* INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 2 Federally Qualified Health Center, CATEGORY = "21" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE ********************************************* * * * A T T E N T I O N * * * * THESE POS RECORD SPECIFICATIONS WERE * * PRODUCED FROM OUR DICTIONARY AT THE * * SAME TIME AS THE POS DATA FILE THAT * * YOU REQUESTED. YOU MAY WISH TO CHECK * * THESE SPECIFICATIONS TO SEE IF ANY * * CHANGES HAVE OCCURED SINCE YOUR RECEIPT * * OF ANY PRIOR DOCUMENTATION. * * * * FILE CREATION DATE = 01/01/2014 * * * ********************************************* DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 2 CLIA Laboratory, CATEGORY = "22" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Provider Category Subtype Code 2 1 2 VARCHAR2 Description: Identifies the subtype of the provider, within the primary category. Used in reporting to show the breakdown of provider categories, mainly for hospitals and SNFs. SAS Name: PRVDR_CTGRY_SBTYP_CD COBOL Name: PRVDR-CTGRY-SBTYP-CD VALUES: 01=CLIA88 Laboratory Provider Category Code 2 3 4 VARCHAR2 Description: Identifies the type of provider participating in the Medicare/Medicaid program. SAS Name: PRVDR_CTGRY_CD COBOL Name: PRVDR-CTGRY-CD VALUES: 22=CLIA Laboratory CHOW Count 2 5 6 NUMBER Description: Number of times this provider has undergone a change of ownership. SAS Name: CHOW_CNT COBOL Name: CHOW-CNT CHOW Date 8 7 14 DATE Description: Effective date of the most recent change of ownership for this provider. SAS Name: CHOW_DT COBOL Name: CHOW-DT Address: City 28 15 42 VARCHAR2 Description: City in which the provider is physically located. SAS Name: CITY_NAME COBOL Name: CITY-NAME Compliance: Acceptable POC 1 43 43 VARCHAR2 Description: Indicates if a provider is in compliance with program requirements based on an acceptable plan for correction of deficiencies. SAS Name: ACPTBL_POC_SW COBOL Name: ACPTBL-POC-SW Compliance: Status 1 44 44 VARCHAR2 Description: Compliance status of a provider at the time of certification survey. SAS Name: CMPLNC_STUS_CD COBOL Name: CMPLNC-STUS-CD * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 3 CLIA Laboratory, CATEGORY = "22" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE VALUES: A=IN COMPLIANCE B=NOT IN COMPLIANCE SSA County Code 3 45 47 VARCHAR2 Description: Social Security Administration geographic code indicating the county where the provider is located. SAS Name: SSA_CNTY_CD COBOL Name: SSA-CNTY-CD Cross Ref Provider Number 10 48 57 CHAR Description: Cross reference provider number SAS Name: CROSS_RFRNC_PRVDR_NUM COBOL Name: CROSS-RFRNC-PRVDR-NUM Certification Date 8 58 65 DATE Description: Equal to the exit date of the initial visit of the Health survey for certifications completed after July 28, 2012. For certifications prior to that date, the certification date is equal to the exit date of the initial visit of the Health survey or LSC survey, whichever is later. SAS Name: CRTFCTN_DT COBOL Name: CRTFCTN-DT Eligibility Indicator 1 66 66 VARCHAR2 Description: Indicates if a facility is eligible to participate in the Medicare and/or Medicaid programs. SAS Name: ELGBLTY_SW COBOL Name: ELGBLTY-SW Facility Name 50 67 116 VARCHAR2 Description: Name of the provider certified to participate in the Medicare and/or Medicaid programs. SAS Name: FAC_NAME COBOL Name: FAC-NAME Medicare Administrative Contractor (MAC) or 5 117 121 VARCHAR2 Intermediary or Carrier Code Description: Number assigned to the Medicare Administrative Contractor, intermediary or carrier servicing this provider. SAS Name: INTRMDRY_CARR_CD COBOL Name: INTRMDRY-CARR-CD VALUES: 00000=DUMMY FOR MEDICAID HHA 00010=BLUE CROSS (ALABAMA) 00011=CAHABA 00020=BLUE CROSS (ARKANSAS) 00030=BLUE CROSS (ARIZONA) 00040=BLUE CROSS (CALIFORNIA) 00060=BLUE CROSS (CONNECTICUT) 00070=BLUE CROSS (DELAWARE) 00090=BLUE CROSS (FLORIDA) 00101=BLUE CROSS (GEORGIA) 00121=HEALTH CARE SERVICE CORPORATION 00122=HCSC - MICHIGAN 00123=HCSC OF MICHIGAN 00130=NATIONAL GOVERNMENT SERVICES 00131=NATIONAL GOVERNMENT SERVICES 00140=BLUE CROSS (IOWA/SOUTH DAKOTA) 00150=BLUE CROSS (KANSAS) 00160=NATIONAL GOVERNMENT SERVICES 00180=NATIONAL GOVERNMENT SERVICES 00181=NATIONAL GOVERNMENT SERVICES 00190=BLUE CROSS (MARYLAND) 00200=BLUE CROSS (MASSACHUSETTS) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 4 CLIA Laboratory, CATEGORY = "22" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 00210=BLUE CROSS (MICHIGAN) 00220=BLUE CROSS (MINNESOTA) 00230=BLUE CROSS (MISSISSIPPI) 00231=BLUE CROSS (LOUISIANA) 00233=PINNACLE 00241=BLUE CROSS (MISSOURI) 00250=BLUE CROSS (MONTANA) 00260=BLUE CROSS (NEBRASKA) 00270=NATIONAL GOVERNMENT SERVICES 00280=BLUE CROSS (NEW JERSEY) 00290=BLUE CROSS (NEW MEXICO) 00308=NATIONAL GOVERNMENT SERVICES 00310=BLUE CROSS (NORTH CAROLINA) 00320=NORIDIAN PART A 00322=NORIDIAN PART A (AK/WA) 00323=NORIDIAN PART A (ID/OR) 00325=NORIDIAN 00332=NATIONAL GOVERNMENT SERVICES 00340=BLUE CROSS (OKLAHOMA) 00350=BLUE CROSS (OREGON) 00351=BLUE CROSS (OREGON) (IDAHO CLAIMS) 00362=BLUE CROSS (INDEPENDENCE) 00363=BLUE CROSS (WESTERN PENNSYLVANIA) 00366=HIGHMARK MEDICARE SERVICES 00370=BLUE CROSS (RHODE ISLAND) 00380=BLUE CROSS (SOUTH CAROLINA) 00390=BLUE CROSS (TENNESSEE) 00400=BLUE CROSS (TEXAS) 00410=BLUE CROSS (UTAH) 00423=BLUE CROSS (VIRGINIA/WEST VA) 00430=BLUE CROSS (WASHINGTON & ALASKA) 00450=NATIONAL GOVERNMENT SERVICES 00452=NATIONAL GOVERNMENT SERVICES 00453=NATIONAL GOVERNMENT SERVICES 00454=NATIONAL GOVERNMENT SERVICES 00456=NATIONAL GOVERNMENT SERVICES 00460=BLUE CROSS (WYOMING) 00468=BLUE CROSS (NORTH CAROLINA FOR PR) 00510=BLUE SHIELD (ALABAMA) 00511=CAHABA 00512=CAHABA 00520=BLUE SHIELD (ARKANSAS) 00528=BLUE SHIELD (ARKANSAS/LOUISIANA) 00542=BLUE SHIELD (CALIFORNIA) 00550=BLUE SHIELD (COLORADO) 00570=BLUE SHIELD (DELAWARE) 00580=BLUE SHIELD (DISTRICT OF COLUMBIA) 00590=BLUE SHIELD (FLORIDA) 00621=BLUE SHIELD (ILLINOIS) 00630=NATIONAL GOVERNMENT SERVICES 00640=BLUE SHIELD (IOWA) 00650=BLUE SHIELD (KANSAS) 00655=BLUE SHIELD (KANSAS/NEBRASKA) 00660=NATIONAL GOVERNMENT SERVICES 00690=BLUE SHIELD (MARYLAND) 00700=BLUE SHIELD (MASSACHUSETTS) 00710=BLUE SHIELD (MICHIGAN) 00720=BLUE SHIELD (MINNESOTA) 00740=BLUE SHIELD (KANSAS CITY) 00751=BLUE SHIELD (MONTANA) 00770=BLUE SHIELD (NEW HAMPSHIRE/VERMONT) 00780=BLUE SHIELD (TRI-STATE) 00801=BLUE SHIELD (BUFFALO) 00803=NATIONAL GOVERNMENT SERVICES * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 5 CLIA Laboratory, CATEGORY = "22" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 00805=NATIONAL GOVERNMENT SERVICES 00820=BLUE SHIELD (NORTH DAKOTA) 00821=NORIDIAN 00824=NORIDIAN GVT SERVICES (CO) 00825=BLUE SHIELD (NORTH DAKOTA/WYOMING) 00826=NORIDIAN GVT SERVICES (IA) 00831=NORIDIAN GVT SERVICES (AK) 00832=NORIDIAN GVT SERVICES (AZ) 00833=NORIDIAN GVT SERVICES (HI) 00834=NORIDIAN GVT SERVICES (NV) 00835=NORIDIAN GVT SERVICES (OR) 00836=NORIDIAN GVT SERVICES (WA) 00860=BLUE SHIELD (PENNSYLVANIA/NEW JERSEY) 00865=BLUE SHIELD (PENNSYLVANIA) 00870=BLUE SHIELD (RHODE ISLAND) 00880=BLUE SHIELD (SOUTH CAROLINA) 00883=PALMETTO GBA PART B 00884=PALMETTO GBA 00889=NORIDIAN GVT SERVICES (SD) 00900=BLUE SHIELD (TEXAS) 00901=TRAILBLAZERS HEALTH ENTERPRISES 00904=TRAILBLAZER 00910=BLUE SHIELD (UTAH) 00930=BLUE SHIELD (WASHINGTON) 00951=WISCONSIN PHYSICIANS SERVICE 00952=WPS - ILLINOIS 00953=WPS - MICHIGAN 00954=WI PHYSICIAN SERVICES - MN 00973=BLUE SHIELD (PUERTO RICO) 00974=BLUE SHIELD (VIRGIN ISLANDS) 01010=AETNA (PEORIA) 01020=AETNA (ALASKA) 01030=AETNA (ARIZONA) 01040=AETNA (GEORGIA) 01101=PALMETTO (CALIFORNIA) 01102=PALMETTO (CALIFORNIA (NORTH) 01120=AETNA (HAWAII) 01192=PALMETTO (CALIFORNIA SOUTH) 01201=PALMETTO (HAWAII) 01202=PALMETTO (HAWAII) 01290=AETNA (NEVADA) 01301=PALMETTO (NEVADA) 01302=PALMETTO (NEVADA) 01360=AETNA (NEW MEXICO) 01370=AETNA (OKLAHOMA) 01380=AETNA (OREGON) 01390=AETNA (WASHINGTON) 01901=PALMETTO GBA 01902=PALMETTO GBA 02050=OCCIDENTAL (CALIFORNIA) 02101=NATIONAL HERITAGE (ALASKA) 02102=NATIONAL HERITAGE (ALASKA) 02201=NATIONAL HERITAGE (IDAHO) 02202=NATIONAL HERITAGE (IDAHO) 02301=NATIONAL HERITAGE (OREGON) 02302=NATIONAL HERITAGE (OREGON) 02401=NATIONAL HERITAGE (WASHINGTON) 02402=NATIONAL HERITAGE (WASHINGTON) 03001=NORIDIAN ADMIN SERVICES 03101=NORIDAN (ARIZONA) 03102=NORIDAN (ARIZONA) 03201=NORIDAN (MONTANA) 03202=NORIDAN (MONTANA) 03301=NORDIAN (NORTH DAKOTA) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 6 CLIA Laboratory, CATEGORY = "22" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 03302=NORDIAN (NORTH DAKOTA) 03401=NORIDIAN (SOUTH DAKOTA) 03402=NORIDIAN (SOUTH DAKOTA) 03501=NORIDIAN (UTAH) 03502=NORIDIAN (UTAH) 03601=NORIDIAN (WYOMING) 03602=NORIDIAN (WYOMING) 04001=TRAILBLAZER 04101=TRAILBLAZER (COLORADO) 04102=TRAILBLAZER (COLORADO) 04111=NOVITAS (COLORADO) 04112=NOVITAS (COLORADO) 04201=TRAILBLAZER (NEW MEXICO) 04202=TRAILBLAZER (NEW MEXICO) 04211=NOVITAS (NEW MEXICO) 04212=NOVITAS (NEW MEXICO) 04301=TRAILBLAZER (OKLAHOMA) 04302=TRAILBLAZER (OKLAHOMA) 04311=NOVITAS (OKLAHOMA) 04312=NOVITAS (OKLAHOMA) 04401=TRAILBLAZER (TEXAS) 04402=TRAILBLAZER (TEXAS) 04411=NOVITAS (TEXAS) 04412=NOVITAS (TEXAS) 04901=MUTUAL LEGACY 04911=NOVITAS 05101=WPS (IOWA) 05102=WPS (IOWA) 05130=EQICOR (IDAHO) 05201=WPS (KANSAS) 05202=WPS (KANSAS) 05301=WPS (MISSOURI) 05302=WPS (MISSOURI WEST) 05392=WPS (MISSOURI EAST) 05401=WPS (NEBRASKA) 05402=WPS (NEBRASKA) 05440=EQICOR (TENNESSEE) 05535=EQICOR (NORTH CAROLINA) 05901=WISCONSIN PHYSICIANS SERVICE 06004=NORIDIAN HHH D 07101=PINNACLE (ARKANSAS) 07102=PINNACLE (ARKANSAS) 07201=PINNACLE (LOUISIANA) 07202=PINNACLE (LOUISIANA) 07301=PINNACLE (MISSISSIPPI) 07302=PINNACLE (MISSISSIPPI) 08101=PINNACLE (INDIANA) 08102=PINNACLE (INDIANA) 08201=PINNACLE (MICHIGAN) 08202=PINNACLE (MICHIGAN) 09101=FIRST COAST (FLORIDA) 09102=FIRST COAST (FLORIDA) 09201=FIRST COAST (PUERTO RICO/VIRGIN ISLANDS) 09202=FIRST COAST (PUERTO RICO) 09302=FIRST COAST (VIRGIN ISLANDS) 10071=TRAVELERS (RRB) 10101=CAHABA GBA (AL) 10102=CAHABA GBA (AL) 10201=CAHABA GBA (GA) 10202=CAHABA GBA (GA) 10230=TRAVELERS (CONNECTICUT) 10240=TRAVELERS (MINNESOTA) 10250=TRAVELERS (MISSISSIPPI) 10301=CAHABA GBA (TN) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 7 CLIA Laboratory, CATEGORY = "22" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 10302=CAHABA GBA (TN) 10490=TRAVELERS (VIRGINIA) 10492=TRAVELERS - VIRGINIA SPECIAL PROJECT 11004=PALMETTO HHH C 11201=PALMETTO GBA (SC) 11202=PALMETTO GBA (SC) 11260=GENERAL AMERICAN 11301=PALMETTO GBA (VA) 11302=PALMETTO GBA (VA) 11401=PALMETTO GBA (WV) 11402=PALMETTO GBA (WV) 11501=PALMETTO GBA (NC) 11502=PALMETTO GBA (NC) 12101=HIGHMARK (DELAWARE) 12102=HIGHMARK (DELAWARE) 12201=HIGHMARK (DISTRICT OF COLUMBIA) 12202=HIGHMARK (DISTRICT OF COLUMBIA) 12301=HIGHMARK (MARYLAND) 12302=HIGHMARK (MARYLAND) 12401=HIGHMARK (NEW JERSEY) 12402=HIGHMARK (NEW JERSEY) 12501=HIGHMARK (PENNSYLVANIA) 12502=HIGHMARK (PENNSYLVANIA) 12901=HIGHMARK 12902=HIGHMARK 13101=NATIONAL GOVT SERVICES (CONNECTICUT) 13102=NATIONAL GOVT SERVICES (CONNECTICUT) 13201=NATIONAL GOVT SERVICES (NEW YORK) 13202=NATIONAL GOVT SERVICES (NEW YORK - EMPIRE) 13282=NATIONAL GOVT SERVICES (NEW YORK - HEALTHNOW) 13292=NATIONAL GOVT SERVICES (NEW YORK - GHI) 14004=NATIONAL HERITAGE (HHA - A) 14101=NATIONAL HERITAGE (MAINE) 14102=NATIONAL HERITAGE (MAINE) 14201=NATIONAL HERITAGE (MASSACHUSETTS) 14202=NATIONAL HERITAGE (MASSACHUSETTS) 14301=NATIONAL HERITAGE (NEW HAMPSHIRE) 14302=NATIONAL HERITAGE (NEW HAMPSHIRE) 14330=GROUP HEALTH INC (NEW YORK) 14401=NATIONAL HERITAGE (RHODE ISLAND) 14402=NATIONAL HERITAGE (RHODE ISLAND) 14501=NATIONAL HERITAGE (VERMONT) 14502=NATIONAL HERITAGE (VERMONT) 15004=CIGNA HHH B 15101=CGS (KENTUCKY) 15102=CGS (KENTUCKY) 15201=CGS (OHIO) 15202=CGS (OHIO) 16360=NATIONWIDE (OHIO) 16510=NATIONWIDE (WEST VIRGINIA) 17120=HAWAII MEDICAL SERVICE ASSOCIATION 21200=MASSACHUSETTS/MAINE 31140=NATIONAL HERITAGE (CA) 31142=NATIONAL HERITAGE INSURANCE CO (MAINE) 31143=NATIONAL HERITAGE INSURANCE CO 31144=NATIONAL HERITAGE INSURANCE CO 31146=NATIONAL HERTAGE INSURANCE 50333=TRAVELERS (NEW YORK) 51051=AETNA (PETALUMA) 51070=AETNA (FARMINGTON) 51100=AETNA (CLEARWATER) 51140=AETNA (PEORIA) 51390=AETNA (FORT WASHINGTON) 52280=MUTUAL OF OMAHA * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 8 CLIA Laboratory, CATEGORY = "22" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 57400=COOPERATIVA (PUERTO RICO) Medicaid Vendor Number 15 122 136 VARCHAR2 Description: Number which may be assigned to a provider by the state Medicaid agency for external control or billing purposes. SAS Name: MDCD_VNDR_NUM COBOL Name: MDCD-VNDR-NUM Original Participation Date 8 137 144 DATE Description: Date a provider is first approved to provide Medicare and/or Medicaid services. SAS Name: ORGNL_PRTCPTN_DT COBOL Name: ORGNL-PRTCPTN-DT Prior CHOW Date 8 145 152 DATE Description: Effective date of the previous change of ownership for this provider. SAS Name: CHOW_PRIOR_DT COBOL Name: CHOW-PRIOR-DT Prior Medicare Administrative Contractor (MAC) or 5 153 157 VARCHAR2 Intermediary or Carrier Code Description: Number assigned to the previous Medicare Administrative Contractor, intermediary or carrier servicing this provider. SAS Name: INTRMDRY_CARR_PRIOR_CD COBOL Name: INTRMDRY-CARR-PRIOR-CD VALUES: 00000=DUMMY FOR MEDICAID HHA 00010=BLUE CROSS (ALABAMA) 00011=CAHABA 00020=BLUE CROSS (ARKANSAS) 00030=BLUE CROSS (ARIZONA) 00040=BLUE CROSS (CALIFORNIA) 00060=BLUE CROSS (CONNECTICUT) 00070=BLUE CROSS (DELAWARE) 00090=BLUE CROSS (FLORIDA) 00101=BLUE CROSS (GEORGIA) 00121=HEALTH CARE SERVICE CORPORATION 00122=HCSC - MICHIGAN 00123=HCSC OF MICHIGAN 00130=NATIONAL GOVERNMENT SERVICES 00131=NATIONAL GOVERNMENT SERVICES 00140=BLUE CROSS (IOWA/SOUTH DAKOTA) 00150=BLUE CROSS (KANSAS) 00160=NATIONAL GOVERNMENT SERVICES 00180=NATIONAL GOVERNMENT SERVICES 00181=NATIONAL GOVERNMENT SERVICES 00190=BLUE CROSS (MARYLAND) 00200=BLUE CROSS (MASSACHUSETTS) 00210=BLUE CROSS (MICHIGAN) 00220=BLUE CROSS (MINNESOTA) 00230=BLUE CROSS (MISSISSIPPI) 00231=BLUE CROSS (LOUISIANA) 00233=PINNACLE 00241=BLUE CROSS (MISSOURI) 00250=BLUE CROSS (MONTANA) 00260=BLUE CROSS (NEBRASKA) 00270=NATIONAL GOVERNMENT SERVICES 00280=BLUE CROSS (NEW JERSEY) 00290=BLUE CROSS (NEW MEXICO) 00308=NATIONAL GOVERNMENT SERVICES 00310=BLUE CROSS (NORTH CAROLINA) 00320=NORIDIAN PART A 00322=NORIDIAN PART A (AK/WA) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 9 CLIA Laboratory, CATEGORY = "22" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 00323=NORIDIAN PART A (ID/OR) 00325=NORIDIAN 00332=NATIONAL GOVERNMENT SERVICES 00340=BLUE CROSS (OKLAHOMA) 00350=BLUE CROSS (OREGON) 00351=BLUE CROSS (OREGON) (IDAHO CLAIMS) 00362=BLUE CROSS (INDEPENDENCE) 00363=BLUE CROSS (WESTERN PENNSYLVANIA) 00366=HIGHMARK MEDICARE SERVICES 00370=BLUE CROSS (RHODE ISLAND) 00380=BLUE CROSS (SOUTH CAROLINA) 00390=BLUE CROSS (TENNESSEE) 00400=BLUE CROSS (TEXAS) 00410=BLUE CROSS (UTAH) 00423=BLUE CROSS (VIRGINIA/WEST VA) 00430=BLUE CROSS (WASHINGTON & ALASKA) 00450=NATIONAL GOVERNMENT SERVICES 00452=NATIONAL GOVERNMENT SERVICES 00453=NATIONAL GOVERNMENT SERVICES 00454=NATIONAL GOVERNMENT SERVICES 00456=NATIONAL GOVERNMENT SERVICES 00460=BLUE CROSS (WYOMING) 00468=BLUE CROSS (NORTH CAROLINA FOR PR) 00510=BLUE SHIELD (ALABAMA) 00511=CAHABA 00512=CAHABA 00520=BLUE SHIELD (ARKANSAS) 00528=BLUE SHIELD (ARKANSAS/LOUISIANA) 00542=BLUE SHIELD (CALIFORNIA) 00550=BLUE SHIELD (COLORADO) 00570=BLUE SHIELD (DELAWARE) 00580=BLUE SHIELD (DISTRICT OF COLUMBIA) 00590=BLUE SHIELD (FLORIDA) 00621=BLUE SHIELD (ILLINOIS) 00630=NATIONAL GOVERNMENT SERVICES 00640=BLUE SHIELD (IOWA) 00650=BLUE SHIELD (KANSAS) 00655=BLUE SHIELD (KANSAS/NEBRASKA) 00660=NATIONAL GOVERNMENT SERVICES 00690=BLUE SHIELD (MARYLAND) 00700=BLUE SHIELD (MASSACHUSETTS) 00710=BLUE SHIELD (MICHIGAN) 00720=BLUE SHIELD (MINNESOTA) 00740=BLUE SHIELD (KANSAS CITY) 00751=BLUE SHIELD (MONTANA) 00770=BLUE SHIELD (NEW HAMPSHIRE/VERMONT) 00780=BLUE SHIELD (TRI-STATE) 00801=BLUE SHIELD (BUFFALO) 00803=NATIONAL GOVERNMENT SERVICES 00805=NATIONAL GOVERNMENT SERVICES 00820=BLUE SHIELD (NORTH DAKOTA) 00821=NORIDIAN 00824=NORIDIAN GVT SERVICES (CO) 00825=BLUE SHIELD (NORTH DAKOTA/WYOMING) 00826=NORIDIAN GVT SERVICES (IA) 00831=NORIDIAN GVT SERVICES (AK) 00832=NORIDIAN GVT SERVICES (AZ) 00833=NORIDIAN GVT SERVICES (HI) 00834=NORIDIAN GVT SERVICES (NV) 00835=NORIDIAN GVT SERVICES (OR) 00836=NORIDIAN GVT SERVICES (WA) 00860=BLUE SHIELD (PENNSYLVANIA/NEW JERSEY) 00865=BLUE SHIELD (PENNSYLVANIA) 00870=BLUE SHIELD (RHODE ISLAND) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 10 CLIA Laboratory, CATEGORY = "22" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 00880=BLUE SHIELD (SOUTH CAROLINA) 00883=PALMETTO GBA PART B 00884=PALMETTO GBA 00889=NORIDIAN GVT SERVICES (SD) 00900=BLUE SHIELD (TEXAS) 00901=TRAILBLAZERS HEALTH ENTERPRISES 00904=TRAILBLAZER 00910=BLUE SHIELD (UTAH) 00930=BLUE SHIELD (WASHINGTON) 00951=WISCONSIN PHYSICIANS SERVICE 00952=WPS - ILLINOIS 00953=WPS - MICHIGAN 00954=WI PHYSICIAN SERVICES - MN 00973=BLUE SHIELD (PUERTO RICO) 00974=BLUE SHIELD (VIRGIN ISLANDS) 01010=AETNA (PEORIA) 01020=AETNA (ALASKA) 01030=AETNA (ARIZONA) 01040=AETNA (GEORGIA) 01101=PALMETTO (CALIFORNIA) 01102=PALMETTO (CALIFORNIA (NORTH) 01120=AETNA (HAWAII) 01192=PALMETTO (CALIFORNIA SOUTH) 01201=PALMETTO (HAWAII) 01202=PALMETTO (HAWAII) 01290=AETNA (NEVADA) 01301=PALMETTO (NEVADA) 01302=PALMETTO (NEVADA) 01360=AETNA (NEW MEXICO) 01370=AETNA (OKLAHOMA) 01380=AETNA (OREGON) 01390=AETNA (WASHINGTON) 01901=PALMETTO GBA 01902=PALMETTO GBA 02050=OCCIDENTAL (CALIFORNIA) 02101=NATIONAL HERITAGE (ALASKA) 02102=NATIONAL HERITAGE (ALASKA) 02201=NATIONAL HERITAGE (IDAHO) 02202=NATIONAL HERITAGE (IDAHO) 02301=NATIONAL HERITAGE (OREGON) 02302=NATIONAL HERITAGE (OREGON) 02401=NATIONAL HERITAGE (WASHINGTON) 02402=NATIONAL HERITAGE (WASHINGTON) 03001=NORIDIAN ADMIN SERVICES 03101=NORIDAN (ARIZONA) 03102=NORIDAN (ARIZONA) 03201=NORIDAN (MONTANA) 03202=NORIDAN (MONTANA) 03301=NORDIAN (NORTH DAKOTA) 03302=NORDIAN (NORTH DAKOTA) 03401=NORIDIAN (SOUTH DAKOTA) 03402=NORIDIAN (SOUTH DAKOTA) 03501=NORIDIAN (UTAH) 03502=NORIDIAN (UTAH) 03601=NORIDIAN (WYOMING) 03602=NORIDIAN (WYOMING) 04001=TRAILBLAZER 04101=TRAILBLAZER (COLORADO) 04102=TRAILBLAZER (COLORADO) 04111=NOVITAS (COLORADO) 04112=NOVITAS (COLORADO) 04201=TRAILBLAZER (NEW MEXICO) 04202=TRAILBLAZER (NEW MEXICO) 04211=NOVITAS (NEW MEXICO) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 11 CLIA Laboratory, CATEGORY = "22" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 04212=NOVITAS (NEW MEXICO) 04301=TRAILBLAZER (OKLAHOMA) 04302=TRAILBLAZER (OKLAHOMA) 04311=NOVITAS (OKLAHOMA) 04312=NOVITAS (OKLAHOMA) 04401=TRAILBLAZER (TEXAS) 04402=TRAILBLAZER (TEXAS) 04411=NOVITAS (TEXAS) 04412=NOVITAS (TEXAS) 04901=MUTUAL LEGACY 04911=NOVITAS 05101=WPS (IOWA) 05102=WPS (IOWA) 05130=EQICOR (IDAHO) 05201=WPS (KANSAS) 05202=WPS (KANSAS) 05301=WPS (MISSOURI) 05302=WPS (MISSOURI WEST) 05392=WPS (MISSOURI EAST) 05401=WPS (NEBRASKA) 05402=WPS (NEBRASKA) 05440=EQICOR (TENNESSEE) 05535=EQICOR (NORTH CAROLINA) 05901=WISCONSIN PHYSICIANS SERVICE 06004=NORIDIAN HHH D 07101=PINNACLE (ARKANSAS) 07102=PINNACLE (ARKANSAS) 07201=PINNACLE (LOUISIANA) 07202=PINNACLE (LOUISIANA) 07301=PINNACLE (MISSISSIPPI) 07302=PINNACLE (MISSISSIPPI) 08101=PINNACLE (INDIANA) 08102=PINNACLE (INDIANA) 08201=PINNACLE (MICHIGAN) 08202=PINNACLE (MICHIGAN) 09101=FIRST COAST (FLORIDA) 09102=FIRST COAST (FLORIDA) 09201=FIRST COAST (PUERTO RICO/VIRGIN ISLANDS) 09202=FIRST COAST (PUERTO RICO) 09302=FIRST COAST (VIRGIN ISLANDS) 10071=TRAVELERS (RRB) 10101=CAHABA GBA (AL) 10102=CAHABA GBA (AL) 10201=CAHABA GBA (GA) 10202=CAHABA GBA (GA) 10230=TRAVELERS (CONNECTICUT) 10240=TRAVELERS (MINNESOTA) 10250=TRAVELERS (MISSISSIPPI) 10301=CAHABA GBA (TN) 10302=CAHABA GBA (TN) 10490=TRAVELERS (VIRGINIA) 10492=TRAVELERS - VIRGINIA SPECIAL PROJECT 11004=PALMETTO HHH C 11201=PALMETTO GBA (SC) 11202=PALMETTO GBA (SC) 11260=GENERAL AMERICAN 11301=PALMETTO GBA (VA) 11302=PALMETTO GBA (VA) 11401=PALMETTO GBA (WV) 11402=PALMETTO GBA (WV) 11501=PALMETTO GBA (NC) 11502=PALMETTO GBA (NC) 12101=HIGHMARK (DELAWARE) 12102=HIGHMARK (DELAWARE) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 12 CLIA Laboratory, CATEGORY = "22" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 12201=HIGHMARK (DISTRICT OF COLUMBIA) 12202=HIGHMARK (DISTRICT OF COLUMBIA) 12301=HIGHMARK (MARYLAND) 12302=HIGHMARK (MARYLAND) 12401=HIGHMARK (NEW JERSEY) 12402=HIGHMARK (NEW JERSEY) 12501=HIGHMARK (PENNSYLVANIA) 12502=HIGHMARK (PENNSYLVANIA) 12901=HIGHMARK 12902=HIGHMARK 13101=NATIONAL GOVT SERVICES (CONNECTICUT) 13102=NATIONAL GOVT SERVICES (CONNECTICUT) 13201=NATIONAL GOVT SERVICES (NEW YORK) 13202=NATIONAL GOVT SERVICES (NEW YORK - EMPIRE) 13282=NATIONAL GOVT SERVICES (NEW YORK - HEALTHNOW) 13292=NATIONAL GOVT SERVICES (NEW YORK - GHI) 14004=NATIONAL HERITAGE (HHA - A) 14101=NATIONAL HERITAGE (MAINE) 14102=NATIONAL HERITAGE (MAINE) 14201=NATIONAL HERITAGE (MASSACHUSETTS) 14202=NATIONAL HERITAGE (MASSACHUSETTS) 14301=NATIONAL HERITAGE (NEW HAMPSHIRE) 14302=NATIONAL HERITAGE (NEW HAMPSHIRE) 14330=GROUP HEALTH INC (NEW YORK) 14401=NATIONAL HERITAGE (RHODE ISLAND) 14402=NATIONAL HERITAGE (RHODE ISLAND) 14501=NATIONAL HERITAGE (VERMONT) 14502=NATIONAL HERITAGE (VERMONT) 15004=CIGNA HHH B 15101=CGS (KENTUCKY) 15102=CGS (KENTUCKY) 15201=CGS (OHIO) 15202=CGS (OHIO) 16360=NATIONWIDE (OHIO) 16510=NATIONWIDE (WEST VIRGINIA) 17120=HAWAII MEDICAL SERVICE ASSOCIATION 21200=MASSACHUSETTS/MAINE 31140=NATIONAL HERITAGE (CA) 31142=NATIONAL HERITAGE INSURANCE CO (MAINE) 31143=NATIONAL HERITAGE INSURANCE CO 31144=NATIONAL HERITAGE INSURANCE CO 31146=NATIONAL HERTAGE INSURANCE 50333=TRAVELERS (NEW YORK) 51051=AETNA (PETALUMA) 51070=AETNA (FARMINGTON) 51100=AETNA (CLEARWATER) 51140=AETNA (PEORIA) 51390=AETNA (FORT WASHINGTON) 52280=MUTUAL OF OMAHA 57400=COOPERATIVA (PUERTO RICO) CCN 10 158 167 VARCHAR2 Description: Six or ten position identification number that is assigned to a certified provider. This is the CMS Certification Number. SAS Name: PRVDR_NUM COBOL Name: PRVDR-NUM Region Code 2 168 169 VARCHAR2 Description: Indicates the CMS Regional Office responsible for the certification of the provider. SAS Name: RGN_CD COBOL Name: RGN-CD VALUES: 01=Boston * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 13 CLIA Laboratory, CATEGORY = "22" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 02=New York 03=Philadelphia 04=Atlanta 05=Chicago 06=Dallas 07=Kansas City 08=Denver 09=San Francisco 10=Seattle Skeleton Record Indicator 1 170 170 VARCHAR2 Description: Indicates if the record is a skeleton record. Only a limited set of data is available for this provider; no survey data exists. SAS Name: SKLTN_REC_SW COBOL Name: SKLTN-REC-SW State Abbreviation 2 171 172 VARCHAR2 Description: Two-character state abbreviation. SAS Name: STATE_CD COBOL Name: STATE-CD VALUES: AK=ALASKA AL=ALABAMA AR=ARKANSAS AS=AMERICAN SAMOA AZ=ARIZONA CA=CALIFORNIA CN=CANADA CO=COLORADO CT=CONNECTICUT DC=DISTRICT OF COLUMBIA DE=DELAWARE FL=FLORIDA FN=INTERNATIONAL GA=GEORGIA GU=GUAM HI=HAWAII IA=IOWA ID=IDAHO IL=ILLINOIS IN=INDIANA KS=KANSAS KY=KENTUCKY LA=LOUISIANA MA=MASSACHUSETTS MD=MARYLAND ME=MAINE MI=MICHIGAN MN=MINNESOTA MO=MISSOURI MP=SAIPAN MS=MISSISSIPPI MT=MONTANA MX=MEXICO NC=NORTH CAROLINA ND=NORTH DAKOTA NE=NEBRASKA NH=NEW HAMPSHIRE NJ=NEW JERSEY NM=NEW MEXICO NV=NEVADA NY=NEW YORK OH=OHIO OK=OKLAHOMA * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 14 CLIA Laboratory, CATEGORY = "22" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE OR=OREGON PA=PENNSYLVANIA PR=PUERTO RICO RI=RHODE ISLAND SC=SOUTH CAROLINA SD=SOUTH DAKOTA TN=TENNESSEE TX=TEXAS UT=UTAH VA=VIRGINIA VI=VIRGIN ISLANDS VT=VERMONT WA=WASHINGTON WI=WISCONSIN WV=WEST VIRGINIA WY=WYOMING SSA State Code 2 173 174 VARCHAR2 Description: Social Security Administration geographic code indicating the state where the provider is located. SAS Name: SSA_STATE_CD COBOL Name: SSA-STATE-CD VALUES: 01=ALABAMA 02=ALASKA 03=ARIZONA 04=ARKANSAS 05=CALIFORNIA 06=COLORADO 07=CONNECTICUT 08=DELAWARE 09=DISTRICT OF COLUMBIA 10=FLORIDA 11=GEORGIA 12=HAWAII 13=IDAHO 14=ILLINOIS 15=INDIANA 16=IOWA 17=KANSAS 18=KENTUCKY 19=LOUISIANA 20=MAINE 21=MARYLAND 22=MASSACHUSETTS 23=MICHIGAN 24=MINNESOTA 25=MISSISSIPPI 26=MISSOURI 27=MONTANA 28=NEBRASKA 29=NEVADA 30=NEW HAMPSHIRE 31=NEW JERSEY 32=NEW MEXICO 33=NEW YORK 34=NORTH CAROLINA 35=NORTH DAKOTA 36=OHIO 37=OKLAHOMA 38=OREGON 39=PENNSYLVANIA 40=PUERTO RICO 41=RHODE ISLAND 42=SOUTH CAROLINA * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 15 CLIA Laboratory, CATEGORY = "22" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 43=SOUTH DAKOTA 44=TENNESSEE 45=TEXAS 46=UTAH 47=VERMONT 48=VIRGIN ISLANDS 49=VIRGINIA 50=WASHINGTON 51=WEST VIRGINIA 52=WISCONSIN 53=WYOMING 54=AFRICA 56=CANADA 57=WEST INDIES 58=EUROPE 59=MEXICO 60=OCEANIA 61=PHILIPPINES 62=SOUTH AMERICA 63=UNITED STATES POSSESSIONS 64=AMERICAN SAMOA 65=GUAM 66=SAIPAN 99=INTERNATIONAL State Region Code 3 175 177 VARCHAR2 Description: Identifies the region within a state where the provider is located. SAS Name: STATE_RGN_CD COBOL Name: STATE-RGN-CD VALUES: AK/001=ALASKA AK/LAB=LABORATORIES AL/001=ALABAMA AL/LAB=LABORATORIES AR/001=ARKANSAS AR/LAB=LABORATORIES AS/001=AMERICAN SAMOA AS/LAB=LABORATORY AZ/AZ=PHOENIX AZ/LAB=ARIZONA LAB AZ/TUC=TUCSON CA/BAK=BAKERSFIELD CA/BER=SAN BERNARDINO CA/BK=BERKELEY CA/BK1=CONTRA COSTA CA/FR=FRESNO CA/L1=L.A. WEST CA/L2=L.A. NORTH CA/L3=L.A. CENTRAL CA/L4=L.A. EAST CA/L5=SAN GABRIEL CA/LAB=LABORATORIES CA/M1=LAB. SOUTH CA/M2=LAB. NORTH CA/ORG=ORANGE CO CA/RIV=RIVERSIDE CA/RWC=REDWOOD COAST CA/S1=SACRAMENTO CA/S2=SACTO SOUTH CA/S3=CHICO CA/SD=SAN DIEGO CA/SDS=SAN DIEGO SOUTH CA/SF=SAN FRANCISCO CA/SJ=SAN JOSE * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 16 CLIA Laboratory, CATEGORY = "22" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE CA/SR=SANTA ROSA CA/VEN=VENTURA CN/001=CANADA CN/LAB=LABORATORY CO/001=COLORADO CO/LAB=LABORATORIES CT/001=CONNECTICUT CT/LAB=LABORATORIES DC/001=DISTRICT OF COLUMBIA DC/LAB=LABORATORIES DE/001=DELAWARE DE/LAB=LABORATORIES FL/FTM=FT. MYERS FL/GAI=GAINESVILLE FL/JAX=JACKSONVILLE FL/LAB=LABORATORIES FL/LAN=LANTANA FL/LAU=LAUDERHILL FL/MIA=MIAMI FL/ORL=ORLANDO FL/PEN=PENSACOLA FL/STP=ST. PETERSBURG FL/TAL=TALLAHASSEE FL/TAM=TAMPA FM/001=FEDERATED STATES OF MICRO FN/001=INTERNATIONAL FN/LAB=LABORATORIES GA/001=GEORGIA GA/GAA=GEORGIA ALL GA/GAC=GEORGIA CENTRAL GA/GAE=GEORGIA EASTERN GA/GAN=GEORGIA NORTH GA/GAS=GEORGIA SOUTH GA/GAW=GEORGIA WESTERN GA/LAB=LABORATORIES GU/001=GUAM GU/LAB=LABORATORIES HI/001=HAWAII HI/LAB=LABORATORIES IA/001=IOWA IA/LAB=LABORATORIES ID/001=IDAHO ID/LAB=LABORATORIES IL/001=ILLINOIS IL/LAB=LABORATORIES IN/001=INDIANA IN/LAB=LABORATORIES KS/LAB=LABORATORIES KS/LAW=LAWRENCE KS/NC=NORTH CENTRAL KANSAS KS/NE=NORTH EAST KANSAS KS/NW=NORTH WEST KANSAS KS/SC=SOUTH CENTRAL KANSAS KS/SE=SOUTH EAST KANSAS KS/SW=SOUTH WEST KANSAS KS/WST=WEST KY/2C1=HOPKINSVILLE KY/2C2=LOUISVILLE KY/2C3=LONDON KY/2C4=LEXINGTON KY/LAB=LABORATORIES LA/001=LOUISIANA LA/LA1=NEW ORLEANS LA/LA2=MANDEVILLE * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 17 CLIA Laboratory, CATEGORY = "22" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE LA/LA3=LAFAYETTE LA/LA4=MONROE LA/LA5=SHREVEPORT LA/LA6=ALEXANDRIA LA/LAB=LABORATORIES LA/LB1=CLIA NEW ORLEANS LA/LB5=CLIA SHREVEPORT LA/LB6=CLIA ALEXANDRIA MA/001=MASSACHUSETTS MA/LAB=LABORATORIES MD/001=MARYLAND MD/LAB=LABORATORIES ME/001=MAINE ME/LAB=LABORATORIES MH/001=MARSHALL ISLANDS MI/001=MICHIGAN MI/LAB=LABORATORIES MN/001=MINNESOTA MN/LAB=LABORATORIES MO/01=REGION01 MO/02=REGION02 MO/03=REGION 03 MO/04=REGION 04 MO/05=REGION 05 MO/06=REGION 06 MO/07=REGION 07 MO/1NH=REGION 1 NH MO/2NH=REGION 2 NH MO/3NH=REGION 3 NH MO/4NH=REGION 4 NH MO/5NH=REGION 5 NH MO/6NH=REGION 6 NH MO/7NH=REGION 7 NH MO/LAB=LABORATORIES MO/MO=STATEWIDE MP/001=NORTHERN MARIANA ISLANDS MP/LAB=LABORATORIES MS/001=MISSISSIPPI MS/LAB=LABORATORIES MT/001=MONTANA MT/LAB=LABORATORIES MX/001=MEXICO MX/LAB=LABORATORY NC/LAB=LABORATORIES NC/NCC=NORTH CAROLINA CENTRAL NC/NCE=NORTH CAROLINA EAST NC/NCN=NORTH CAROLINA NORTH NC/NCS=NORTH CAROLINA SOUTH NC/NCW=NORTH CAROLINA WEST ND/001=NORTH DAKOTA ND/LAB=LABORATORIES NE/1=NORTH CENTRAL NE/2=CENTRAL NE/3=NORTHEAST NE/4=SOUTHEAST NE/5=WESTERN NE/LAB=LABORATORIES NH/001=NEW HAMPSHIRE NH/LAB=LABORATORIES NJ/001=NEW JERSEY NJ/LAB=LABORATORIES NM/001=NEW MEXICO NM/LAB=LABORATORIES NV/CC=CARSON CITY * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 18 CLIA Laboratory, CATEGORY = "22" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE NV/LAB=LABORATORIES NV/LV=LAS VEGAS NY/001=BUFFALO NY/002=ROCHESTER NY/003=SYRACUSE NY/004=ALBANY NY/005=NEW ROCHELLE NY/006=NEW YORK CITY NY/007=SUFFOLK/NASSAU COUNTY NY/LAB=LABORATORIES OH/001=OHIO OH/LAB=LABORATORIES OK/001=OKLAHOMA OK/LAB=LABORATORIES OR/001=OFFICE #1 OR/002=OFFICE #2 OR/003=OFFICE #3 OR/LAB=LABORATORIES PA/001=PENNSYLVANIA PA/LAB=LABORATORIES PR/001=PUERTO RICO PR/LAB=LABORATORIES PW/001=PALAU RI/001=RHODE ISLAND RI/LAB=LABORATORIES SC/001=SOUTH CAROLINA SC/LAB=LABORATORIES SD/001=SOUTH DAKOTA SD/LAB=LABORATORIES TN/LAB=LABORATORIES TN/TNC=TENNESSEE COOKEVILLE TN/TNE=TENNESSEE EASTERN TN/TNM=TENNESSEE MIDDLE TN/TNW=TENNESSEE WESTERN TX/001=TEXAS TX/L01=AMARILLO-LTC TX/L02=ABILENE-LTC TX/L03=ARLINGTON-LTC TX/L04=TYLER-LTC TX/L05=BEAUMONT-LTC TX/L06=HOUSTON-LTC TX/L07=TEMPLE-LTC TX/L08=SAN ANTONIO-LTC TX/L09=SAN ANGELO-LTC TX/L10=EL PASO-LTC TX/L11=CORPUS CHRISTI-LTC TX/LAB=LABORATORIES TX/TX1=LUBBOCK TX/TX2=ARLINGTON TX/TX3=SAN ANTONIO TX/TX4=HOUSTON TX/TX5=TYLER TX/TX6=AUSTIN UT/001=UTAH UT/LAB=LABORATORIES VA/001=VIRGINIA VA/LAB=LABORATORIES VI/001=VIRGIN ISLANDS VI/LAB=LABORATORIES VT/001=VERMONT VT/LAB=LABORATORIES WA/001=ALL OTHERS (NON-LTC FAC) WA/D1=SPOKANE & YAKIMA AREAS WA/D1A=District 1, Unit A * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 19 CLIA Laboratory, CATEGORY = "22" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE WA/D1B=District 1, Unit B WA/D1C=District 1, Unit C WA/D1D=District 1, Unit D WA/D2=SPOKANE & SE WA/D2A=District 2, Unit A WA/D2B=District 2, Unit B WA/D2C=District 2, Unit C WA/D2D=District 2, Unit D WA/D2E=District 2, Unit E WA/D2F=District 2, Unit F WA/D2G=District 2, Unit G WA/D3=NW WASHINGTON WA/D3A=District 3, Unit A WA/D3B=District 3, Unit B WA/D3C=District 3, Unit C WA/D3D=District 3, Unit D WA/D3E=District 3, Unit E WA/D4A=GREATER SEATTLE AREA WA/D4B=S KING COUNTY WA/D5A=PIERCE CTY & PENINSULA WA/D5B=PIERCE CTY & GRAYS HARBOR WA/D6=OLYMPIA AREA WA/LAB=LABORATORIES WI/001=WISCONSIN WI/LAB=LABORATORIES WV/001=WEST VIRGINIA WV/LAB=LABORATORIES WY/001=WYOMING WY/LAB=LABORATORIES Address: Street 50 178 227 VARCHAR2 Description: Street address where the provider is located. SAS Name: ST_ADR COBOL Name: ST-ADR Telephone Number 10 228 237 VARCHAR2 Description: Telephone number of the provider. SAS Name: PHNE_NUM COBOL Name: PHNE-NUM Termination Code 2 238 239 VARCHAR2 Description: Indicates the current termination status for the provider. SAS Name: PGM_TRMNTN_CD COBOL Name: PGM-TRMNTN-CD VALUES: 00=ACTIVE PROVIDER 01=VOLUNTARY-MERGER, CLOSURE 02=VOLUNTARY-DISSATISFACTION WITH REIMBURSEMENT 03=VOLUNTARY-RISK OF INVOLUNTARY TERMINATION 04=VOLUNTARY-OTHER REASON FOR WITHDRAWAL 05=INVOLUNTARY-FAILURE TO MEET HEALTH/SAFETY REQ 06=INVOLUNTARY-FAILURE TO MEET AGREEMENT 07=OTHER-PROVIDER STATUS CHANGE 08=NONPAYMENT OF FEES - CLIA Only 09=REV/UNSUCCESSFUL PARTICIPATION IN PT - CLIA Only 10=REV/OTHER REASON - CLIA Only 11=INCOMPLETE CLIA APPLICATION INFORMATION - CLIA Only 12=NO LONGER PERFORMING TESTS - CLIA Only 13=MULTIPLE TO SINGLE SITE CERTIFICATE - CLIA Only 14=SHARED LABORATORY - CLIA Only 15=FAILURE TO RENEW WAIVER PPM CERTIFICATE - CLIA Only 16=DUPLICATE CLIA NUMBER - CLIA Only 17=MAIL RETURNED NO FORWARD ADDRESS CERT ENDED - CLIA Only 20=NOTIFICATION BANKRUPTCY - CLIA Only * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 20 CLIA Laboratory, CATEGORY = "22" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 33=ACCREDITATION NOT CONFIRMED - CLIA Only 80=AWAITING STATE APPROVAL 99=OIG ACTION - DO NOT ACTIVATE - CLIA Only Termination or Expiration Date 8 240 247 DATE Description: Date the provider was terminated. For CLIA providers, date the laboratory's certificate was terminated or the expiration date of the current CLIA certificate. SAS Name: TRMNTN_EXPRTN_DT COBOL Name: TRMNTN-EXPRTN-DT Type of Action Code 1 248 248 VARCHAR2 Description: Identifies the reason for the certification. Type of action from the official survey record, CMS 1539 form. SAS Name: CRTFCTN_ACTN_TYPE_CD COBOL Name: CRTFCTN-ACTN-TYPE-CD VALUES: 1=INITIAL 2=RECERTIFICATION 3=TERMINATION 4=CHANGE OF OWNERSHIP 5=VALIDATION 8=FULL SURVEY AFTER COMPLAINT Ownership Type Code 2 249 250 VARCHAR2 Description: Indicates the ownership type of the provider. SAS Name: GNRL_CNTL_TYPE_CD COBOL Name: GNRL-CNTL-TYPE-CD VALUES: 01=RELIGIOUS AFFILIATION 02=PRIVATE 03=OTHER 04=PROPRIETARY 05=GOVERNMENT - CITY 06=GOVERNMENT - COUNTY 07=GOVERNMENT - STATE 08=GOVERNMENT - FEDERAL 09=GOVERNMENT - OTHER 10=UNKNOWN Address: ZIP Code 5 251 255 VARCHAR2 Description: Five-digit ZIP code for a provider's physical address. SAS Name: ZIP_CD COBOL Name: ZIP-CD FIPS State Code 2 256 257 VARCHAR2 Description: FIPS State Code SAS Name: FIPS_STATE_CD COBOL Name: FIPS-STATE-CD FIPS County Code 3 258 260 VARCHAR2 Description: FIPS County Code SAS Name: FIPS_CNTY_CD COBOL Name: FIPS-CNTY-CD CBSA Urban Rural Indicator 1 261 261 VARCHAR2 Description: CBSA (Core Based Statistical Area) indicates whether the county is defined as Urban or Rural. SAS Name: CBSA_URBN_RRL_IND COBOL Name: CBSA-URBN-RRL-IND AABB Accredited Code 1 262 262 VARCHAR2 Description: Indicates if the lab reported that it is accredited by the American Association of Blood Banks. This information is from the lab's CMS-116. SAS Name: AABB_ACRDTD_CD * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 21 CLIA Laboratory, CATEGORY = "22" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE COBOL Name: AABB-ACRDTD-CD VALUES: X=ACCREDITED AABB Accredited Y Match Date 8 263 270 DATE Description: Date the American Association of Blood Banks confirmed the lab is accredited. When the lab is accredited by multiple accrediting organizations, the earliest Y match date initiates billing of the certificate of accreditation fees. SAS Name: AABB_ACRDTD_Y_MATCH_DT COBOL Name: AABB-ACRDTD-Y-MATCH-DT AABB Accredited Y Match Indicator 1 271 271 VARCHAR2 Description: Indicates if the lab is confirmed as accredited by the American Association of Blood Banks. SAS Name: AABB_ACRDTD_Y_MATCH_SW COBOL Name: AABB-ACRDTD-Y-MATCH-SW Affiliated Provider Number 1 10 272 281 CHAR Description: Affiliated provider number 1 SAS Name: AFFLTD_PRVDR_NUM_1 COBOL Name: AFFLTD-PRVDR-NUM-1 Affiliated Provider Number 2 10 282 291 CHAR Description: Affiliated provider number 2 SAS Name: AFFLTD_PRVDR_NUM_2 COBOL Name: AFFLTD-PRVDR-NUM-2 Affiliated Provider Number 3 10 292 301 CHAR Description: Affiliated provider number 3 SAS Name: AFFLTD_PRVDR_NUM_3 COBOL Name: AFFLTD-PRVDR-NUM-3 Affiliated Provider Number 4 10 302 311 CHAR Description: Affiliated provider number 4 SAS Name: AFFLTD_PRVDR_NUM_4 COBOL Name: AFFLTD-PRVDR-NUM-4 Affiliated Provider Number 5 10 312 321 CHAR Description: Affiliated provider number 5 SAS Name: AFFLTD_PRVDR_NUM_5 COBOL Name: AFFLTD-PRVDR-NUM-5 Affiliated Provider Number 6 10 322 331 CHAR Description: Affiliated provider number 6 SAS Name: AFFLTD_PRVDR_NUM_6 COBOL Name: AFFLTD-PRVDR-NUM-6 Affiliated Provider Number 7 10 332 341 CHAR Description: Affiliated provider number 7 SAS Name: AFFLTD_PRVDR_NUM_7 COBOL Name: AFFLTD-PRVDR-NUM-7 Affiliated Provider Number 8 10 342 351 CHAR Description: Affiliated provider number 8 SAS Name: AFFLTD_PRVDR_NUM_8 COBOL Name: AFFLTD-PRVDR-NUM-8 AOA Accredited Code 1 352 352 VARCHAR2 Description: Indicates if the lab reported that it is accredited by the American Osteopathic Association. This information is from the lab's CMS-116. SAS Name: AOA_ACRDTD_CD COBOL Name: AOA-ACRDTD-CD * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 22 CLIA Laboratory, CATEGORY = "22" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE VALUES: X=ACCREDITED AOA Accredited Y Match Date 8 353 360 DATE Description: Date the American Osteopathic Association confirmed the lab is accredited. When the lab is accredited by multiple accrediting organizations, the earliest Y match date initiates billing of the certificate of accreditation fees. SAS Name: AOA_ACRDTD_Y_MATCH_DT COBOL Name: AOA-ACRDTD-Y-MATCH-DT AOA Accredited Y Match Indicator 1 361 361 VARCHAR2 Description: Indicates if the lab is confirmed as accredited by the American Osteopathic Association. SAS Name: AOA_ACRDTD_Y_MATCH_SW COBOL Name: AOA-ACRDTD-Y-MATCH-SW Application Received SA Date 8 362 369 DATE Description: Date the CMS-116 application was received by the state agency. SAS Name: APLCTN_RCVD_DT COBOL Name: APLCTN-RCVD-DT Application Type Code 1 370 370 VARCHAR2 Description: The type of CLIA certificate applied for by a laboratory. SAS Name: APLCTN_TYPE_CD COBOL Name: APLCTN-TYPE-CD VALUES: 1=COMPLIANCE 2=WAIVER 3=ACCREDITATION 4=PPM ASHI Accredited Code 1 371 371 VARCHAR2 Description: Indicates if the lab reported that it is accredited by the American Society for Histocompatibility and Immunogenetics. This information is from the lab's CMS-116. SAS Name: ASHI_ACRDTD_CD COBOL Name: ASHI-ACRDTD-CD VALUES: X=ACCREDITED ASHI Accredited Y Match Date 8 372 379 DATE Description: Date the American Society for Histocompatibility and Immunogenetics confirmed the lab is accredited. When the lab is accredited by multiple accrediting organizations, the earliest Y match date initiates billing of the certificate of accreditation fees. SAS Name: ASHI_ACRDTD_Y_MATCH_DT COBOL Name: ASHI-ACRDTD-Y-MATCH-DT ASHI Accredited Y Match Indicator 1 380 380 VARCHAR2 Description: Indicates if the lab is confirmed as accredited by the American Society for Histocompatibility and Immunogenetics. SAS Name: ASHI_ACRDTD_Y_MATCH_SW COBOL Name: ASHI-ACRDTD-Y-MATCH-SW CAP Accredited Code 1 381 381 VARCHAR2 Description: Indicates if the lab reported that it is accredited by the College of American Pathologists. This information is from the lab's CMS-116. SAS Name: CAP_ACRDTD_CD COBOL Name: CAP-ACRDTD-CD VALUES: X=ACCREDITED * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 23 CLIA Laboratory, CATEGORY = "22" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE CAP Accredited Y Match Date 8 382 389 DATE Description: Date the College of American Pathologists confirmed the lab is accredited. When the lab is accredited by multiple accrediting organizations, the earliest Y match date initiates billing of the certificate of accreditation fees. SAS Name: CAP_ACRDTD_Y_MATCH_DT COBOL Name: CAP-ACRDTD-Y-MATCH-DT CAP Accredited Y Match Indicator 1 390 390 VARCHAR2 Description: Indicates if the lab is confirmed as accredited by the College of American Pathologists. SAS Name: CAP_ACRDTD_Y_MATCH_SW COBOL Name: CAP-ACRDTD-Y-MATCH-SW CLIA Certificate Effective Date 8 391 398 DATE Description: Date the current laboratory certificate is effective, determined by the approval date of the certificate application unless overridden. SAS Name: CRTFCT_EFCTV_DT COBOL Name: CRTFCT-EFCTV-DT CLIA Certificate Mailed Date 8 399 406 DATE Description: The date the certificate was mailed. SAS Name: CRTFCT_MAIL_DT COBOL Name: CRTFCT-MAIL-DT CLIA Certificate Type Code 1 407 407 VARCHAR2 Description: A code that identifies the type of laboratory certificate currently in effect. SAS Name: CRTFCT_TYPE_CD COBOL Name: CRTFCT-TYPE-CD VALUES: 1=COMPLIANCE/COMP 2=WAIVER/WAIVER 3=ACCREDITATION/ACCRED 4=PPM/PPM 9=REGISTRATION/REG Current CLIA Lab Clsfctn CD 2 408 409 CHAR Description: Current Lab Classification SAS Name: CLIA_LAB_CLASS_CD COBOL Name: CLIA-LAB-CLASS-CD VALUES: 00=CLIA LABORATORY 05=CLIA EXEMPT LABORATORY 10=CLIA VA LABORATORY CLIA Lab Classification CD 1 2 410 411 CHAR Description: Laboratory Classification 1 SAS Name: CLIA_LAB_CLASS_CD_1 COBOL Name: CLIA-LAB-CLASS-CD-1 VALUES: 00=CLIA LABORATORY 05=CLIA EXEMPT LABORATORY 10=CLIA VA LABORATORY CLIA Lab Classification CD 10 2 412 413 CHAR Description: Laboratory Classification 10 SAS Name: CLIA_LAB_CLASS_CD_10 COBOL Name: CLIA-LAB-CLASS-CD-10 VALUES: 00=CLIA LABORATORY 05=CLIA EXEMPT LABORATORY 10=CLIA VA LABORATORY CLIA Lab Classification CD 2 2 414 415 CHAR * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 24 CLIA Laboratory, CATEGORY = "22" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Description: Laboratory Classification 2 SAS Name: CLIA_LAB_CLASS_CD_2 COBOL Name: CLIA-LAB-CLASS-CD-2 VALUES: 00=CLIA LABORATORY 05=CLIA EXEMPT LABORATORY 10=CLIA VA LABORATORY CLIA Lab Classification CD 3 2 416 417 CHAR Description: Laboratory Classification 3 SAS Name: CLIA_LAB_CLASS_CD_3 COBOL Name: CLIA-LAB-CLASS-CD-3 VALUES: 00=CLIA LABORATORY 05=CLIA EXEMPT LABORATORY 10=CLIA VA LABORATORY CLIA Lab Classification CD 4 2 418 419 CHAR Description: Laboratory Classification 4 SAS Name: CLIA_LAB_CLASS_CD_4 COBOL Name: CLIA-LAB-CLASS-CD-4 VALUES: 00=CLIA LABORATORY 05=CLIA EXEMPT LABORATORY 10=CLIA VA LABORATORY CLIA Lab Classification CD 5 2 420 421 CHAR Description: Laboratory Classification 5 SAS Name: CLIA_LAB_CLASS_CD_5 COBOL Name: CLIA-LAB-CLASS-CD-5 VALUES: 00=CLIA LABORATORY 05=CLIA EXEMPT LABORATORY 10=CLIA VA LABORATORY CLIA Lab Classification CD 6 2 422 423 CHAR Description: Laboratory Classification 6 SAS Name: CLIA_LAB_CLASS_CD_6 COBOL Name: CLIA-LAB-CLASS-CD-6 VALUES: 00=CLIA LABORATORY 05=CLIA EXEMPT LABORATORY 10=CLIA VA LABORATORY CLIA Lab Classification CD 7 2 424 425 CHAR Description: Laboratory Classification 7 SAS Name: CLIA_LAB_CLASS_CD_7 COBOL Name: CLIA-LAB-CLASS-CD-7 VALUES: 00=CLIA LABORATORY 05=CLIA EXEMPT LABORATORY 10=CLIA VA LABORATORY CLIA Lab Classification CD 8 2 426 427 CHAR Description: Laboratory Classification 8 SAS Name: CLIA_LAB_CLASS_CD_8 COBOL Name: CLIA-LAB-CLASS-CD-8 VALUES: 00=CLIA LABORATORY 05=CLIA EXEMPT LABORATORY 10=CLIA VA LABORATORY CLIA Lab Classification CD 9 2 428 429 CHAR Description: Laboratory Classification 9 SAS Name: CLIA_LAB_CLASS_CD_9 COBOL Name: CLIA-LAB-CLASS-CD-9 VALUES: 00=CLIA LABORATORY 05=CLIA EXEMPT LABORATORY 10=CLIA VA LABORATORY CLIA Medicare Number 12 430 441 VARCHAR2 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 25 CLIA Laboratory, CATEGORY = "22" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Description: CLIA Medicare Number SAS Name: CLIA_MDCR_NUM COBOL Name: CLIA-MDCR-NUM CLIA Termination Code 2 442 443 VARCHAR2 Description: The reason a facility has been terminated from the Medicare and/or Medicaid programs. SAS Name: CLIA_TRMNTN_CD COBOL Name: CLIA-TRMNTN-CD VALUES: 00=ACTIVE PROVIDER 01=VOLUNTARY-MERGER, CLOSURE 02=VOLUNTARY-DISSATISFACTION WITH REIMBURSEMENT 03=VOLUNTARY-RISK OF INVOLUNTARY TERMINATION 04=VOLUNTARY-OTHER REASON FOR WITHDRAWAL 05=INVOLUNTARY-FAILURE TO MEET HEALTH/SAFETY REQ 06=INVOLUNTARY-FAILURE TO MEET AGREEMENT 07=OTHER-PROVIDER STATUS CHANGE 08=NONPAYMENT OF FEES 09=REV/UNSUCCESSFUL PARTICIPATION IN PT 10=REV/OTHER REASON 11=INCOMPLETE CLIA APPLICATION INFORMATION 12=NO LONGER PERFORMING TESTS 13=MULTIPLE TO SINGLE SITE CERTIFICATE 14=SHARED LABORATORY 15=FAILURE TO RENEW WAIVER PPM CERTIFICATE 16=DUPLICATE CLIA NUMBER 17=MAIL RETURNED NO FORWARD ADDRESS CERT ENDED 20=NOTIFICATION BANKRUPTCY 33=ACCREDITATION NOT CONFIRMED 80=AWAITING STATE APPROVAL 99=OIG ACTION - DO NOT ACTIVATE CMS-116 Accreditation Schedule Code 1 444 444 VARCHAR2 Description: Indicates the lab's accreditation schedule code calculated by the CLIA system, based on the information in the most recent CMS-116 application form. Applies only to labs with a certificate of accredition. SAS Name: ACRDTN_SCHDL_CD COBOL Name: ACRDTN-SCHDL-CD VALUES: A=SPEC COUNT < 4 (2,001 TO 10,000 TOT. VOL.) B=SPEC COUNT > 3 (2,001 T0 10,000 TOT. VOL.) C=SPEC COUNT < 4 (10,001 TO 25,000 TOT. VOL.) D=SPEC COUNT > 3 (10,001 TO 25,000 TOT. VOL.) E=SPEC COUNT > 0 (25,001 TO 50,000 TOT. VOL.) F=SPEC COUNT > 0 (50,001 TO 75,000 TOT. VOL.) G=SPEC COUNT > 0 (75,001 TO 100,000 TOT. VOL.) H=SPEC COUNT > 0 (100,001 TO 500,000 TOT. VOL.) I=SPEC COUNT > 0 (500,001 TO 1,000,000 TOT VOL) J=SPEC COUNT > 0 (1,000,001 OR MORE TOT. VOL.) V=TOTAL VOLUME: 1 TO 2,000 CMS-116 Accredited Annual Test Volume 13 445 457 NUMBER Description: Annual test volume of the lab for all specialties as reported on the most recent CMS-116 application form. Applies only to labs with a certificate of accredition. SAS Name: FORM_116_ACRDTD_TEST_VOL_CNT COBOL Name: FORM-116-ACRDTD-TEST-VOL-CNT CMS-116 Annual Test Volume 13 458 470 NUMBER Description: Annual test volume of the lab for all specialties as reported on the most recent CMS-116 application form. Applies only to labs with a certificate of compliance or accreditation. SAS Name: FORM_116_TEST_VOL_CNT * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 26 CLIA Laboratory, CATEGORY = "22" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE COBOL Name: FORM-116-TEST-VOL-CNT COLA Accredited Code 1 471 471 VARCHAR2 Description: Indicates if the lab reported that it is accredited by the Commission on Office Laboratory Accreditation. This information is from the lab's CMS-116. SAS Name: COLA_ACRDTD_CD COBOL Name: COLA-ACRDTD-CD VALUES: X=ACCREDITED COLA Accredited Y Match Date 8 472 479 DATE Description: Date the Commission on Office Laboratory Accreditation confirmed the lab is accredited. When the lab is accredited by multiple accrediting organizations, the earliest Y match date initiates billing of the certificate of accreditation fees. SAS Name: COLA_ACRDTD_Y_MATCH_DT COBOL Name: COLA-ACRDTD-Y-MATCH-DT COLA Accredited Y Match Indicator 1 480 480 VARCHAR2 Description: Indicates if the lab is confirmed as accredited by the Commission on Office Laboratory Accreditation. SAS Name: COLA_ACRDTD_Y_MATCH_SW COBOL Name: COLA-ACRDTD-Y-MATCH-SW Directly Affiliated Lab Count 1 481 481 NUMBER Description: Number of laboratories directly affiliated SAS Name: DRCTLY_AFLTD_LAB_CNT COBOL Name: DRCTLY-AFLTD-LAB-CNT Fax Phone Number 10 482 491 VARCHAR2 Description: 10-digit fax phone number of the primary contact or the operator of the provider. SAS Name: FAX_PHNE_NUM COBOL Name: FAX-PHNE-NUM Fiscal Year End Date (MMDD) 4 492 495 VARCHAR2 Description: End date, consisting of the month and day, of the provider's fiscal year. SAS Name: FY_END_MO_DAY_CD COBOL Name: FY-END-MO-DAY-CD JC Accredited Code 1 496 496 VARCHAR2 Description: Indicates if the lab reported that it is accredited by the Joint Commission. This information is from the lab's CMS-116. SAS Name: JCAHO_ACRDTD_CD COBOL Name: JCAHO-ACRDTD-CD VALUES: X=ACCREDITED JC Accredited Y Match Date 8 497 504 DATE Description: Date the Joint Commission confirmed the lab is accredited. When the lab is accredited by multiple accrediting organizations, the earliest Y match date initiates billing of the certificate of accreditation fees. SAS Name: JCAHO_ACRDTD_Y_MATCH_DT COBOL Name: JCAHO-ACRDTD-Y-MATCH-DT JC Accredited Y Match Indicator 1 505 505 VARCHAR2 Description: Indicates if the lab is confirmed as accredited by the Joint Commission. SAS Name: JCAHO_ACRDTD_Y_MATCH_SW COBOL Name: JCAHO-ACRDTD-Y-MATCH-SW * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 27 CLIA Laboratory, CATEGORY = "22" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Lab Site Count 4 506 509 NUMBER Description: Total number of lab sites for which a lab has applied for a single certificate. SAS Name: LAB_SITE_CNT COBOL Name: LAB-SITE-CNT Gnrl Fac Type Cd 2 510 511 CHAR Description: General Fac Type Cd SAS Name: GNRL_FAC_TYPE_CD COBOL Name: GNRL-FAC-TYPE-CD Multiple Site Certificate Indicator 1 512 512 VARCHAR2 Description: Indicates if a lab has applied for one certificate for multiple sites. SAS Name: MLT_SITE_EXCPTN_SW COBOL Name: MLT-SITE-EXCPTN-SW Multiple Site Exception: Public Health Indicator 1 513 513 VARCHAR2 Description: Indicates if the certificate is for multiple sites with non-profit, federal, state or local government status and engaged in limited public health testing. SAS Name: NON_PRFT_EXCPTN_SW COBOL Name: NON-PRFT-EXCPTN-SW PPM Test Volume Count 13 514 526 NUMBER Description: Volume of Provider Performed Microscopy tests performed by the lab. SAS Name: PPMP_TEST_VOL_CNT COBOL Name: PPMP-TEST-VOL-CNT Previously Regulated Indicator 1 527 527 VARCHAR2 Description: Indicates if the laboratory was licensed under CLIA 67 or participated in the Medicare/Medicaid programs. SAS Name: CLIA_67_LCNSD_SW COBOL Name: CLIA-67-LCNSD-SW Related Provider Number 10 528 537 CHAR Description: Related provider number SAS Name: RLTD_PRVDR_NUM COBOL Name: RLTD-PRVDR-NUM Shared Lab Indicator 1 538 538 VARCHAR2 Description: Indicates if the lab is a shared lab. Only the lab type of Physician Office may answer yes to the shared lab field. A shared lab is when two or more sole practicing physicians collectively pool resources to fund a lab's operation. A shared lab may also include two or more physician group practices that share the expenses for the lab's operation. SAS Name: SHR_LAB_SW COBOL Name: SHR-LAB-SW Shared Lab Xref Number 10 539 548 CHAR Description: Shared lab xref number SAS Name: SHRD_LAB_XRFRNC_NUM COBOL Name: SHRD-LAB-XRFRNC-NUM Survey Certificate Schedule Code 1 549 549 VARCHAR2 Description: 1557 Certificate Schedule Code. This code is system-generated and is based on the test volume and specialties entered into ODIE following the survey. CLIA fees are based on the schedule codes. SAS Name: FORM_1557_CRTFCT_SCHDL_CD * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 28 CLIA Laboratory, CATEGORY = "22" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE COBOL Name: FORM-1557-CRTFCT-SCHDL-CD VALUES: A=SPEC COUNT < 4 (2,001 TO 10,000 TOT. VOL.) B=SPEC COUNT > 3 (2,001 T0 10,000 TOT. VOL.) C=SPEC COUNT < 4 (10,001 TO 25,000 TOT. VOL.) D=SPEC COUNT > 3 (10,001 TO 25,000 TOT. VOL.) E=SPEC COUNT > 0 (25,001 TO 50,000 TOT. VOL.) F=SPEC COUNT > 0 (50,001 TO 75,000 TOT. VOL.) G=SPEC COUNT > 0 (75,001 TO 100,000 TOT. VOL.) H=SPEC COUNT > 0 (100,001 TO 500,000 TOT. VOL.) I=SPEC COUNT > 0 (500,001 TO 1,000,000 TOT VOL) J=SPEC COUNT > 0 (1,000,001 OR MORE TOT. VOL.) V=TOTAL VOLUME: 1 TO 2,000 Survey Compliance Schedule Code 1 550 550 VARCHAR2 Description: 1557 Compliance Schedule Code. This code is system-generated and is based on the number of tests and specialties entered into ODIE following the survey. CLIA fees are based on the schedule codes. SAS Name: FORM_1557_CMPLNC_SCHDL_CD COBOL Name: FORM-1557-CMPLNC-SCHDL-CD VALUES: A=SPEC COUNT < 4 (2,001 TO 10,000 TOT. VOL.) B=SPEC COUNT > 3 (2,001 T0 10,000 TOT. VOL.) C=SPEC COUNT < 4 (10,001 TO 25,000 TOT. VOL.) D=SPEC COUNT > 3 (10,001 TO 25,000 TOT. VOL.) E=SPEC COUNT > 0 (25,001 TO 50,000 TOT. VOL.) F=SPEC COUNT > 0 (50,001 TO 75,000 TOT. VOL.) G=SPEC COUNT > 0 (75,001 TO 100,000 TOT. VOL.) H=SPEC COUNT > 0 (100,001 TO 500,000 TOT. VOL.) I=SPEC COUNT > 0 (500,001 TO 1,000,000 TOT VOL) J=SPEC COUNT > 0 (1,000,001 OR MORE TOT. VOL.) V=TOTAL VOLUME: 1 TO 2,000 Survey Test Volume Count 13 551 563 NUMBER Description: Number of tests performed annually in a laboratory. This information is collected at the time of the state survey agency inspection. SAS Name: FORM_1557_TEST_VOL_CNT COBOL Name: FORM-1557-TEST-VOL-CNT Validation Survey Date 8 564 571 DATE Description: Date of the most recent validation survey of a deemed provider, performed by the state agency. SAS Name: VLDTN_SRVY_DT COBOL Name: VLDTN-SRVY-DT Waived Test Volume Count 13 572 584 NUMBER Description: Volume of waived tests performed by the lab. SAS Name: WVD_TEST_VOL_CNT COBOL Name: WVD-TEST-VOL-CNT