Medicare Advantage and Prescription Drug Plans December 28 ...

Plan Communications User Guide Appendices, Version 6.3
F.11 Part B Claims Data File
F.11.1 Record Type 1
Item Field Size Position Description
1 Contract Number 5 1-5 MCO contract number
2 Record Type 1 6 Record Type Number 6 –
Physician/Supplier
Record Type Number 7 – Durable
Medical Equipment
3 CAN-BIC 12 7-18 HIC Number
4 Period From 8 19-26 Start Date – YYYYMMDD
5 Period To 8 27-34 End Date – YYYYMMDD
6 Date of Birth 8 35-42 Beneficiary's Date of Birth –
YYYYMMDD
7 Surname 6 43-48 First six positions of Beneficiary’s
surname.
8 First Name 1 49 First letter of Beneficiary’s first
name.
9 Middle Initial 1 50 First letter of Beneficiary’s middle
name.
10 Reimbursement Amount 11 51-61 Reimbursement amount for claim.
11 Total Allowed Charges 11 62-72 Total allowed charges for claim.
12 Report Date 6 73-78 Claims processed through date –
YYYYMM. Assigned by the system
as this file is produced. This is the
cut-off date for including a claim in
this file.
13 Contractor identification number 5 79-83 Identification number of the
contractor that processed claim.
14 Provider identification number 10 84-93 Provider’s identification number.
15 Internal Control Number 15 94-108 Internal control number assigned by
the Medicare contractor to claim.
16 Provider Payment Amount 11 109-119 Total amount paid to provider for this
claim.
17 Beneficiary Payment Amount 11 120-130 Total amount paid to Beneficiary for
this claim.
18 Filler 57 131-187 Spaces
Total Length = 187
December 28, 2012 F-50 Part B Claims Data File