Medicare Advantage and Prescription Drug Plans December 28 ...

Plan Communications User Guide Appendices, Version 6.3
Item
Field
Field
Type
Length Position Description
10 Nursing Home Admission Date DATE 8 125-132
11
Last Nursing Home
Assessment Date
DATE 8 133-140
12 Part A Indicator CHAR 1 141
13 Nursing Home Name CHAR 50 142-191
14 Medicare Provider ID CHAR 12 192-203
15 Provider Telephone Number CHAR 13 204-216
16 Provider Address CHAR 50 217-266
17 Provider City CHAR 20 267-286
18 Provider State Code CHAR 2 287-288
19 Provider Zip Code CHAR 11 289-299
Total Length = 299
Admission date associated with the last
assessment for the resident.
CCYYMMDD – Format
Target date of the last assessment for
the resident.
CCYYMMDD – Format
Reason for assessment (AA8B)
associated with the last assessment for
the resident.
0 = No
1 = Yes
Name of Nursing Home associated with
the last assessment for the resident.
Medicare Provider ID of Nursing Home
associated with the last assessment for
the resident.
Telephone Number of Nursing Home
associated with the last assessment for
the resident.
Address of Nursing Home associated
with the last assessment for the resident.
City of Nursing Home associated with
the last assessment for the resident.
State Code of Nursing Home associated
with the last assessment for the resident.
Zip Code of Nursing Home associated
with the last assessment for the resident.
December 28, 2012 F-139 LTI Resident Report Data File