Versions Compared

Version Old Version 2 New Version 3
Changes made by

vickyp

vickyp

Saved on

Key

  • This line was added.
  • This line was removed.
  • Formatting was changed.

Template 

...

The table below describes each column in expected Excel file.

WorksheetColumnDescriptionPossible Values
ClaimsSender IDThe license number of a healthcare entity that is the sender of the transaction.
Receiver IDThe license number of a healthcare entity that is the receiver of the transaction.
Claim ID

A unique number assigned by a healthcare provider to identify the claim. This is also known as the provider’s claim reference number. 

If the patient is not insured and pays out of pocket, this is the external invoice reference number.


ID PayerA unique number assigned by an insurer to identify the claim. It helps the provider and payer to locate the claim.
Member IDThe patient’s insurance member number, if the patient is claiming insurance. Otherwise, it equals to EncounterFacilityID#EncounterPatientID.
Payer ID

If the patient is claiming insurance cover, this is the Insurer's license number. 

Other values:

  • If the patient is claiming insurance from an Insurer not included in the list of valid licenses - '@' followed by the name of the Insurer.
  • If the patient is paying directly for services provided - 'SelfPay'.
  • If the patient neither claims insurance nor pays directly for services provided - 'ProFormaPayer'. 
www.haad.ae/dictionary >> Licenses
Provider IDThe facility license number of the healthcare provider claiming from the payer. If the provider has no valid license number, the provider is '@' followed by the name of the provider.
Emirates ID Number

The unique number the government assigns to a citizen. When an EmiratesIDNumber is not available :

  • 000-0000-0000000-0 - National without card;
  • 111-1111-1111111-1 - Expatriate resident without a card;
  • 222-2222-2222222-2 - Non national, non-expat resident without a card;
  • 999-9999-9999999-9 - Unknown status, without a card.

Facility IDThe license number of the facility responsible for the encounter. If the reported encounter happened in a not licensed facility, it equals to '@' followed by the name of the facility.
Encounter TypeThe type of encounter (inpatients, daycases, emergencies and outpatients). They vary according to whether the encounter went past midnight, lasted for more than 24 hours, involved a hospital bed and whether they involved an emergency room.

1 = No Bed + No emergency room
2 = No Bed + Emergency room
3 = Inpatient Bed + No emergency room
4 = Inpatient Bed + Emergency room
5 = Daycase Bed + No emergency room
6 = Daycase Bed + Emergency room
7 = Nationals Screening
8 = New Visa Screening
9 = Renewal Visa Screening
12 = Home
13 = Assisted Living Facility
15 = Mobile Unit
41 = Ambulance - Land
42 = Ambulance - Air or Water

Patient IDThe unique number a healthcare provider assigns to a patient. This is often known as the medical record number.
Eligibility ID PayerThe AuthorizationIDPayer provided by the Insurer/TPA in the latest Eligibility transaction (PriorAuthorization with AuthorizationType=Eligibility). Used to demonstrate that the payer has confirmed patient’s eligibility.
Encounter Start

The date and time at which the patient comes under the care of a responsible clinician.

  • For Elective patients this will typically be the date and time of the visit registration/admission on arrival of the patient at the healthcare facility.
  • For Emergency patients this will typically be the date and time of the registration and admission on arrival of the patient at the healthcare facility.
  • For Transfer patients between facilities (i.e. inter-hospital transfers), this will typically be the date and time of the visit registration and admission on arrival of the patient at the receiving healthcare facility.
  • For Livebirth this will typically be the date and time of the registration and admission of the newborn at the healthcare facility. The Encounter start will also be the date and time of birth.
  • For Stillbirth this will typically be the date and time of the registration of the stillborn at the healthcare facility. The Encounter start will also be the date and time of stillbirth.
  • For Death on arrival this will typically be the date and time of the visit registration on arrival of the patient at the healthcare facility for pronouncement. 

Encounter End

The time the patient ceases to be under the direct care of a responsible clinician.

  • For inpatients and day patients this would be the discharge date and time.
  • For emergency patients this would be the time that the patient was released from the ER. 

Encounter Start TypeThe type which defines how the encounter started.

1 = Elective, i.e., an Encounter is scheduled in advance
2 = Emergency
3 = Transfer admission from acute care
4 = Live birth
5 = Still birth
6 = Dead On Arrival
7 = Continuing Encounter
8 = Transfer admission from non-acute care

Encounter End TypeHow The type which defines how the patient was discharged. 1 = Discharged with approval
2 = Discharged against advice
3 = Discharged absent without leave
4 = Discharge transfer to acute care
5 = Deceased
6 = Not discharged
7 = Discharge transfer to non-acute care.
Transfer SourceEncounterTransferSource is the The healthcare facility from where a hospital transfer originated (EncounterStartType Encounter Start Type = 3 Transfer). The originating healthcare facility is described by facility license number. Lists of valid license numbers are available on www.shafafiya.org/dictionary >> Licenses. If  If the facility is not in the list of licensed providers, enter “@” it equals to '@' followed by the name of the facility.
Transfer DestinationEncounterTransferDestination is the The healthcare facility to which a hospital transfer is made at the end of an encounter (Encounter (EncounterEndType End Type = 4 Transfer). This is facility license number. Lists of valid license numbers are available on www.shafafiya.org/dictionary >> Licenses.  If the facility is not in the list of licensed providers, enter “@” it equals to '@' followed by the name of the facility.
Resubmission TypeThe type of resubmission of a claim or prior request. Validation rule: value ‘legacy’ is not allowed for PriorRequest 
Resubmission Comment

Package Name

DiagnosesClaim IDReference to Claim ID on Claims worksheet
Diagnosis Type

The type of diagnosis being recorded.

  • Principal
:
  • - Identifies the principal diagnosis
code (full ICD-9-CM)
  • for the condition established after examination
. It will identify
  • , the nature of a disease or illness.
• Inpatients | Condition established, after study, to be chiefly responsible for occasioning the admission of the patient to the hospital for care. • Ambulatory patients | The condition or problem that explains the clinician’s assessment of the presenting symptoms/problems and corresponds to the tests or services provided. This assessment may be a suspected diagnosis or a rule-out diagnosis and is based on the patient’s presenting history and physical and the physician’s review of symptoms. This may also be a symptom where the underlying cause has yet to be determined Secondary: • Inpatients |
  • Secondary: - All conditions that co-exist at the time of admission, or develop subsequently, which affect the treatment received and/or the length of stay.
Diagnoses that refer to an earlier episode that have no bearing on the current hospital stay are to be excluded. Conditions should be coded that affect patient care in terms of requiring: Clinical evaluation, therapeutic treatment, diagnostic procedures, extended length of hospital stay, increased nursing care and/or monitoring. • Ambulatory patients | All co-existing conditions, including chronic conditions that exist at the time of the Encounter or visit and require or affect patient management. • External causes of injury, poisoning or adverse affect are coded as supplementary codes to the diagnosis codes of the actual condition such as “Motor Vehicle Accident” that caused a fracture of the tibia. Note | For quality purposes, it is important to be able to track Hospital-acquired infections. The corresponding E-Code is 849.7 Admitting:
  •  
  • Admitting -The diagnosis that the physician identifies at the time of admission.
Note | This diagnosis might differ from EncounterDiagnosisPrincipal.
  •  
 ICD10-CM
Diagnosis CodeThe value for the diagnosis code as per coding manual.
Dx Info TypeThe type of additional information for the diagnosis. POA : - Present On Admission (POA) indicator
Dx Info CodeThe code value related to the DxInfoType.
ActivitiesClaim IDReference to Claim ID on Claims worksheet
Activity IDUnique identifier of an activity within a claim.
Activity StartThe date and time at which an activity started. For a DRG code, it is the date and time of discharge. If the date, but not the time is recorded, the time is assumed to be 00:00. 
Activity TypeThe type of an activity/procedure. 

3 = CPT

;


4 = HCPCS

;


5 = Trade Drug

;


6 = Dental

;


8 = Service Code

;


9 =

IR-

DRG

; 10 = Generic Drug.

Activity CodeAn activity code, specified by its type for the activity performed.
QuantityThe number of units for an activity.NNN.DDDD
NetThe net charges billed by the provider to the payer for an activity. 
Patient ShareAny fee that payer is expecting the provider to collect from the patient.
Ordering ClinicianThe license number of the clinician who ordered the service or referred the patient for the service.
ClinicianThe license number of the clinician responsible for the activity. In general, this is the person providing the treatment or care for the patient.
Prior Authorization IDThe corresponding prior authorization number.
ObservationsClaim IDReference to Claim ID on Claims worksheet
Activity IDReference to Activity ID on Activities worksheet
Observation Type
CPT
"/>
"
LOINC
"/>
"
Text
"/>
"
File
"/>
"
Universal Dental
Observation CodeThe code describing the Observation value.
Observation ValueThe observed value of the Activity. Restriction: Must be expressed in SI Units.
Observation Value TypeUnit of measure for the ObservationValue.

...