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Office of Workers' Compensation Programs

Division of Federal Employees' Compensation (DFEC)

Bill Pay Data Dictionary

Name

START

END

FIELD TYPE

BILL HISTORY field NAME

DESCRIPTION

GROUP SUBDIVISIONS

DEFINITION OF LEGAL VALUES

Case Number

1

9

CHAR/9

BIL-HIS-CASE-NO

Unique Number Assigned To Each Case By The Responsible District Office

 

Payee Number

10

18

CHAR/9

BIL-HIS-PAYEE-NO

Unique Identifier Assigned To Each Provider (Ssn Or Tax Id)

 

Service From

19

26

DATE/8

BIL-HIS-SVC-FR

Beginning Date Of Service

YYYYMMDD

 

Service To Date

27

34

DATE/8

BIL-HIS-SVC-TO

Ending Date Of Service

YYYYMMDD

 

Record Type

35

35

CHAR/1

BIL-HIS-RECORD-TYPE

Type Of Record

 

B = Normal Bill Paid By System

C = Cancelled Check/Adj.

D = Cash Receipt

M = Manual Payment

Payee Data

36

44

CHAR/9

BIL-HIS-R-PAYEE-NO

Claimant’s Id Number

 

Payee Name

45

79

CHAR/35

 

Claimant’s Name

 

Filler

45

77

CHAR/33

 

 

Blank

Name Suffix

78

79

CHAR/2

BIL-HIS-PAYEE-DIR-NAME-SFX

 

This Data Is Available For Bills Paid Prior To 9/4/03

Payee Address

80

114

CHAR/35

BIL-HIS-PAYEE-ADD1

Payee’s Address

 

Payee Address

115

149

CHAR/35

BIL-HIS-PAYEE-ADD2

Payee’s Address

 

Payee Address

150

179

CHAR/35

BIL-HIS-PAYEE-ADD3

Payee’s Address

 

Payee’s City

180

199

CHAR/20

BIL-HIS-PAYEE-CITY

 

 

Payee’s State

200

201

CHAR/2

BIL-HIS-PAYEE-STATE

 

 

Payee’s Zip Code

202

206

CHAR/5

BIL-HIS-PAYEE-ZIP

 

 

4-Digit Zip Reserve

207

210

CHAR/4

BIL-HIS-PAYEE-ZIP-RESERVE

 

 

Provider Type

211

211

CHAR/1

BIL-HIS-PROV-TYPE

 

F = PHARMACY

H = HOSPITAL

P = PHYSICIAN

Reimbursement Code

212

212

CHAR/1

BIL-HIS-REIMB-CD

Indicates Payment Made To The Claimant

Blank = Provider

R = Claimant

Pharmacy Number

213

219

CHAR/7

BIL-HIS-PHARMACY-NO

Pharmacy NABP Number

 

Pay Center Code

220

225

CHAR/6

BIL-HIS-PAY-CENTER-CODE

Code Used To Identify A Central Payment Center For A Pharmacy Chain

This Data Is Available For Bills Paid Prior To 9/4/03

Clearing House Id

226

228

CHAR/3

BIL-HIS-CLEAR-HOUSE-ID

Clearinghouse Id Number

This Data Is Available For Bills Paid Prior To 9/4/03

Employee Last Name

229

238

CHAR/10

BIL-HIS-EMP-LAST-NAME

Claimant’s Last Name

 

Employee First Initial

239

239

CHAR/1

BIL-HIS-EMP-FIRST-INIT

Claimant’s First Initial

 

Area Code

240

243

CHAR/4

BIL-HIS-AREA-CODE

SMSA/MSA Identifier

Per FIPS Code Table

Physician Bill Redefine Area

Procedure Code

244

248

CHAR/5

BIL-HIS-PROC-CODE-1-5

Billed Procedure Code

Valid Cpt-4, HCPC’s, Revenue Center Or OWCP Procedure Code Indicating Services Provided 

Modifier Code

249

250

CHAR/2

BIL-HIS-MODIFIER-CODE

Indicates Different Level Of Service

 

Appeals Code

251

251

CHAR/1

BIL-HIS-APPEALS-CODE

Fee Schedule Appeal Code

B,F,G,W,1-7,Blank

Filler

252

253

CHAR/2

 

 

Blank

Rx Bills Redefine Area

Rx Number

244

250

CHAR/7

BIL-HIS-RX-NO

Prescription Number

 

Rx Appeal

251

251

CHAR/1

BIL-HIS-RX-APPEAL

Rx Appealed

 

Rx Refills

252

253

CHAR/2

BIL-HIS-RX-REFILL

Number Of Refills

 

Medical Bills Redefine Area

Diagnosed Related Group Number

244

246

CHAR/3

BIL-HIS-DRG-NO

Diagnosis Related Group For Inpatient Bills

 

Filler

247

250

CHAR/4

 

 

Blank

Appeal

251

251

CHAR/1

BIL-HIS-APPEAL

Medical Bill Appealed

Y = Yes

N = No

Filler

252

253

CHAR/2

 

 

Blank

Fund Adjustment Redefine Area

Transfer Indicator

244

244

CHAR/1

BIL-HIS-FUND-TRANSFER-IND

Funds Have Been Transferred

This Data Is Available For Bills Paid Prior To 9/4/03

Adjustment Indicator

245

245

CHAR/1

BIL-HIS-MAINT-ADJUD-IND

Adjustment Has Been Made

This Data Is Available For Bills Paid Prior To 9/4/03

Filler

246

253

CHAR/8

 

 

Blank

Return to All

Category Code

254

254

CHAR/1

BIL-HIS-CATEGORY-CODE

Procedure Code Category

A = Anesthesia

E = Evaluation/Management

M = Medicine

P = Pathology/Laboratory

R = Radiology/Nuclear Med/

       Diagnostic Ultrasound

S = Surgery

Work Unit Value

255

257

CHAR/3

BIL-HIS-WORK-UNIT-VAL

Work Relative Value Unit

000/Refer to EXPANDED RECORD

Practice Unit Value

258

260

CHAR/3

BIL-HIS-PRACT-UNIT-VAL

Practice Expense Relative Value Unit

000/Refer to EXPANDED RECORD

Malpractice Unit Value

261

263

CHAR/3

BIL-HIS-MALPRACT-UNIT-VAL

Malpractice Relative Value Unit

000/Refer to EXPANDED RECORD

Unit Cost

264

266

CHAR/3

BIL-HIS-UNIT-COST

Conversion Factor

000/Refer to EXPANDED RECORD

1-4, Ix  Value

267

269

CHAR/3

BIL-HIS-1-4-IX-VAL

Work Geographic Adjustment Factor

000/Refer to EXPANDED RECORD

Practice Ix Value

270

272

CHAR/3

BIL-HIS-PRACT-IX-VAL

Practice Expense Geographic Adjustment Factor

000/Refer to EXPANDED RECORD

Malpractice Ix Unit

273

275

CHAR/3

BIL-HIS-MALPRACT-IX-VAL

Malpractice Expense Geographic Adjustment Factor

000/Refer to EXPANDED RECORD

Percent Modifier

276

277

CHAR/2

BIL-HIS-MODIFIER-PERCENT

Adjustment Factor For Procedure Code Modifier

00/Refer to EXPANDED RECORD

National Drug Code

278

288

CHAR/11

BIL-HIS-NDC-NO

National Drug Code

 

2 Yr High Price

289

293

CHAR/5

BIL-HIS-PRICE-2YR-HIGH

Not Used

This Data Is Available For Bills Paid Prior To 9/4/03

Dispense Fee

294

295

CHAR/2

BIL-HIS-DISPENSE-RATE

Allowed Dispensing Fee For Prescription

00/Refer to EXPANDED RECORD

Allowed Fee

296

300

CHAR/5

BIL-HIS-ALLOWED-FEE-AMT

Allowable Cost For Prescription

00000/Refer to EXPANDED RECORD

Drg Amount

296

300

CHAR/5

BIL-HIS-DRG-AMT

Actual Cost, Calculated By Diagnostic Related Group For Inpatient Bills

 

 

Servicing State

301

302

CHAR/2

BIL-HIS-SVC-STATE

State Where Service Was Performed

 

Zip Code

303

307

CHAR/5

BIL-HIS-ZIP-CODE

Zip Code Where Service Was Performed

 

Prompt Payment

308

308

CHAR/1

BIL-HIS-PROMPT-PMT

Prompt Payment Flag Indicating Contractual Payment Obligation

This Data Is Available For Bills Paid Prior To 9/4/03

Bill Number

309

320

CHAR/12

BIL-HIS-BILL-NO

 

This Data Is Available For Bills Paid Prior To 9/4/03

Invoice Type

321

321

CHAR/1

BIL-HIS-INVOICE-TYPE

Type Of Invoice

This Data Is Available For Bills Paid Prior To 9/4/03

Invoice Number

322

329

CHAR/8

BIL-HIS-INVOICE-NO

Invoice Number

This Data Is Available For Bills Paid Prior To 9/4/03

Invoice Date

322

329

GROUP (8)

BIL-HIS-INVOICE-DATE

If Invoice Type=D, Date Provider Created The Bill

If Invoice Type=N, Providers Unique Id Number For The Bill

This Data Is Available For Bills Paid Prior To 9/4/03

Tcn

309

325

CHAR/17

BIL-HIS-TCN

Unique Transaction Control Number

This Data Is Unavailable For Bills Paid Prior To 9/4/03

Dispense Rate2

326

329

CHAR/4

BIL-HIS-DISP-RATE-ACS

Dispensing Rate

This Data Is Unavailable For Bills Paid Prior To 9/4/03    0000/Refer to EXPANDED RECORD

Charge Amount

330

334

CHAR/5

BIIL-HIS-CHARGE-AMT

Amount Charged By Provider

00000/Refer to EXPANDED RECORD

Ineligible Amt

335

339

CHAR/5

BIL-HIS-INEL-AMT

Amount Not Covered

00000/Refer to EXPANDED RECORD

Ineligible Code

340

340

CHAR/1

BIL-HIS-INEL-CODE

Ineligible Payment Code

 

Fee Reduction Amt

341

345

CHAR/5

BIL-HIS-FEE-REDUCTION-AMT

Amount Fee Reduced

00000/Refer to EXPANDED RECORD

Payment Amount

346

350

CHAR/5

BIL-HIS-PAYMENT-AMT

Net Amount Paid

00000/Refer to EXPANDED RECORD

Units

351

355

CHAR/5

BIL-HIS-UNITS

Service Units Billed

00000/Refer to EXPANDED RECORD

Locator Code

356

358

CHAR/3

BIL-HIS-LOCATOR-CODE

UB92 Loc 4; Code Indicates Type Of Institution

 

Presciber’s Name

359

368

CHAR/10

BIL-HIS-PRESCRIBER-NAME

Physician’s Name

 

Date Received

369

376

CHAR/8

BIL-HIS-DATE-RCVD

Date Bill Was Received

YYYYMMDD

 

Date Keyed

377

384

CHAR/8

BIL-HIS-DATE-KEYED

Date Bill Was Keyed For Payment

YYYYMMDD

 

Date Paid

385

392

CHAR/8

BIL-HIS-DATE-OF PAY

Date Bill Was Paid (Check Date)

YYYYMMDD

 

Adjustment Date

393

400

CHAR/8

BIL-HIS-DATE-OF-ADJUSTMENT

Date An Adjustment Transaction Was Entered Against A Bill

YYYYMMDD

 

Authorizing Official

401

403

CHAR/3

BIL-HIS-AUTH-OFFICIAL

Conditional; System Generated Id

3 Character Alpha

Bypass Code

404

404

CHAR/1

BIL-HIS-BYPASS-CODE

Indicates Type Of Payment Or Adjustment

 

District Office Input Code

405

406

CHAR/2

BIL-HIS-DIST-OFF-INPUT

District Office Code

 

District Office Control Code

407

408

CHAR/2

BIL-HIS-DIST-OFF-CNTL

District Office Sequent Code

This Data Is Available For Bills Paid Prior To 9/4/03

Error Code

409

409

CHAR/1

BIL-HIS-ERROR-CODE

Not Used

 

Batch Id Number

410

415

CHAR/6

BIL-HIS-BATCH-NO

The Batch The Bill Was Keyed With

This Data Is Available For Bills Paid Prior To 9/4/03

Operator Identifier

416

423

CHAR/8

BIL-HIS-OPERATOR-IDENT

System Generated Logon Id

This Data Is Available For Bills Paid Prior To 9/4/03

Tcn To Credit

407

423

CHAR/17

BIL-HIS-TCN-TO-CREDIT

Original Case Number

This Data Is Unavailable For Bills Paid Prior To 9/4/03

Payee Case From Code

424

424

CHAR/1

BIL-HIS-PAYEE-CASE-FROM-CD

Code indicates if a change to a case number or provider id

 

Payee Case From

425

433

CHAR/9

BIL-HIS-PAYEE-CASE-FROM

Original Case Number Or Provider Id

 

Payee Case To Code

434

434

CHAR/1

BIL-HIS-PAYEE-CASE-TO-CD

Code Indicates If A Change To A Case Number Or Provider Id

 

Payee Case To

435

443

CHAR/9

BIL-HIS-PAYEE-CASE-TO

Corrected Case Number Or Provider Id

 

Bill Id Number

444

445

CHAR/2

BIL-HIS-BILL-ID-NO

Not used

000

Bill Line Number

446

448

CHAR/4

BIL-HIS-BILL-LINE-ITEM-NO

Not used

000

Record Sequence

449

450

CHAR/2

BIL-HIS-RECORD-SEQ

Not used

00

Resolver Id

451

453

CHAR/8

BIL-HIS-RESOLVER-IDENT

 

 

Irslevy Flag

454

458

CHAR/1

BIL-HIS-IRS-LEVY-FLAG

Not used

Blank

New Tcn

459

475

CHAR/16

BIL-HST-NEW-TCN

Not used

Blank

 

EXPANDED RECORD

FIELD NAME

START

END

FIELD TYPE

BILL HISTORY REC  NAME

Description

Group Subdivisions

Definition Of Legal Values

 

476

480

CHAR/5

WORK-UNIT-VAL

Work Relative Value Unit

Numeric Value from CPT4 & HFCA Tables

 

481

485

CHAR/5

PRACT-UNIT-VAL

Practice Expense Relative Value Unit

Numeric Value from CPT4 & HFCA Tables

 

486

490

CHAR/5

MALPRACT-UNIT-VAL

Malpractice Relative Value Unit

Numeric Value From CPT4 & HFCA Tables

 

491

495

CHAR/5

UNIT-COST

Conversion Factor

 

 

496

499

CHAR/4

IX-VAL

Work Geographic Adjustment Factor

 

 

500

503

CHAR/4

PRACT-IX-VAL

Practice Expense Geographic Adjustment Factor

 

 

504

507

CHAR/4

MALPRACT-IX-VAL

Malpractice Expense Geographic Adjustment Factor

 

 

508

510

CHAR/3

MODIFIER-PERCENT

Adjustment Factor For Procedure Code Modifier

 

 

511

519

CHAR/9

PRICE-2YR-HIGH

 

This Data Is Available For Bills Paid Prior To 9/4/03

Otherwise Blank

 

520

526

CHAR/7

DISPENSE-RATE

Allowed Dispensing Fee For Prescription

 

 

527

534

CHAR/8

ALLOWED-FEE-AMT

Allowable Cost For Prescription

 

 

535

542

CHAR/8

CHARGE-AMT

Provider Charged Amount

 

 

543

550

CHAR/8

INEL-AMT

Amount Not Covered

 

 

551

558

CHAR/8

FEE-REDUCTION-AMT

Amount Fee Reduced

 

 

559

566

CHAR/8

PAYMENT-AMT

Net Amount Paid

 

 

567

574

CHAR/8

UNITS

Service Units Billed

 

 

575

577

CHAR/3

BILL-ID-NO

Sequential Number Of Bill Within A Batch Of Bills

 

 

578

581

CHAR/4

LINE-ITEM-NO

Sequential Number Of Bill Line Item

Modified Element

 

582

584

CHAR/3

RECORD-SEQ

 

Modified Element