Medicare Advantage and Prescription Drug Plans December 28 ...

F.11.2 Record Type 2
Plan Communications User Guide Appendices, Version 6.3
Item Field Size Position Description
1 Contract Number 5 1-5 MCO contract number
2 Record Type 1 6 Record Type Number 5 – Home Health Agency
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 Name 1 50 First letter of Beneficiary’s middle name.
10 Reimbursement 11 51-61 Reimbursement amount for claim.
Amount
11 Total Charges 11 62-72 Total charges on the claim.
12 Report Date 6 73-78 Claims processed through date – YYYYMM. Assigned by the
system when processing claims. This is the cut-off date for
including a claim in this file.
13 Contractor
identification
number
14 Provider
identification
number
5 79-83 Identification number of the contractor that processed the
claim.
6 84-89 Provider’s identification number.
15 Filler 98 90-187 Spaces
Total Length = 187
December 28, 2012 F-51 Part B Claims Data File