Domain

Data Element

Definition

Ready for Prototype

Plan Identifier

A unique identification number for the entity that has responsibility for paying the claim. The plan and sponsor may be the same organization.

No

Enrollee Identifier

The unique identification number for the members of a plan. The enrollee and dependents would each have a unique ID.

No

Provider Specialty Type

Identification of the provider’s professional classification or specialty (e.g., physician, psychiatrist, psychologist, master level therapist, peer counselor).

No

Facility Identifier

If services are rendered in an organization (e.g., the provider is employed by an organization that holds the contract with the plan, hospital, etc.), this is a unique ID that identifies the facility.

No

Claim Identification or Transaction Number

The unique identification number assigned to the transaction.

Yes

Date of Service

The date the service is delivered to member.

Yes

Date Service Begins

The date the service started (e.g., hospital admission date, partial care start date, first outpatient visit in an episode of care).

Yes

Service Continued

Date Service Ends

The date the service terminated (e.g., hospital discharge date, partial care stop date, last outpatient visit in an episode of care).

Yes

Admission Date (Inpatient)

The start date for inpatient services.

Yes

Discharge Date (Inpatient)

The discharge date for inpatient services.

Yes

Duration of Service

The actual time in hours and minutes provider was involved in the encounter.

Yes

Type of Service

The codes for services delivered by the provider. This might include a subset of codes that describe treatment in detail (e.g. individual supportive psychotherapy, cognitive-behavioral group therapy).

Partial

Provider Identifier

The code that uniquely identifies the service provider for this encounter (may be more than one).

No

Service Location

The place of service delivery.

Partial

Medications Prescribed

The data will include prescription(s), unit/dose, refill number using coding recommended in HIPAA standards: National Council for Prescription Drug Programs (NCPDP).

Partial

Disposition/ Discharge Status

The chief reason for termination or discharge and the recommendation of the provider at the end of the encounter (e.g., further treatment needed).

Partial

Discontinuation Date

The date the provider terminates the client from treatment.

Yes

Member

Principal Diagnosis

The diagnosis chiefly responsible for admission of the member (inpatient) or for seeking the service (outpatient).

Partial

Primary Diagnosis

The diagnosis that is responsible for the majority of the care given to the member or the resources used in the care (inpatient and outpatient). Primary and principal diagnosis may often be identical.

Partial

Other Diagnosis

Other diagnoses that coexist or develop subsequently that may affect the treatment received or length of stay. NCVHS recommends coding for onset prior to admission (yes or no).

Partial

Legal Status

The member’s legal status with regard to the encounter (e.g., involuntary civil or criminal commitment, voluntary admission).

Yes

Cost

Total Charge

The total charges for the encounter (this should reflect the total cost of the encounter).

Yes

Member Co-pay

The amount of payment covered by the member.

Yes

Payment Method

Method of payments (pmpm, case rate, fee for service, etc.)

Yes

Plan Pay

The amount of payment expected to be covered by the plan for fee for service charges.

Yes