFA	23	Claim Institutional Professional Amount	CLM_INSTNL_PRFNL_AMT	170	184	15	-9(11).99	For inpatient and outpatient claims, the amount of physician and other professional charges covered under Medicare Part B (e.g., if computing interim payment these charges are deducted)	Professional Component Charge	ExplanationOfBenefit.adjudication.where(category.coding.where(system='https://bluebutton.cms.gov/fhir/CodeSystem/Adjudication' and code='CLM_INSTNL_PRFNL_AMT').exists()).amount.value
264	CCLFA	24	Claim Noncovered Charge Amount	CLM_NCVRD_CHRG_AMT	185	203	19	-9(15).99	The charges for institutional long-term care are not reimbursable by the primary payer. The non-covered charges do not refer to charges not covered for any other service.	Noncovered Charge Amount	ExplanationOfBenefit.total.where(category.coding.where(system='http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication' and code='noncovered').exists() and category.coding.where(system='https://bluebutton.cms.gov/fhir/CodeSystem/Adjudication' and code='CLM_NCVRD_CHRG_AMT').exists()).amount.value
265	CCLFA	25	Claim Medicare Deductible Amount	CLM_MDCR_DDCTBL_AMT	204	222	19	-9(15).99	An amount identifying the portion applied toward the deductible a beneficiary is responsible for.	Inpatient/Outpatient Total Deduction Amount	ExplanationOfBenefit.total.where(category.coding.where(system='http://terminology.hl7.org/CodeSystem/adjudication' and code='deductible').exists() and category.coding.where(system='https://bluebutton.cms.gov/fhir/CodeSystem/Adjudication' and code='CLM_MDCR_DDCTBL_AMT').exists()).amount.value
266	CCLFA	26	Claim Related Condition Code Periodic interim payments (PIP) - 62	CLM_RLT_COND_CD	223	224	2	X(2)	The code that indicates a condition relating to an institutional claim that may affect payer processing.	Claim Related Condition Code	ExplanationOfBenefit.supportingInfo.where(code.coding.system='https://bluebutton.cms.gov/fhir/CodeSystem/CLM-RLT-COND-CD').code.coding.code
267	CCLFA	27	Operating Outlier Amount (DSH) - 17	CLM_OPRTNL_OUTLR_AMT	225	243	19	-9(15).99	Operating Outlier Amount (DSH)
268	CCLFA	28	Medicare new technology add-on payment - 77	CLM_MDCR_NEW_TECH_AMT	244	262	19	-9(15).99	Medicare new technology add-on payment
269	CCLFA	29	Islet Isolation Add- on payment amount - Q7	CLM_ISLET_ISOLN_AMT	263	281	19	-9(15).99	Islet Isolation Add-on payment amount
270	CCLFA	30	Part A Sequestration reduction amounts - 73	CLM_SQSTRTN_RDCTN_AMT	282	300	19	-9(15).99	The payment to the provider will be reduced by the amount specified by CMS.
271	CCLFA	31	Claim Adjustment Reason Code (CARC)	CLM_1_REV_CNTR_ANSI_RSN_CD	301	303	3	X(3)	A Fiscal Intermediary Shared System (FISS) code identifying the type of adjustment being performed.	Claim Line Adjustment Reason Code 1	ExplanationOfBenefit.item.adjudication.reason.coding.where(system='https://bluebutton.cms.gov/fhir/CodeSystem/ANSI-RSN-CD').code
272	CCLFA	32	Claim Adjustment Segment (CAS) Group Code	CLM_1_REV_CNTR_ANSI_GRP_CD	304	305	2	X(2)	These codes categorize a payment adjustment.	Claim Line Adjustment Group Code 1	ExplanationOfBenefit.item.adjudication.reason.coding.where(system='https://bluebutton.cms.gov/fhir/CodeSystem/ANSI-GRP-CD').code
273	CCLFA	33	Capital MIPS Payment Costs	CLM_MIPS_PMT_AMT	306	324	19	-9(15).99	Capital MIPS payment costs
274	CCLFB	1	Current Claim Unique Identifier	CUR_CLM_UNIQ_ID	1	13	13	9(13)	A unique identification number assigned to the claim. I H	The claim unique ID is a unique ID for the claim within the source system.	ExplanationOfBenefit.identifier.where(type.coding.system = 'http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBIdentifierType' and type.coding.code = 'uc' ).value
275	CCLFB	2	Claim Line Number	CLM_LINE_NUM	14	23	10	9(10)	A sequential number that identifies a specific claim line within a given claim.	Line Item Sequence Number	ExplanationOfBenefit.item.sequence
276	CCLFB	3	Medicare Beneficiary Identifier	BENE_MBI_ID	24	34	11	X(11)	A Medicare Beneficiary Identifier assigned to a beneficiary. I H	Medicare Beneficiary Identifier	Patient.identifier.where(system='http://hl7.org/fhir/sid/us-mbi').value
277	CCLFB	4	Beneficiary HIC Number	BENE_HIC_NUM	35	45	11	X(11)	Legacy Beneficiary HICN field. Note: To comply with MACRA of 2015, after the end of the New Medicare Card Transition Period in December 2019, only the MBI will be accepted on claims, and the HICN value will no longer be displayed. The Beneficiary HIC Number will be blank in CCLFs generated effective January 1, 2020, onwards.
278	CCLFB	5	Claim Type Code	CLM_TYPE_CD	46	47	2	9(02)	Signifies the type of claim being submitted through the Medicare or Medicaid programs Claim type code include: 71=RIC O local carrier non- DMEPOS claim 72=RIC O local carrier DMEPOS claim	Claim Type Code	ExplanationOfBenefit.type.coding.where(system = 'https://bluebutton.cms.gov/fhir/CodeSystem/CLM-TYPE-CD').code
279	CCLFB	6	PBP Benefit Enhancement Indicator	CLM_LINE_NGACO_PBPMT_SW	48	48	1	X(1)	A single character code of “Y” or “N” that indicates whether a particular claim line is tied to a PBP benefit enhancement. Blank if no data are available. Note: This field was created for both NGACO and VTAPM models. NGACO sunset in 2022 but this field will continue to be used for the VTAPM model.	Claim Line NGACO PBPMT Switch	ExplanationOfBenefit.supportingInfo.where(category.coding.where(system='https://bluebutton.cms.gov/fhir/CodeSystem/Supporting-Information').exists() and category.coding.where(code='CLM_LINE_NGACO_PBPMT_SW').exists()).value
280	CCLFB	7	Post Discharge Home Visit Benefit Enhancement Indicator	CLM_LINE_NGACO_PDSCHRG_HCBS_SW	49	49	1	X(1)	A single character code of “Y” or “N” that indicates whether a particular claim line is tied to a Post Discharge Home Visit benefit enhancement. Blank if no data are available. Note: This field was created for both NGACO and VTAPM models. NGACO sunset in 2022 but this field will continue to be used for the VTAPM model.	Claim Line NGACO Post Discharge HCBS Switch	ExplanationOfBenefit.supportingInfo.where(category.coding.where(system='https://bluebutton.cms.gov/fhir/CodeSystem/Supporting-Information').exists() and category.coding.where(code='CLM_LINE_NGACO_PDSCHRG_HCBS_SW').exists()).value
281	CCLFB	8	SNF 3-Day Waiver Benefit Enhancement Indicator	CLM_LINE_NGACO_SNF_WVR_SW	50	50	1	X(1)	A single character code of “Y” or “N” that indicates whether a particular claim line is tied to a SNF 3-Day Waiver benefit enhancement. Blank if no data are available. Note: This field was created for both NGACO and VTAPM models. NGACO sunset in 2022 but this field will continue to be used for the VTAPM model.	Claim Line NGACO SNF Waiver Switch	ExplanationOfBenefit.supportingInfo.where(category.coding.where(system='https://bluebutton.cms.gov/fhir/CodeSystem/Supporting-Information').exists() and category.coding.where(code='CLM_LINE_NGACO_SNF_WVR_SW').exists()).value
282	CCLFB	9	Telehealth Benefit Enhancement Indicator	CLM_LINE_NGACO_TLHLTH_SW	51	51	1	X(1)	A single character code of “Y” or “N” that indicates whether a particular claim line is tied to a Telehealth benefit enhancement. Blank if no data are available. Note: This field was created for both NGACO and VTAPM models. NGACO sunset in 2022 but this field will continue to be used for the VTAPM model.	Claim Line NGACO Telehealth Switch	ExplanationOfBenefit.supportingInfo.where(category.coding.where(system='https://bluebutton.cms.gov/fhir/CodeSystem/Supporting-Information').exists() and category.coding.where(code='CLM_LINE_NGACO_TLHLTH_SW').exists()).value
283	CCLFB	10	AIPBP Benefit Enhancement Indicator	CLM_LINE_NGACO_CPTATN_SW	52	52	1	X(1)	A single character code of “Y” or “N” that indicates whether a particular claim line is tied to an AIPBP benefit enhancement. Blank if no data are available. Note: This field was created for both NGACO and VTAPM models. NGACO sunset in 2022 but this field will continue to be used for the VTAPM model.	Claim Line NGACO Capitation Switch	ExplanationOfBenefit.supportingInfo.where(category.coding.where(system='https://bluebutton.cms.gov/fhir/CodeSystem/Supporting-Information').exists() and category.coding.where(code='CLM_LINE_NGACO_CPTATN_SW').exists()).value
284	CCLFB	11	First Program Demonstration Number	CLM_DEMO_1ST_NUM	53	54	2	X(2)	Medicare Demonstration Special Processing Number (SPN). This is a first demonstration number. This field will be used to hold the 2-byte number for future use with the Bundled Payments for Care Improvement initiative.	Claim Line Benefit Enhancement 1 Code	ExplanationOfBenefit.supportingInfo.where(category.coding.where(system='https://bluebutton.cms.gov/fhir/CodeSystem/Supporting-Information').exists() and category.coding.where(code='CLM_BNFT_ENHNCMT_CD').exists()).value
285	CCLFB	12	Second Program Demonstration Number	CLM_DEMO_2ND_NUM	55	56	2	X(2)	Medicare Demonstration Special Processing Number (SPN). This is a second demonstration number. This field will be used to hold the 2-byte number for future use with the Bundled Payments for Care Improvement initiative.	Claim Line Benefit Enhancement 2 Code	ExplanationOfBenefit.supportingInfo.where(category.coding.where(system='https://bluebutton.cms.gov/fhir/CodeSystem/Supporting-Information').exists() and category.coding.where(code='CLM_BNFT_ENHNCMT_CD').exists()).value
286	CCLFB	13	Third Program Demonstration Number	CLM_DEMO_3RD_NUM	57	58	2	X(2)	Medicare Demonstration Special Processing Number (SPN). This is a third demonstration number. This field will be used to hold the 2-byte number for future use with the Bundled Payments for Care Improvement initiative.	Claim Line Benefit Enhancement 3 Code	ExplanationOfBenefit.supportingInfo.where(category.coding.where(system='https://bluebutton.cms.gov/fhir/CodeSystem/Supporting-Information').exists() and category.coding.where(code='CLM_BNFT_ENHNCMT_CD').exists()).value
287	CCLFB	14	Fourth Program Demonstration Number	CLM_DEMO_4TH_NUM	59	60	2	X(2)	Medicare Demonstration Special Processing Number (SPN). This is a fourth demonstration number. This field will be used to hold the 2-byte number for future use with the Bundled Payments for Care Improvement initiative.	Claim Line Benefit Enhancement 4 Code	ExplanationOfBenefit.supportingInfo.where(category.coding.where(system='https://bluebutton.cms.gov/fhir/CodeSystem/Supporting-Information').exists() and category.coding.where(code='CLM_BNFT_ENHNCMT_CD').exists()).value
288	CCLFB	15	Fifth Program Demonstration Number	CLM_DEMO_5TH_NUM	61	62	2	X(2)	Medicare Demonstration Special Processing Number (SPN). This is a fifth demonstration number. This field will be used to hold the 2-byte number for future use with the Bundled Payments for Care Improvement initiative.	Claim Line Benefit Enhancement 5 Code	ExplanationOfBenefit.supportingInfo.where(category.coding.where(system='https://bluebutton.cms.gov/fhir/CodeSystem/Supporting-Information').exists() and category.coding.where(code='CLM_BNFT_ENHNCMT_CD').exists()).value
289	CCLFB	16	PBP/AIPBP Inclusion Amount	CLM_PBP_INCLSN_AMT	63	77	15	-9(11).99	The amount that would have been paid in the absence of PBP/AIPBP Reduction. The value for the PBP/AIPBP Inclusion Amount is derived from the table and column called “CMS_VIEW_CLM_PRD.CLM_LINE_OTHR_APLD_AMT” when the value code within the field called “CLM_LINE_OTHR_APLD_CD” equals “J.”
290	CCLFB	17	PBP/AIPBP Reduction Amount	CLM_PBP_RDCTN_AMT	78	92	15	-9(11).99	The PBP/AIPBP Reduction Amount withheld from payment to the Provider. The value for the PBP/AIPBP Reduction Amount is derived from the table and column called “CMS_VIEW_CLM_PRD.CLM_LINE_OTHR_APLD_AMT” when the value code within the field called “CLM_LINE_OTHR_APLD_CD” equals “L.”
291	CCLFB	18	Care Management Home Visits	CLM_NGACO_CMG_WVR_SW	93	93	1	X(1)	A single character code of “Y” or “N” that indicates whether a particular claim is tied to a Care Management Home Visits benefit enhancement. Blank if no data are available. Note: This field was created for both NGACO and VTAPM models. NGACO sunset in 2022 but this field will continue to be used for the VTAPM model.	Claim Line ACO Care Management HCBS Switch	ExplanationOfBenefit.supportingInfo.where(category.coding.where(system='https://bluebutton.cms.gov/fhir/CodeSystem/Supporting-Information').exists() and category.coding.where(code='CLM_LINE_ACO_CARE_MGMT_HCBS_SW').exists()).value
292	CCLFB	19	Claim Medicare Deductible Amount	CLM_MDCR_DDCTBL_AMT	94	112	19	-9(15).99	Amount indicates the Medicare deductible amount billed to Medicaid for this service. The Medicare Deductible Amount does not necessarily reflect the amount actually paid.	Inpatient/Outpatient Total Deduction Amount	ExplanationOfBenefit.total.where(category.coding.where(system='http://terminology.hl7.org/CodeSystem/adjudication' and code='deductible').exists() and category.coding.where(system='https://bluebutton.cms.gov/fhir/CodeSystem/Adjudication' and code='CLM_MDCR_DDCTBL_AMT').exists()).amount.value
293	CCLFB	20	Part B Sequestration reduction amounts	CLM_SQSTRTN_RDCTN_AMT	113	127	15	-9(11).99	The payment to the provider will be reduced by the amount specified by CMS. Only one period has been defined by CMS for a 2% reduction that began on 04/01/2013 as part of government sequestration.
294	CCLFB	21	Claim Line Carrier Health Professional Shortage Area Scarcity Code	CLM_LINE_CARR_HPSA_SCRCTY_CD	128	128	1	X(1)	A code used to track the Health Professional Shortage Area (HPSA) related bonus payments on Part B Professional claims	HPSA Scarcity Code	ExplanationOfBenefit.item.extension.where(url='https://bluebutton.cms.gov/fhir/StructureDefinition/CLM-LINE-CARR-HPSA-SCRCTY-CD').value.code

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