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CMS Manual System Department of Health & Human Services (DHHS)
Pub 100-20 One-Time Notification Centers for Medicare & Medicaid Services (CMS)
Transmittal 1667 Date: May 12, 2016
Change Request 9605 NOTE: This Transmittal is no longer sensitive and is being re-communicated August 18, 2016. The Transmittal Number, date of Transmittal and all other information remains the same. This instruction may now be posted to the Internet.
SUBJECT: Analysis Only CR - Medicare ID end-date I. SUMMARY OF CHANGES: The Purpose of this CR is Analysis Only to determine the impact on FISS processing if PECOS does not send a Medicare ID end-date to in the FISS extract file. PECOS will determine if the same Medicare ID is active in PECOS on at least one other 855A enrollment, irrespective of whether CHOW information exists or not. If the Medicare ID Is active on atleast one enrollment, PECOS will not send the Medicare ID end date.This rule will apply to both 02 and 07 child records in the PECOS extract file to FISS. There are no proposed changes to FISS or its processes. Background: When PECOS sends a Medicare ID termination, PECOS pairs it with a specific enrollment ID, expecting that the Medicare ID will be terminated in FISS for only that enrollment ID. When FISS receives a Medicare ID termination from PECOS, FISS terminates all occurrences of this Medicare ID. When duplicate Medicare IDs are received in one day, the last one FISS processes is the one that takes effect (termination vs. activation). The PECOS team shall be responsible for taking meeting minutes and distribution. EFFECTIVE DATE: October 1, 2016 *Unless otherwise specified, the effective date is the date of service. IMPLEMENTATION DATE: October 3, 2016 Disclaimer for manual changes only: The revision date and transmittal number apply only to red italicized material. Any other material was previously published and remains unchanged. However, if this revision contains a table of contents, you will receive the new/revised information only, and not the entire table of contents. II. CHANGES IN MANUAL INSTRUCTIONS: (N/A if manual is not updated) R=REVISED, N=NEW, D=DELETED-Only One Per Row.
R/N/D CHAPTER / SECTION / SUBSECTION / TITLE
N/A III. FUNDING: For Medicare Administrative Contractors (MACs): The Medicare Administrative Contractor is hereby advised that this constitutes technical direction as defined in your contract. CMS does not construe this as a change to the MAC Statement of Work. The contractor is
not obligated to incur costs in excess of the amounts allotted in your contract unless and until specifically authorized by the Contracting Officer. If the contractor considers anything provided, as described above, to be outside the current scope of work, the contractor shall withhold performance on the part(s) in question and immediately notify the Contracting Officer, in writing or by e-mail, and request formal directions regarding continued performance requirements. IV. ATTACHMENTS: One Time Notification
Attachment - One-Time Notification
Pub. 100-20 Transmittal: 1667 Date: May 12, 2016 Change Request: 9605
NOTE: This Transmittal is no longer sensitive and is being re-communicated August 18, 2016. The Transmittal Number, date of Transmittal and all other information remains the same. This instruction may now be posted to the Internet.
SUBJECT: Analysis Only CR - Medicare ID end-date EFFECTIVE DATE: October 1, 2016 *Unless otherwise specified, the effective date is the date of service. IMPLEMENTATION DATE: October 3, 2016 I. GENERAL INFORMATION A. Background: When Provider Enrollment, Chain & Ownership System (PECOS) sends a Medicare ID termination, Provider Enrollment, Chain & Ownership System (PECOS) pairs it with a specific enrollment ID, expecting that the Medicare ID will be terminated in Fiscal Intermediary Shared System (FISS) for only that enrollment ID. When FISS receives a Medicare ID termination from Provider Enrollment, Chain & Ownership System (PECOS), Fiscal Intermediary Shared System (FISS) terminates all occurrences of this Medicare ID. When duplicate Medicare IDs are received in one day, the last one Fiscal Intermediary Shared System (FISS) processes is the one that takes effect (termination vs. activation). B. Policy: NA II. BUSINESS REQUIREMENTS TABLE "Shall" denotes a mandatory requirement, and "should" denotes an optional requirement.
Number Requirement Responsibility A/B
MAC DME
MAC
Shared-System
Maintainers
Other
A B HHH
FISS
MCS
VMS
CWF
9605.1 The FISS maintainer shall participate in up to five one hour meetings with the PECOS maintainer.
X X
9605.2 The FISS maintainer shall provide an impact analysis for the following within five business days following the first call:
• PECOS will not send a Medicare ID end-date to in the FISS extract file, if the same Medicare ID is active in PECOS on at least one other 855A enrollment, irrespective of whether Change of Ownership information exists or
X
Number Requirement Responsibility A/B
MAC DME
MAC
Shared-System
Maintainers
Other
A B HHH
FISS
MCS
VMS
CWF
not. This rule will apply to both 02 and 07 child records in the extract file.
9605.3 The FISS contractor shall provide a written response or a supplement document within five business days after the first call for the following:
1. When payment claims are submitted to FISS, does FISS only use the Medicare ID to uniquely identify the provider to be paid? Or does FISS also use fields such as Legal Business Name (LBN), NPI, TIN, etc.?
2. In the extract file PECOS (attached) sends to FISS, which child records does FISS use to decide if a Medicare ID should be end-dated? The PECOS FISS extract file may have a Medicare ID end-date in child record 02 (Medicare Identification) and child record 07 (Change of Ownership). Does FISS reference any other fields in the extract file to apply a Medicare ID end date?
X
9605.4 The FISS maintainer shall provide documentation, such as an System Design Document or other supplement documentation to explain FISS processing of the PECOS extract data within five business days after the first call. We’ve attached the extract file layout from the PECOS System Design Document.
X
III. PROVIDER EDUCATION TABLE Number Requirement Responsibility
A/B
MAC DME
MAC
CEDI A B H
HH
None IV. SUPPORTING INFORMATION Section A: Recommendations and supporting information associated with listed requirements: N/A
"Should" denotes a recommendation.
X-Ref Requirement Number
Recommendations or other supporting information:
Section B: All other recommendations and supporting information: N/A V. CONTACTS Pre-Implementation Contact(s): Sandhya Mathur, 410-786-3476 or [email protected] Post-Implementation Contact(s): Contact your Contracting Officer's Representative (COR). VI. FUNDING Section A: For Medicare Administrative Contractors (MACs): The Medicare Administrative Contractor is hereby advised that this constitutes technical direction as defined in your contract. CMS does not construe this as a change to the MAC Statement of Work. The contractor is not obligated to incur costs in excess of the amounts allotted in your contract unless and until specifically authorized by the Contracting Officer. If the contractor considers anything provided, as described above, to be outside the current scope of work, the contractor shall withhold performance on the part(s) in question and immediately notify the Contracting Officer, in writing or by e-mail, and request formal directions regarding continued performance requirements. ATTACHMENTS: 1
63.1.1 FISS Extract Layout
The PECOS FISS Enrollment Record Export Layout is the format that stores PECOS enrollment record data that is put on the CMS mainframe on a daily basis for the Medicare Part A claims payment system to retrieve. The FISS Extract file consists of the file header record, the file trailer record, the enrollment base record and up to seven enrollment child records for each enrollment record. The header record is the first record included in the FISS Extract file. Records between the file header and trailer record represent the exported enrollment records for that specific FI. The trailer record is the last record included in the FISS Extract file. The trailer record indicates the end of the file. The enrollment base record exists for each enrollment record in the FISS Extract file. The enrollment base record includes data fields for PECOS associate-level information like the provider’s TIN, LBN, provider type, etc. Child records provide additional information and are tied to the enrollment base record by information in the child record layout, which contain the following elements:
• Record Type
• FI Contractor ID
• Create date
• PECOS Associate Control (PAC) ID
• Enrollment ID This information is at the beginning of each child record. The PECOS export data is sent to the FISS system in the following format: Table Error! No text of specified style in document.-1 FISS Extract Header Record
Description Field Name Length Default Value
Start Position
PECOS Table PECOS Field
Record Type BSE-REC-TYPE 2 1
FI Contractor ID
HDR-FI-ID 5 3
Create Year HDR-CREAT-CCYY
4 8
Create Month
HDR-CREAT-MM
2 12
Create Day HDR-CREAT-DD
2 14
Filler 806 16
Total Length
821
Table Error! No text of specified style in document.-2 FISS Extract Trailer Record
Description Field Name Length Default Value
Start Position
PECOS Table PECOS Field
Record Type FILE-RECORD-TYPE
2 1
FI Contractor ID
TRAILER-FI-ID 5 3
Record Count
FILE-RECORD-COUNT
7 8
Filler 807 15
Total Length
821
Table Error! No text of specified style in document.-3 FISS Extract Enrollment Base Record
Description
Field Name
Length
Default Value
Start Position
PECOS Table PECOS Field
Record Type BSE-REC-TYPE
2 00 1
FI Contractor ID
BSE-FI-ID 5 N/A 3 PEC_ASC_CTRR_ASN CNTRCTR_ID
Create Date BSE-CREAT-DT
8 N/A 8 PEC_ENRT CREAT_TS
PAC ID BSE-PAC-ID
10 N/A 16 PEC_ENRT_ASC PECOS_ASCT_CNTL_ID
Enrollment ID
BSE-ENR-ID
15 N/A 26 PEC_ENRT_STUS ENRLMT_ID
Legal Business Name
BSE-LBA-NAME
70 N/A 41 PEC_ORG_BUSNS_NAME
ORG_NAME
TIN BSE-ORG-TIN
9 N/A 111 PEC_EIN TIN
Provider Type
PROVIDER-TYPE
2 N/A 120 PEC_PRVDR_ENRT FAC_TYPE_CD
Foreign Address Indicator
COR-ADR-FRN-CD
1 N/A 122 PEC_MAIL_ADR FRGN_CD
Line 1 Street Address
COR-ADR-LN1
55 N/A 123 PEC_MAIL_ADR LINE_1_ST_ADR
Line 2 Street Address
COR-ADR-LN2
55 N/A 178 PEC_MAIL_ADR LINE_2_ST_ADR
City COR-ADR-CITY
30 N/A 233 PEC_MAIL_ADR CITY_NAME
Description
Field Name
Length
Default Value
Start Position
PECOS Table PECOS Field
State COR-ADR-STATE
2 N/A 263 PEC_MAIL_ADR STATE_CD
Foreign State
COR-ADR-FRN-STATE
30 N/A 265 PEC_MAIL_ADR FRGN_STATE_NAME
Zip-Code COR-ADR-ZIP
15 N/A 295 PEC_MAIL_ADR ZIP_CD
Foreign Postal Code
COR-ADR-PCODE
15 N/A 310 PEC_MAIL_ADR FRGN_PSTL_CD
Country COR-ADR-CNTRY
30 N/A 325 PEC_MAIL_ADR CNTRY_NAME
Start Date COR-ADR-SDATE
8 N/A 355 PEC_MAIL_ADR ADR_ID_TS
Phone COR-ADR-PHONE
20 N/A 363 PEC_MAIL_ADR TEL_NUM
Fax COR-ADR-FAX
20 N/A 383 PEC_MAIL_ADR FAX_NUM
Email COR-ADR-EMAIL
80 N/A 403 PEC_MAIL_ADR EMAIL_ADR
Filler FILLER 339 N/A 483
Total Length
821
Table Error! No text of specified style in document.-4 FISS Extract Child Record Types
* Record Type Values "01" – HOSPITAL-TYPE
"02" – MEDICARE-IDENTIFICATION
"03" – ENROLLMENT STATUS
"04" – PRACTICE-LOCATION
"05" – SPECIAL PAYMENT
"06" – L&T SUBMITTAL REASON
"07" – CHOW/ACQUISITION/MERGER/CONSOLIDATION
“08” - MEDICARE ID-NPI COMBINATION ASSOCIATION TO PRACTICE LOCATION
“09” – ADMINISTRATIVE FLAGS (PEND only)
“17” – ADMINISTRATIVE FLAGS
Table Error! No text of specified style in document.-5 FISS Extract Hospital Type Child Record
Description
Field Name Length
Default Value
Start Position
PECOS Table PECOS Field
General HSP-GENERAL
1 N/A 41 PEC_HOSP_SBGRP_UNIT
IF HOSP_SBGRP_UNIT_CD =’GH’
set value to ‘Y’ otherwise ‘N’
Acute Care HSP-ACUTE 1 N/A 42 PEC_HOSP_SBGRP_UNIT
IF HOSP_SBGRP_UNIT_CD =’HA’
set value to ‘Y’ otherwise ‘N’
Children's (excluded from PPS)
HSP-CHILDREN
1 N/A 43 PEC_HOSP_SBGRP_UNIT
IF HOSP_SBGRP_UNIT_CD =’CH’
set value to ‘Y’ otherwise ‘N’
Long-Term (excluded from PPS)
HSP-LONG 1 N/A 44 PEC_HOSP_SBGRP_UNIT
IF HOSP_SBGRP_UNIT_CD =’LT’
set value to ‘Y’ otherwise ‘N’
Psychiatric (excluded from PPS)
HSP-PSYCHIATRIC-EXPPS
1 N/A 45 PEC_HOSP_SBGRP_UNIT
IF HOSP_SBGRP_UNIT_CD =’HP’
set value to ‘Y’ otherwise ‘N’
Rehabilitation (excluded from PPS)
HSP-REHAB 1 N/A 46 PEC_HOSP_SBGRP_UNIT
IF HOSP_SBGRP_UNIT_CD =’HR’
set value to ‘Y’ otherwise ‘N’
Short-Term (General and Specialty)
HSP-SHORT 1 N/A 47 PEC_HOSP_SBGRP_UNIT
IF HOSP_SBGRP_UNIT_CD =’ST’
set value to ‘Y’ otherwise ‘N’
Swing-Bed Approved
HSP-SWING 1 N/A 48 PEC_HOSP_SBGRP_UNIT
IF HOSP_SBGRP_UNIT_CD = ’SBA’
set value to ‘Y’ otherwise ‘N’
Psychiatric Unit
HSP-PSYCHIATRIC
1 N/A 49 PEC_HOSP_SBGRP_UNIT
IF HOSP_SBGRP_UNIT_CD =’PU’
set value to ‘Y’ otherwise ‘N’
Description
Field Name Length
Default Value
Start Position
PECOS Table PECOS Field
Other HSP-OTHER 1 N/A 50 PEC_HOSP_SBGRP_UNIT
IF HOSP_SBGRP_UNIT_CD = ‘O’
set value to ‘Y’ otherwise ‘N’
Other Specify
HSP-OTHER-SP
60 N/A 51 PEC_HOSP_SBGRP_UNIT
HOSP_SBGRP_UNIT_OTHR _TXT
End Date HSP-END-DT 8 N/A 111 PEC_HOSP_SBGRP_UNIT
UPDT_TS
Filler FILLER 703 N/A 119
Total Length
821
Table Error! No text of specified style in document.-6 FISS Extract Medicare Identification Child
Record
Description Field Name Length Default Value
Start Position
PECOS Table PECOS Field
Medicare ID Type
MED-ID-TYPE 2 N/A 41 PEC_MDCR_NUM MDCR_TYPE_CD
Medicare ID MED-ID 15 N/A 43 PEC_MDCR_NUM MDCR_ID
End Date MED-ID-END-DT
8 N/A 58 PEC_MDCR_NUM END_DT
Effective Date
MED-ID-START 8 N/A 66 PEC_MDCR_NUM EFCTV_DT
Filler FILLER 748 N/A 74
Total Length
821
Table Error! No text of specified style in document.-7 FISS Extract Enrollment Status Child
Record
Description Field Name Length Default Value Start Position
PECOS Table PECOS Field
Enrollment Status Code
ENROLLMENT-STATUS-CODE
2 N/A 41 PEC_ENRT_STUS STUS_CD
Description Field Name Length Default Value Start Position
PECOS Table PECOS Field
Enrollment Status Reason Code
ENROLLMENT-STATUS-REASON
3 Codes will be as they are in the system, except when the status reason code 080 (“Application Fee Not Received”) is populated as the status reason in PECOS, code 074 (“CMS Approved Revocation”) will be populated on the extract.
Additionally, when status reason code 075 (“Non-responsive to revalidation”) is populated as the status reason in PECOS, code 009 (“Other”) will be populated on the extract.
43 PEC_ENRT_STUS RSN_CD
Effective Date
ENROLLMENT-STATUS-EFF-DT
8 N/A 46 PEC_ENRT_STUS CREAT_TS
End Date ENROLLMENT-STATUS-END-DT
8 N/A 54 PEC_ENRT_STUS UPDT_TS
Other Specify
ENROLLMENT-OTHER
30 N/A 62 PEC_ENRT_STUS OTHR_RSN_TXT
Filler FILLER 450 N/A 92
Total Length
501
Table Error! No text of specified style in document.-8 FISS Extract Practice Location Child
Record
Description Field Name Length
Default Value
Start Position
PECOS Table PECOS Field
Practice Location Name
PRACTICE-NAME 35 N/A 41 PEC_PRCTC_LCTN PRCTC_LCTN_NAME
HHA Branch PRACTICE-HHA-TYPE
1 N/A 76 PEC_PRCTC_LCTN PRCTC_HHA_BRNCH_SW
Hospital Psychiatric Unit
PRACTICE-HOS-PSY-TYPE
1 N/A 77 PEC_PRCTC_LCTN PRCTC_PSYCH_SW
Hospital Rehabilitation Unit
PRACTICE-HOS-REHAB-TYPE
1 N/A 78 PEC_PRCTC_LCTN PRCTC_REHAB_SW
Description Field Name Length
Default Value
Start Position
PECOS Table PECOS Field
OPT Extension Site
PRACTICE-OPT-TYPE
1 N/A 79 PEC_PRCTC_LCTN OPT_EXTNSN_SITE_SW
Hospital-Swing Bed Unit
PRACTICE-SWING-TYPE
1 N/A 80 PEC_PRCTC_LCTN HOSP_SB_UNIT_SW
Other PRACTICE-OTHER-TYPE
1 N/A 81 PEC_PRCTC_LCTN HLTH_CARE_FAC_SW
Other Specify
PRACTICE-OTHER-SP
60 N/A 82 PEC_PRCTC_LCTN HLTH_FAC_OTHR_TXT
Location Type
LOCATION-TYPE 1 N/A 142 PEC_PRCTC_LCTN PRCTC_PRTBL_CD
Primary Practice Location Switch
PRIMARY-IND 1 N/A 143 PEC_PRCTC_LCTN PRMRY_PRCTC_LOC_SW
Line 1 Street Address
PRACTICE-STR-ADR-LINE1
55 N/A 144 PEC_ENRLMT_ADR LINE_1_ST_ADR
Line 2 Street Address
PRACTICE-STR-ADR-LINE2
55 N/A 199 PEC_ENRLMT_ADR LINE_2_ST_ADR
City PRACTICE-CITY 30 N/A 254 PEC_ENRLMT_ADR CITY_NAME
State PRACTICE-STATE 2 N/A 284 PEC_ENRLMT_ADR STATE_NAME
ZIP Code PRACTICE-ZIP-CODE
15 N/A 286 PEC_ENRLMT_ADR ZIP_CD
Telephone PRACTICE-TELEPHONE
20 N/A 301 PEC_ENRLMT_ADR TEL_NUM
Email PRACTICE-EMAIL 80 N/A 321 PEC_ENRLMT_ADR EMAIL_ADR
Fax PRACTICE-FAX 20 N/A 401 PEC_ENRLMT_ADR FAX_NUM
Filler FILLER 10 N/A 421
Start Date PRACTICE-START-DATE
8 N/A 431 PEC_ENRLMT_ADR EFCTV_DT
End Date PRACTICE-END-DATE
8 N/A 449 PEC_ENRLMT_ADR TRMNTN_DT
FDA Mammography Number
FDA-MAMMOGRAPHY-PRACTICE
15 N/A 457 PEC_LCTN_FDA_MAM
RDLGY_CRTFCT_ID
FDA Mammography Number End Date
FDA-MAMMOGRAPHY-END-DATE
8 N/A 472 PEC_LCTN_FDA_MAM
END_DT
Practice Location Key
PRACTICE_LCTN_KEY
20 N/A 480 PEC_PRCTC_LCTN PEC_ENRLMT_ADR_SK
Filler FILLER 322 N/A 500
Total Length
821
Table Error! No text of specified style in document.-9 FISS Extract Special Payments Location
Child Record
Description
Field Name Length
Default Value
Start Position
PECOS Table PECOS Field
Foreign/
Domestic Code
FOREIGN-DOMESTIC-CODE-SP
1 N/A 41 PEC_ENRLMT_ADR
FRGN_CD
Line 1 Street Address
SP-PY-STR-ADR-LINE1
55 N/A 42 PEC_ENRLMT_ADR
LINE_1_ST_ADR
Line 2 Street Address
SP-PY-STR-ADR-LINE2
55 N/A 97 PEC_ENRLMT_ADR
LINE_2_ST_ADR
City SP-PY-CITY 30 N/A 152 PEC_ENRLMT_ADR
CITY_NAME
State SP-PY-STATE 2 N/A 182 PEC_ENRLMT_ADR
STATE_CD
Foreign State
SP-PY-FOREIGN-ST 30 N/A 184 PEC_ENRLMT_ADR
FRGN_STATE_NAME
ZIP Code SP-PY-ZIP-CODE 15 N/A 214 PEC_ENRLMT_ADR
ZIP_CD
Foreign Postal Code
SP-PY-POSTAL-CD 15 N/A 229 PEC_ENRLMT_ADR
FRGN_PSTL_CD
Country SP-PY-COUNTRY 30 N/A 244 PEC_ENRLMT_ADR
CNTRY_NAME
Start Date SP-PY-START-DATE 8 N/A 274 PEC_ENRLMT_ADR
EFCTV_DT
End Date SP-PY-END-DATE 8 N/A 282 PEC_ENRLMT_ADR
TRMNTN_DT
Filler FILLER 10 N/A 290
Practice Location Key
PRACTICE_LCTN_KEY
20 N/A 300 PEC_PAY_TO_LCTN
PEC_ENRLMT_ADR_SK
Filler FILLER 502 N/A 320
Total Length
821
Table Error! No text of specified style in document.-10 FISS Extract L&T Submittal Reason Child
Record
Description Field Name Length Default Value
Start Position
PECOS Table PECOS Field
L&T Submittal Code
LT-STATUS-CODE
2 N/A 41 PEC_ENRLMT_EVNT SBMTL_RSN_CD
Termination Date
TERM-DATE 8 N/A 43 PEC_ENRLMT_EVNT EFCTV_DT
Description Field Name Length Default Value
Start Position
PECOS Table PECOS Field
Filler FILLER 771 N/A 51
Total Length 821 N/A
Table Error! No text of specified style in document.-11 FISS Extract
CHOW/Acquisition/Merger/Consolidation Child Record
Description Field Name Length Default Value
Start Position
PECOS Table PECOS Field
Type Indicator
CHOW-IND 1 N/A 41 PEC_CHOW TYPE_CD
Enrollment ID of [Buyer or Seller]
CHOW-ENR-ID 15 N/A 42 PEC_CHOW ENRLMT_ID
Medicare ID Number of [Buyer or Seller]
CHOW-MEDICARE-ID
15 N/A 57 PEC_CHOW OSCAR_NUM
Medicare Type
CHOW-MEDICARE-TYPE
2 “OS” 72
Medicare ID End Date
CHOW-MEDICARE-END
8 N/A 74 PEC_CHOW END_DT
Legal Business Name of [Buyer or Seller]
CHOW-LBA-NAME
70 N/A 82 PEC_CHOW ORG_NAME
TIN of [Buyer or Seller]
CHOW-ORG-TIN
9 N/A 152 PEC_CHOW TIN
CHOW Effective Date
CHOW-EFFCTV-DT
8 N/A 161 PEC_CHOW CHOW_EFECTV_DT
New CHOW Date Indicator
NEW-CHOW-DT-IND
1 N 169 PEC_CHOW NEW_CHOW_DT_SW
Practice Location Address Line 1 of [Buyer or Seller]
CHOW-PRAC-LOC-ADR-LN1
55 N/A 170 PEC_CHOW SLR_ADR_LINE_1
Practice Location Address Line 2 of [Buyer or Seller]
CHOW-PRAC-LOC-ADR-LN2
55 N/A 225 PEC_CHOW SLR_ADR_LINE_2
Description Field Name Length Default Value
Start Position
PECOS Table PECOS Field
Practice Location Address City of [Buyer or Seller]
CHOW-PRAC-LOC-ADR-CITY
30 N/A 280 PEC_CHOW SLR_ADR_CITY
Practice Location Address State of [Buyer or Seller]
CHOW-PRAC-LOC-ADR-STATE
2 N/A 310 PEC_CHOW SLR_ADR_STATE
Practice Location Address ZIP Code of [Buyer or Seller]
CHOW-PRAC-LOC-ADR-ZIP
15 N/A 312 PEC_CHOW SLR_ADR_ZIP_CD
Filler FILLER 495 N/A 327
Total Length
821
Table Error! No text of specified style in document.-12 FISS Extract NPI-Medicare ID
Combination to Practice Location Child Record
Description
Field Name Length
Default Value
Start Position
PECOS Table PECOS Field
OSCAR OSCAR 10 N/A 41 PEC_LCTN_PIN MDCR_ID
(Where MDCR_TYPE_CD = ‘OS’)
NPI NPI-ID 10 N/A 51 PEC_MDCR_ID_NPI_ASCTN
NPI
(Where PRMRY_PRCTC_LCTN_SW = ‘Y’)
Practice Location Key
PRACTICE_LCTN_KEY
20 N/A 61 PEC_MDCR_ID_NPI_ASCTN
PEC_ENRLMT_ADR_SK
Primary Practice Location Switch
PRIMARY-IND 1 N/A 81 PEC_MDCR_ID_NPI_ASCTN
PRMRY_PRCTC_LCTN_SW
Effective Date
MDCR-ID-NPI-EFCTV-DT
8 N/A 82 PEC_MDCR_ID_NPI_ASCTN
EFCTV_DT
End Date MDCR-ID-NPI-END-DT
8 N/A 90 PEC_MDCR_ID_NPI_ASCTN
END_DT
Filler FILLER 724 N/A 98
Total Length
821
Table Error! No text of specified style in document.-13 FISS Administrative Flags Child Record - 09
Description
Field Name
Length
Default Value
Start Position
PECOS Table PECOS Field Comments
Flag Status Code
FLAG-STATUS-CD
3 N/A 41 PEC_ADMIN_FLAG
STUS_CD
Possible Values:
• 102 – PEND
Flag Status Description
FLAG-STATUS-DESC
25 N/A 44 PEC_ADMIN_FLAG_STUS_RFRNC
ADMIN_FLAG_STUS_DESC
Possible Values:
• “PEND”
Flag Reason FLAG-RSN
25 N/A 69 PEC_ADMIN_FLAG_RSN_RFRNC
ADMIN_FLAG_RSN_DESC
Possible Values:
• “FAILURE TO RESPOND TO REV”
Medicare ID Type
MEDICARE-ID-TYPE
2 N/A 94 PEC_ADMIN_FLAG_MDCR_CMBNTN
MDCR_TYPE_CD
Medicare ID MEDICARE-ID
15 N/A 96 PEC_ADMIN_FLAG_MDCR_CMBNTN
MDCR_ID
Add Date FLAG-ADD-DT
8 N/A 111 PEC_ADMIN_FLAG
EFCTV_DT
Effective Date
FLAG-EFCTV-DT
8 N/A 119 PEC_ADMIN_FLAG_MDCR_CMBNTN
CREAT_TS
Remove Date
FLAG-RMV-DT
8 N/A 127 PEC_ADMIN_FLAG
END_DT
End Date FLAG-END-DT
8 N/A 135 PEC_ADMIN_FLAG_MDCR_CMBNTN
MDCR_END_DT
Comments FLAG-COMMENTS
255 N/A 143 PEC_ADMIN_FLAG
CMT_TXT
Revalidation Mail-Out Date
REVAL-MAILED-DT
8 N/A 398 PEC_REENRLMT_SLCTD_DT
MAILED_DT
Description
Field Name
Length
Default Value
Start Position
PECOS Table PECOS Field Comments
Filler FILLER
416 406
Total Length
821
Table Error! No text of specified style in document.-14 FISS Administrative Flags Child Record -
17
Description
Field Name
Length
Default Value
Start Position
PECOS Table PECOS Field Comments
Flag Status Code
FLAG-STATUS-CD
2 N/A 41 PEC_ADMIN_FLAG
STUS_CD
Possible Values:
• 02 – Non Response Revalidation
Flag Status Description
FLAG-STATUS-DESC
25 N/A 43 PEC_ADMIN_FLAG_STUS_RFRNC
ADMIN_FLAG_STUS_DESC
Possible Values:
• “Non Response Revalidation”
Flag Reason FLAG-RSN
25 N/A 68 PEC_ADMIN_FLAG_RSN_RFRNC
ADMIN_FLAG_RSN_DESC
Possible Values:
• “FAILURE TO REVALIDATE”
Medicare ID Type
MEDICARE-ID-TYPE
2 N/A 93 PEC_ADMIN_FLAG_MDCR_CMBNTN
MDCR_TYPE_CD
Medicare ID MEDICARE-ID
15 N/A 95 PEC_ADMIN_FLAG_MDCR_CMBNTN
MDCR_ID
Add Date FLAG-ADD-DT
8 N/A 110 PEC_ADMIN_FLAG
EFCTV_DT
Effective Date
FLAG-EFCTV-DT
8 N/A 118 PEC_ADMIN_FLAG_MDCR_CMBNTN
CREAT_TS
Description
Field Name
Length
Default Value
Start Position
PECOS Table PECOS Field Comments
Remove Date
FLAG-RMV-DT
8 N/A 126 PEC_ADMIN_FLAG
END_DT
End Date FLAG-END-DT
8 N/A 134 PEC_ADMIN_FLAG_MDCR_CMBNTN
MDCR_END_DT
Comments FLAG-COMMENTS
255 N/A 142 PEC_ADMIN_FLAG
CMT_TXT
Revalidation Mail-Out Date
REVAL-MAILED-DT
8 N/A 397 PEC_REENRLMT_SLCTD_DT
MAILED_DT
Filler FILLER
417 405
Total Length
821
