********************************************* * * * 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 = 01/01/2013 * * * ********************************************* DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 CLIA Laboratory, CATEGORY = "22" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Provider Category Subtype Code 2 1 2 VARCHAR2 Description: This field is used mainly by batch report programs to determine the breakdown of the provider category. This field is mainly used for SNFs and hospitals. SAS Name: PRVDR_CTGRY_SBTYP_CD COBOL Name: PRVDR-CTGRY-SBTYP-CD VALUES: 01=CLIA88 Laboratory Provider Category Code 2 3 4 VARCHAR2 Description: This code identifies the category which is most descriptive of the facility identified on the Medicare/Medicaid Certification and Transmittal Form (CMS 1539). SAS Name: PRVDR_CTGRY_CD COBOL Name: PRVDR-CTGRY-CD VALUES: 22=CLIA Laboratory Change of Ownership Count 2 5 6 NUMBER Description: The number of times a change of ownership (CHOW) has taken place for a particular provider. SAS Name: CHOW_CNT COBOL Name: CHOW-CNT Change of Ownership Date 8 7 14 DATE Description: Effective date of a change of ownership. SAS Name: CHOW_DT * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 2 CLIA Laboratory, CATEGORY = "22" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE COBOL Name: CHOW-DT City 28 15 42 VARCHAR2 Description: City in which the provider is physically located. SAS Name: CITY_NAME COBOL Name: CITY-NAME Compliance: Plan of Correction 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: Indicates if a provider is in compliance with program requirements. SAS Name: CMPLNC_STUS_CD COBOL Name: CMPLNC-STUS-CD VALUES: A=IN COMPLIANCE B=NOT IN COMPLIANCE SSA County Code 3 45 47 VARCHAR2 Description: SSA (State Survey Agency) geographic code indicating the county where the facility 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: 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 Switch 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: The name of a provider certified to participate in the Medicare and/or Medicaid programs. SAS Name: FAC_NAME COBOL Name: FAC-NAME Intermediary Carrier Code 5 117 121 VARCHAR2 Description: A number assigned to an intermediary or carrier servicing a provider or supplier. Not all numbers apply to all provider types. 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 3 CLIA Laboratory, CATEGORY = "22" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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) 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) 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 00460=BLUE CROSS (WYOMING) 00468=BLUE CROSS (NORTH CAROLINA FOR PR) 00510=BLUE SHIELD (ALABAMA) 00511=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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 4 CLIA Laboratory, CATEGORY = "22" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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) 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 00889=NORIDIAN GVT SERVICES (SD) 00900=BLUE SHIELD (TEXAS) 00901=TRAILBLAZERS HEALTH ENTERPRISES 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) 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 5 CLIA Laboratory, CATEGORY = "22" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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) 04101=TRAILBLAZER (COLORADO) 04102=TRAILBLAZER (COLORADO) 04201=TRAILBLAZER (NEW MEXICO) 04202=TRAILBLAZER (NEW MEXICO) 04301=TRAILBLAZER (OKLAHOMA) 04302=TRAILBLAZER (OKLAHOMA) 04401=TRAILBLAZER (TEXAS) 04402=TRAILBLAZER (TEXAS) 04901=MUTUAL LEGACY 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) 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 6 CLIA Laboratory, CATEGORY = "22" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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) 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 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) Medicare or Medicaid Vendor Number 15 122 136 VARCHAR2 Description: A number which may be assigned to a facility by the state Medicaid agency for external control or billing purposes. SAS Name: MDCD_VNDR_NUM COBOL Name: MDCD-VNDR-NUM Participation Date 8 137 144 DATE Description: The date a facility is first approved to provide Medicare * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 7 CLIA Laboratory, CATEGORY = "22" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE and/or Medicaid services. SAS Name: ORGNL_PRTCPTN_DT COBOL Name: ORGNL-PRTCPTN-DT Prior Change of Ownership Date 8 145 152 DATE Description: The date of a prior change of ownership. SAS Name: CHOW_PRIOR_DT COBOL Name: CHOW-PRIOR-DT Intermediary Carrier Prior Code 5 153 157 VARCHAR2 Description: The previous intermediary carrier number. 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) 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) 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 8 CLIA Laboratory, CATEGORY = "22" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 00450=NATIONAL GOVERNMENT SERVICES 00452=NATIONAL GOVERNMENT SERVICES 00453=NATIONAL GOVERNMENT SERVICES 00454=NATIONAL GOVERNMENT SERVICES 00460=BLUE CROSS (WYOMING) 00468=BLUE CROSS (NORTH CAROLINA FOR PR) 00510=BLUE SHIELD (ALABAMA) 00511=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) 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 00889=NORIDIAN GVT SERVICES (SD) 00900=BLUE SHIELD (TEXAS) 00901=TRAILBLAZERS HEALTH ENTERPRISES 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 9 CLIA Laboratory, CATEGORY = "22" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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) 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) 04101=TRAILBLAZER (COLORADO) 04102=TRAILBLAZER (COLORADO) 04201=TRAILBLAZER (NEW MEXICO) 04202=TRAILBLAZER (NEW MEXICO) 04301=TRAILBLAZER (OKLAHOMA) 04302=TRAILBLAZER (OKLAHOMA) 04401=TRAILBLAZER (TEXAS) 04402=TRAILBLAZER (TEXAS) 04901=MUTUAL LEGACY 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) 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 10 CLIA Laboratory, CATEGORY = "22" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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) 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) 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 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 11 CLIA Laboratory, CATEGORY = "22" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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) Provider Number 10 158 167 VARCHAR2 Description: A six or ten position identification number that is assigned to a certified provider. SAS Name: PRVDR_NUM COBOL Name: PRVDR-NUM Record Status Code 1 168 168 VARCHAR2 Description: This indicator specifies the current status of the record. SAS Name: REC_STUS_CD COBOL Name: REC-STUS-CD VALUES: A=ACCEPTED RECORD C=COMPLAINT RECORD Region Code 2 169 170 VARCHAR2 Description: The regional location of the provider. SAS Name: RGN_CD COBOL Name: RGN-CD VALUES: 01=BOSTON 02=NEW YORK 03=PHILADELPHIA 04=ATLANTA 05=CHICAGO 06=DALLAS 07=KANSAS CITY 08=DENVER 09=SAN FRANCISCO 10=SEATTLE Skeleton Record Switch 1 171 171 VARCHAR2 Description: Indicates the record is a skeleton record. Only a limited set of the provider data is available for this provider. SAS Name: SKLTN_REC_SW COBOL Name: SKLTN-REC-SW State Abbreviation 2 172 173 VARCHAR2 Description: The 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=FOREIGN * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 12 CLIA Laboratory, CATEGORY = "22" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 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 2 174 175 VARCHAR2 Description: SSA (Social Security Administration) geographic code indicating the state of the provider's residence. Must agree with the first two positions of the Provider number (except California: 05 and 55; Texas: 45 and 67; FL: 10 and 68; MD: 21 and 80). 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 13 CLIA Laboratory, CATEGORY = "22" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 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=FOREIGN State Region Code 3 176 178 VARCHAR2 Description: For selected states, identifies the particular region within the state where the provider is located. SAS Name: STATE_RGN_CD COBOL Name: STATE-RGN-CD VALUES: AK/001=ALASKA * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 14 CLIA Laboratory, CATEGORY = "22" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 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=FOREIGN FN/LAB=LABORATORIES GA/001=GEORGIA GA/GAA=GEORGIA ALL GA/GAC=GEORGIA CENTRAL GA/GAE=GEORGIA EASTERN * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 15 CLIA Laboratory, CATEGORY = "22" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 16 CLIA Laboratory, CATEGORY = "22" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 17 CLIA Laboratory, CATEGORY = "22" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 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 Street Address 50 179 228 VARCHAR2 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 18 CLIA Laboratory, CATEGORY = "22" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Description: Street address of a provider that is certified to provide Medicare and/or Medicaid services. SAS Name: ST_ADR COBOL Name: ST-ADR Telephone Number 10 229 238 VARCHAR2 Description: The 10-digit telephone number of the primary contact or the operator of a provider. SAS Name: PHNE_NUM COBOL Name: PHNE-NUM Termination Code 1 2 239 240 VARCHAR2 Description: Termination code number one: the reason a facility has been terminated from the CLIA, Medicare and/or Medicaid programs. 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=INCMPLETE 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 33=ACCREDITATION NOT CONFIRMED - CLIA Only 80=AWAITING STATE APPROVAL 99=OIG ACTION - DO NOT ACTIVATE - CLIA Only Termination Date / Expiration Date 1 8 241 248 DATE Description: The date the laboratory's certificate terminated or the expiration date of the current CLIA certificate. For other non-CLIA providers, it is the date the facility was terminated. SAS Name: TRMNTN_EXPRTN_DT COBOL Name: TRMNTN-EXPRTN-DT Type of Action 1 249 249 VARCHAR2 Description: Type of action on the 'official' survey record. This field is copied from type of action on the HCFA-1539, certification and transmittal. SAS Name: SRVY_PRPSE_CD COBOL Name: SRVY-PRPSE-CD VALUES: 1=INITIAL 2=RECERTIFICATION 3=TERMINATION 4=CHANGE OF OWNERSHIP 5=VALIDATION 6=ONSITE SURVEY DUE TO FLEXIBLE SURVEY - CLIA Only 8=FULL SURVEY AFTER COMPLAINT - CLIA ONLY General Type of Control Code 2 250 251 VARCHAR2 Description: Indicates the nature of the organization that operates a * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 19 CLIA Laboratory, CATEGORY = "22" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE provider of services. 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 ZIP Code 5 252 256 VARCHAR2 Description: The five-digit postal code for the provider. SAS Name: ZIP_CD COBOL Name: ZIP-CD FIPS State Code 2 257 258 VARCHAR2 Description: FIPS State Code SAS Name: FIPS_STATE_CD COBOL Name: FIPS-STATE-CD FIPS County Code 3 259 261 VARCHAR2 Description: FIPS County Code SAS Name: FIPS_CNTY_CD COBOL Name: FIPS-CNTY-CD CBSA Urban Rural Indicator 1 262 262 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 Affiliated Provider Number 1 10 263 272 CHAR Description: Affiliated provider number 1 SAS Name: AFFLTD_PRVDR_NUM_1 COBOL Name: AFFLTD-PRVDR-NUM-1 Affiliated Provider Number 2 10 273 282 CHAR Description: Affiliated provider number 2 SAS Name: AFFLTD_PRVDR_NUM_2 COBOL Name: AFFLTD-PRVDR-NUM-2 Affiliated Provider Number 3 10 283 292 CHAR Description: Affiliated provider number 3 SAS Name: AFFLTD_PRVDR_NUM_3 COBOL Name: AFFLTD-PRVDR-NUM-3 Affiliated Provider Number 4 10 293 302 CHAR Description: Affiliated provider number 4 SAS Name: AFFLTD_PRVDR_NUM_4 COBOL Name: AFFLTD-PRVDR-NUM-4 Affiliated Provider Number 5 10 303 312 CHAR Description: Affiliated provider number 5 SAS Name: AFFLTD_PRVDR_NUM_5 COBOL Name: AFFLTD-PRVDR-NUM-5 Affiliated Provider Number 6 10 313 322 CHAR Description: Affiliated provider number 6 SAS Name: AFFLTD_PRVDR_NUM_6 COBOL Name: AFFLTD-PRVDR-NUM-6 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 20 CLIA Laboratory, CATEGORY = "22" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Affiliated Provider Number 7 10 323 332 CHAR Description: Affiliated provider number 7 SAS Name: AFFLTD_PRVDR_NUM_7 COBOL Name: AFFLTD-PRVDR-NUM-7 Affiliated Provider Number 8 10 333 342 CHAR Description: Affiliated provider number 8 SAS Name: AFFLTD_PRVDR_NUM_8 COBOL Name: AFFLTD-PRVDR-NUM-8 Accreditation Schedule Code 1 343 343 VARCHAR2 Description: Accreditation schedule code. This schedule is calculated using the CLIA application data. 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 Accredited by AABB 1 344 344 VARCHAR2 Description: Indicates if the lab is accredited by the American Association of Blood Banks (AABB). This information is from the lab's CMS-116. SAS Name: AABB_ACRDTD_CD COBOL Name: AABB-ACRDTD-CD VALUES: X=ACCREDITED Accredited by AOA 1 345 345 VARCHAR2 Description: Indicates if the lab is accredited by the American Osteopathic Association (AOA). This information is from the laboratory's form HCFA-116. SAS Name: AOA_ACRDTD_CD COBOL Name: AOA-ACRDTD-CD VALUES: X=ACCREDITED Accredited by ASHI 1 346 346 VARCHAR2 Description: Indicates if the lab is accredited by the American Society for Histocompatibility and Immunogenetics (ASHI). This information is from the laboratory's form HCFA-116. SAS Name: ASHI_ACRDTD_CD COBOL Name: ASHI-ACRDTD-CD VALUES: X=ACCREDITED Accredited by CAP 1 347 347 VARCHAR2 Description: Indicates if the laboratory is accredited by the College of American Pathologists (CAP). This information is from the laboratory's form HCFA-116. SAS Name: CAP_ACRDTD_CD COBOL Name: CAP-ACRDTD-CD VALUES: X=ACCREDITED Accredited by COLA 1 348 348 VARCHAR2 Description: Indicates if the lab is accredited by the Commission on Office Laboratory Accreditation (COLA). This information is from the laboratory's form HCFA-116. * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 21 CLIA Laboratory, CATEGORY = "22" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS Name: COLA_ACRDTD_CD COBOL Name: COLA-ACRDTD-CD VALUES: X=ACCREDITED Accredited by JCAHO 1 349 349 VARCHAR2 Description: Indicates if the lab is accredited by the Joint Commission on Accreditation of Health Care Organizations (JCAHO). This information is from the laboratory's form HCFA-116. SAS Name: JCAHO_ACRDTD_CD COBOL Name: JCAHO-ACRDTD-CD VALUES: X=ACCREDITED Accredited Y Match Date AABB 8 350 357 DATE Description: The date the American Association of Blood Banks notifies CMS that lab is accredited with AABB. The earliest Y match date initiates the billing of the certificate of accreditation fees. SAS Name: AABB_ACRDTD_Y_MATCH_DT COBOL Name: AABB-ACRDTD-Y-MATCH-DT Accredited Y Match Date AOA 8 358 365 DATE Description: The date the lab was accredited by the American Osteopathic Association. This information is supplied by the accrediting organization. SAS Name: AOA_ACRDTD_Y_MATCH_DT COBOL Name: AOA-ACRDTD-Y-MATCH-DT Accredited Y Match Date ASHI 8 366 373 DATE Description: The date the lab was accredited by the American Society for Histocompatibility and Immunogenetics (ASHI). This information is supplied by the accrediting organization. SAS Name: ASHI_ACRDTD_Y_MATCH_DT COBOL Name: ASHI-ACRDTD-Y-MATCH-DT Accredited Y Match Date CAP 8 374 381 DATE Description: The date the College of American Pathologists (CAP) notifies CMS that lab is accredited by CAP. The earliest Y match date initiates the billing for the certificate of accreditation fees. SAS Name: CAP_ACRDTD_Y_MATCH_DT COBOL Name: CAP-ACRDTD-Y-MATCH-DT Accredited Y Match Date COLA 8 382 389 DATE Description: The date the Commission of Office Laboratory Accreditation (COLA) notifies CMS that lab is accredited with COLA. The earliest Y match date initiates the billing of the certificate of accreditation fees. SAS Name: COLA_ACRDTD_Y_MATCH_DT COBOL Name: COLA-ACRDTD-Y-MATCH-DT Accredited Y Match Date JCAHO 8 390 397 DATE Description: The date the Joint Commission on Accreditation of Health Care Organizations (JCAHO) notifies CMS that lab is accredited. The earliest Y match date initiates billing. SAS Name: JCAHO_ACRDTD_Y_MATCH_DT COBOL Name: JCAHO-ACRDTD-Y-MATCH-DT Accredited Y Match Switch AABB 1 398 398 VARCHAR2 Description: Indicates if the lab is accredited by the American Association of Blood Banks. This information is supplied by the accrediting organization. SAS Name: AABB_ACRDTD_Y_MATCH_SW COBOL Name: AABB-ACRDTD-Y-MATCH-SW * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 22 CLIA Laboratory, CATEGORY = "22" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Accredited Y Match Switch COLA 1 399 399 VARCHAR2 Description: Indicates if the lab is accredited by the Commission on Office Laboratory Accreditation (COLA). This information is supplied by the accrediting organization. SAS Name: COLA_ACRDTD_Y_MATCH_SW COBOL Name: COLA-ACRDTD-Y-MATCH-SW Accredited Y Match Switch JCAHO 1 400 400 VARCHAR2 Description: This date is generated when a laboratory record is updated with a change that directly affects the CLIA certificate data. When changed, the information is then made available to the Medicaid State Agencies. SAS Name: JCAHO_ACRDTD_Y_MATCH_SW COBOL Name: JCAHO-ACRDTD-Y-MATCH-SW Acredited Y Match Switch AOA 1 401 401 VARCHAR2 Description: Indicates if the lab is accredited by the American Osteopathic Association. This information is supplied by the accrediting organization. SAS Name: AOA_ACRDTD_Y_MATCH_SW COBOL Name: AOA-ACRDTD-Y-MATCH-SW Acredited Y Match Switch ASHI 1 402 402 VARCHAR2 Description: Indicates if the lab is accredited by the American Society for Histocompatibility and Immunogenetics (ASHI). This information is supplied by the accrediting organization. SAS Name: ASHI_ACRDTD_Y_MATCH_SW COBOL Name: ASHI-ACRDTD-Y-MATCH-SW Acredited Y Match Switch CAP 1 403 403 VARCHAR2 Description: Indicates if the lab is accredited by College of American Pathologists (CAP). This information is supplied by the accrediting organization. SAS Name: CAP_ACRDTD_Y_MATCH_SW COBOL Name: CAP-ACRDTD-Y-MATCH-SW Application Accredited Annual Test Volume 13 404 416 NUMBER Description: Accredited annual test volume. This field is calculated using the CLIA application data. SAS Name: FORM_116_ACRDTD_TEST_VOL_CNT COBOL Name: FORM-116-ACRDTD-TEST-VOL-CNT Application Received Date 8 417 424 DATE Description: The date the application was received. The date the application was added or the 109 data was updated with application data. SAS Name: APLCTN_RCVD_DT COBOL Name: APLCTN-RCVD-DT Application Total Annual Test Volume 13 425 437 NUMBER Description: Application total annual test volume. This field is calculated using CLIA application data. SAS Name: FORM_116_TEST_VOL_CNT COBOL Name: FORM-116-TEST-VOL-CNT Application Type Code 1 438 438 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 23 CLIA Laboratory, CATEGORY = "22" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 4=PPM CLIA Certificate Effective Date (1) 8 439 446 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 (1) 8 447 454 DATE Description: The date the certificate was mailed. SAS Name: CRTFCT_MAIL_DT COBOL Name: CRTFCT-MAIL-DT CLIA Certificate Type Code (1) 1 455 455 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 2 456 457 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 2 458 459 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 2 460 461 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 2 462 463 CHAR 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 2 464 465 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 24 CLIA Laboratory, CATEGORY = "22" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE CLIA Lab Classification CD 4 2 466 467 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 2 468 469 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 2 470 471 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 2 472 473 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 2 474 475 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 2 476 477 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 12 478 489 VARCHAR2 Description: CLIA Medicare number. SAS Name: CLIA_MDCR_NUM COBOL Name: CLIA-MDCR-NUM CLIA Termination Code 2 490 491 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 25 CLIA Laboratory, CATEGORY = "22" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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=INCMPLETE 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 Fax Phone Number 10 492 501 VARCHAR2 Description: The 10-digit fax phone number of the primary contact or the operator of the laboratory. SAS Name: FAX_PHNE_NUM COBOL Name: FAX-PHNE-NUM Fiscal Year Ending Date 4 502 505 VARCHAR2 Description: The ending date (month and day) of a facility's fiscal year. SAS Name: FY_END_MO_DAY_CD COBOL Name: FY-END-MO-DAY-CD Multiple Site Certificate Switch 1 506 506 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 Non-Profit Code 1 507 507 VARCHAR2 Description: Non-profit code indicator. SAS Name: NON_PRFT_EXCPTN_SW COBOL Name: NON-PRFT-EXCPTN-SW Number of Lab Sites 4 508 511 NUMBER Description: The 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 Number of Labs Directly Affiliated 1 512 512 NUMBER Description: Number of laboratories directly affiliated SAS Name: DRCTLY_AFLTD_LAB_CNT COBOL Name: DRCTLY-AFLTD-LAB-CNT PPMP Test Volume Count 13 513 525 NUMBER Description: The volume of tests performed by the PPMP (Provider Performed Microscopy Procedures) lab. SAS Name: PPMP_TEST_VOL_CNT COBOL Name: PPMP-TEST-VOL-CNT Previously Regulated Switch 1 526 526 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 26 CLIA Laboratory, CATEGORY = "22" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Related Provider Number 10 527 536 CHAR Description: Related provider number SAS Name: RLTD_PRVDR_NUM COBOL Name: RLTD-PRVDR-NUM Shared Lab Xref Number 10 537 546 CHAR Description: Shared lab xref number SAS Name: SHRD_LAB_XRFRNC_NUM COBOL Name: SHRD-LAB-XRFRNC-NUM Shared Lab Switch 1 547 547 VARCHAR2 Description: Shared lab indicator. SAS Name: SHR_LAB_SW COBOL Name: SHR-LAB-SW Survey Certificate Schedule Code 1 548 548 VARCHAR2 Description: 1557 Certificate Schedule Code. This code is system-generated and is based on the test volume and special ties entered into ODIE following the survey. CLIA fees are based on teh schedule codes. SAS Name: FORM_1557_CRTFCT_SCHDL_CD 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 1 549 549 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 Total 13 550 562 NUMBER Description: Survey test volume total. The 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 Total Waived Test Volume 13 563 575 NUMBER Description: Total waived test volumes. SAS Name: WVD_TEST_VOL_CNT COBOL Name: WVD-TEST-VOL-CNT * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 27 CLIA Laboratory, CATEGORY = "22" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Type of Facility 2 576 577 VARCHAR2 Description: Indicates the category which represents the type of facility. SAS Name: GNRL_FAC_TYPE_CD COBOL Name: GNRL-FAC-TYPE-CD VALUES: 01=AMBULANCE 02=AMBULATORY SURGERY CENTER 03=ANCILLARY TEST SITE 04=ASSISTED LIVING FACILITY 05=BLOOD BANKS 06=COMMUNITY CLINIC 07=COMPREHENSIVE OUTPATIENT REHAB 08=END STAGE RENAL DISEASE DIALYSIS 09=FEDERALLY QUALIFIED HEALTH CENTER 10=HEALTH FAIR 11=HEALTH MAINTENANCE ORGANIZATION 12=HOME HEALTH AGENCY 13=HOSPICE 14=HOSPITAL 15=INDEPENDENT 16=INDUSTRIAL 17=INSURANCE 18=ICF FOR MENTALLY RETARDED 19=MOBILE LAB 20=PHARMACY 21=PHYSICIAN OFFICE 22=OTHER PRACTITIONER 23=PRISON 24=PUBLIC HEALTH LABORATORY 25=RURAL HEALTH CLINIC 26=SCHOOL/STUDENT HEALTH SERVICE 27=SKILLED NURSING/NURSING FACILITY 28=TISSUE BANK/RESPOSITORIES 29=OTHER