CCR POMS MANUAL
Consolidated Community Reporting
Performance Outcome Management System
Reporting Manual for Consumer, Encounter and
Subcapitation Data
March 1, 2007 (Version 1.02)
Version 1.01 (September 1, 2005)
Version 1.0 (February 1, 2005)
TABLE OF CONTENTS
Section 1.............................................................................................................................. 3
Introduction ..................................................................................................................... 3
General Information ........................................................................................................ 5
Section 2.............................................................................................................................. 7
Consumer Data File Record Descriptions....................................................................... 7
Consumer Data File “Unknowns, Data Errors and Correction Instructions” ................. 9
CCR POMS Consumer Data File & Record Layout Specifications ............................. 12
Consumer Data Catalog Definitions ............................................................................. 17
Revision Dates for Consumer Data Elements ............................................................... 76
CCR POMS Consumer Data Import Errors .................................................................. 78
Section 3............................................................................................................................ 80
Encounter Data Files and Record Types ....................................................................... 80
Subcapitation Financial Data File ................................................................................. 81
Encounter Data File & Record Layout Specifications .................................................. 82
Subcapitation Data File & Record Layout Specifications ............................................ 88
Encounter and Subcapitation Data Catalog Summary .................................................. 91
Encounter and Subcapitation Data Catalog Definitions ............................................... 93
Revision Dates for Encounter and Subcapitation Data Elements ............................... 148
Encounter Data and Subcapitation Financial Data Adjustment Overview ................. 150
Encounter Data Import Errors ..................................................................................... 152
Subcapitation Data Import Errors ............................................................................... 155
Section 4- ........................................................................................................................ 156
Appendix A- Priority Groups...................................................................................... 156
Appendix B- MH Bulletin OMH-94-04 ..................................................................... 158
Appendix C- Expenditure Reporting Options............................................................. 161
Appendix D- CCR POMS Submission Process .......................................................... 169
Appendix E- Historical Documents In Re: Summary Expenditure Collection .......... 170
PRV414- MA Provider File Layout ............................................................................ 175
Reporting of Services Provided to Unidentified Consumers ...................................... 177
Reporting of Services Provided to a Consumer over a Quarterly or Monthly Period 178
Glossary of Terms ....................................................................................................... 179
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Section 1
Introduction
Effective February 1, 1997, the Commonwealth introduced a new integrated and
coordinated health care delivery system to serve Medical Assistance eligible
persons who require medical, psychiatric, and substance abuse services through
a capitated mandatory managed care program. Psychiatric and substance abuse
services within the new system are provided by Behavioral Health Managed Care
Organizations (BHMCOs), under the administration of the HealthChoices
Behavioral Health Program.
The Office of Mental Health / Substance Abuse Services (OMHSAS) created a
data base called the Performance Outcome Management System (POMS), to
produce a set of performance measures/indicators to continuously evaluate and
improve the effectiveness of the HealthChoices Behavioral Health Managed Care
Programs. In addition to data from the HealthChoices capitated managed care
program, the POMS data base was designed to also contain data about
consumers, services, and expenditures in county-base / CHIPP funded
programs. Further, the data base will eventually contain data from secondary
sources - other state agencies such as the Department of Corrections, State
Police, and the Department of Education.
HealthChoices data collection began effective February 1, 1997 from the
BHMCOs in the five Southeast Zone counties: Bucks, Chester, Delaware,
Montgomery, and Philadelphia. Since then, two additional ‘zones’ have been
implemented. The Southwest Zone counties: (Allegheny, Armstrong, Beaver,
Butler, Fayette, Greene, Indiana, Lawrence, Washington and Westmoreland)
was implemented January, 1999. The Lehigh/Capital Zone counties: (Adams,
Berks, Cumberland, Dauphin, Lancaster, Lebanon, Lehigh, Northampton, Perry,
and York) was implemented in October, 2001. HealthChoices Behavioral Health
began a statewide expansion in July, 2006. The Northeast counties of Luzerne,
Lackawanna, Susquehanna and Wyoming were implemented July 1, 2006. The
North/Central counties were implement January 1, 2007 and include the counties
of Bradford, Cameron, Centre, Clarion, Clearfield, Columbia, Elk, Forest,
Huntingdon, Jefferson, Juniata, McKean, Mifflin, Montour, Northumberland,
Potter, Schuylkill, Snyder, Sullivan, Tioga, Union, Warren and Wayne.
POMS data about consumers is presently collected from BHMCOs in quarterly
submission files that contain Consumer Registry records and Quarterly Status
records. A HealthChoices POMS Reporting Manual for Consumer Data was
created in September, 1996, to describe how BHMCOs are to report this data.
The POMS data base is also presently supplied with reports of capitation funded
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Behavioral Health services, called Encounter Data. This data is provided to
OMHSAS from the PROMISe system.
Pursuant to the goal of an integrated clinical and administrative system, data
about mental health consumers and services covered by county-base and
CHIPP (Community Hospital Integration Project) funds using the previous
Consolidated Community Reporting System (CCRS) was discontinued in favor of
submissions in the same format as Health Choices data. By adjusting the CCRS
reporting requirements in this manner, the data collected from the county-base
and CHIPP funded programs can be merged with the data collected from the
HealthChoices capitation program to provide a unified system for management,
monitoring, and reporting purposes. The first submission of consumer and
service data relating to county-base and CHIPP funds using the new CCR POMS
reporting requirements described in this document was effective with the
reporting period of the third quarter of calendar year 1999. This manual
describes how the County Mental Health Programs will report information about
mental health consumers and services funded by county-base and CHIPP
allocations.
Services that are to be reported within CCR POMS are determined by how these
services are funded. All consumers whose services are subsidized by the county
Mental Health program through a program funded contract or directly provided by
the CAU are to be reported in CCR POMS. A service that is paid totally by
Medical Assistance is not to be reported.
A BSU (Base Services Unit) registered consumer is defined as a consumer
who has completed the intake process at the BSU and information has
been collected at the county who maintains an episode of treatment.
Services provided to non registered consumers should still be reported as
long as the county pays for the service. When reporting these services, if a
primary diagnosis has not been obtained, Primary Diagnosis (067) may be
entered as 7999.
This manual and all accompanying documents are posted on the
Department of Public Welfare Intranet web site:
http://dpwintra.dpw.state.pa.us/omhsas/
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General Information
1. The Department requires the county/joinder programs to submit Consumer
Data, Encounter data, and Subcapitation Financial Data quarterly, no more than
60 days past the end of the quarter. All data will be submitted via the
eGovernment Secure Data Exchange.
2. The Consumer Data file will include the following record types:
 20 Header
 21 Consumer Registry records
 22 Quarterly Status records
 29 Trailer
Note that a header record and trailer record must accompany the Consumer
Registry records and Quarterly Status records in the Consumer Data file. The file
must be sorted in ascending sequence on Record Type. When Quarterly Status
records are submitted, they are submitted following the Consumer Registry
records.
3. The Encounter Data file will include the following record types:
 1 Header
 6 Medical Services
 8 Inpatient
 9 Trailer
Note that a header record and trailer record must accompany the Encounter
records in the quarterly Encounter Data file. Also note again that the file must be
sorted in ascending sequence on Record Type.
4. The Subcapitation Financial Data file will include the following record types:
 1 Header
 2 Financial Detail
 3 Trailer
Again, note the header record and trailer record and note that the file must be
sorted in ascending sequence on Record Type.
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General Information (continued)
5. The data portion of all records in the Consumer Data file is 300 characters.
Each record type within the Encounter Data file has a different length. The same
is true for the Subcapitation Financial Data file. See the File and Record Layout
Specifications of each file for details. Character coding in the data portions must
be done according to the IBM Standard ASCII Character Set. For both files, the
data portion of each record is followed by a carriage return character and then a
line feed character (as defined in the ASCII Control Character Table). Be aware
that many software applications insert both a Carriage Return and a Line Feed
when a Line Feed alone is requested, which would result in record lengths one
character too long. Incorrect record length will cause an entire submission to be
rejected. If your software writes a Carriage Return and a Line Feed when asked
only for a Line Feed, then you should omit the Carriage Return character from
your output record setup.
Similarly, different operating systems and software applications mark the end-offile (EOF) differently. The EOF should be the binary code equivalent of decimal
code 26 from the ASCII Control Character Table. (Be sure to place it immediately
after the Carriage Return-Line Feed combination that marks the end of the Trailer
Record.) When viewed as a hexadecimal code, this character is represented as
1A. Some PC software provides for the input of this character using the
combination keystroke ^Z (CTRL-Z). As an alternative, a Carriage Return-Line
Feed combination immediately following the Carriage Return-Line Feed at the
end of the Trailer record will communicate an EOF that our software will
recognize.
6. General information about how to access eGovernment Secure Data
Exchange, file naming conventions, and processing result files returned to the
CAU may be found in Appendix D.
7. If the entire submission is rejected, the errors should be corrected and the
entire file resubmitted. Otherwise, correct the individual records that are in error
and submit only these records again. Resubmissions and correction
submissions are to be made within 30 days.
8. Questions about the eGovernment Secure Data Exchange may be directed to
Ken Meier of the Bureau of Information Systems at (717) 772-7974. For
eGovernment Secure Data Exchange password issues contact the Bureau of
Information Systems account administration help desk at (800) 281-5340. Please
note that you must change your password in e-Gov every 60 days.
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Section 2
Consumer Data File Record Descriptions
Header Record-The Header Record for a Consumer Data file identifies the CAU, the
reporting period for which records are submitted, and the date the submission file was
created. If the Record Type is not "20", or if the CAU Code, Reporting Year Month,
Submission Indicator, or File Creation Date is invalid or missing, the entire submission
will be rejected.
Consumer Registry Record-The Consumer Registry record documents each
commencement, course and continuity of mental health treatment from a county-base or
CHIPP funded program. A HealthChoices Consumer reported in the Behavioral
HealthChoices POMS submission must also be included in the CCR POMS reporting if
mental health services covered by county-base or CHIPP funds are also provided. The
Recipient Registration Date (Catalog No. 2110) field reflects the commencement of a
plan of care and the Recipient Closure Date (Catalog No. 2111) field reflects the
termination of that plan of care. This record also contains data regarding the consumer's
demographic and clinical characteristics. This record is required when the county/joinder
program "opens" a plan of care for the consumer. A Consumer Registry record is not
required for members who receive occasional crisis services.
The first CCR Consumer Data submission must contain at least one Consumer Registry
record for each consumer who was open with a plan of care for mental health treatment at
any time during the initial reporting period. In other words, it is to include one Consumer
Registry record for every consumer open for mental health treatment at the end of the
initial reporting period and one Consumer Registry record for every time any consumer
was opened and closed for mental health treatment during the first reporting period. The
consumer is considered closed when closed from a county/joinder program. A closure
from a Base Service Unit (BSU) where the consumer remains open in the county/joinder
program is not to be reported. Subsequent submissions will include corrections, consumer
closures and new consumer registrations. Note that subsequent submissions will not
include consumers who were open throughout the reporting period. Also note that a
consumer can have more than one Consumer Registry record in a reporting period.
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Consumer Data File Record Descriptions (continued)
Quarterly Status Record-Although the Quarterly Status record was originally designed
and used in HealthChoices reporting, for CCR POMS reporting there must be one
Quarterly Status record submitted for each CCR POMS Priority Group Consumer who
was open and receiving mental health treatment during the year (July 1 through June 30).
Mental Health Priority Group classifications continue as defined in the 1996/97 CCRS
Reporting Manual.
POMS Priority Group Consumers are defined as:
 "03" (Adult Target Population #1),
 “04” (Adult Target Population #2),
 "54" (C&A Target Population #1),
 "55" (C&A Target Population #2)
Effective January 1, 2003 the Adult Priority Group definition was expanded to include
‘04’ - Adult Target Population #2. Consumers with a POMS Recipient Priority Group for
Mental Health code of "05" (Adult Target Population #3), or "56" (C&A Target
Population #3) are not considered POMS Priority Group Consumers. Mental Health
Priority Group definitions from the 1996/97CCRS Reporting Manual are provided in
Appendix A, and Mental Health Bulletin OMH-94-04 (which is referenced by the Mental
Health Priority Group Definitions) is provided in Appendix B.
The above definitions of a POMS Priority Group Consumer pertain to the Priority Group
at registration or closure, as reported in the Consumer Registry record, or to the Priority
Group at update, as reported in the Quarterly Status record.
A Quarterly Status record is also required for a consumer who is not a POMS Priority
Group Consumer when a change in Priority Group occurs. For example, if a consumer
was reported at registration to have a POMS Recipient Priority Group for Mental Health
code of "98" ("None of the above but receiving Mental Health Services") and
subsequently the mental health diagnosis changes so as to place the consumer correctly
within Adult Target Population #3 (POMS Recipient Priority Group for Mental Health
code "05"), then a Quarterly Status Record should be submitted reporting the change.
Trailer Record
The trailer record will contain the number of records of each type submitted. If the
number of records indicated in the trailer record does not agree with the actual count, the
submission will not be accepted.
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Consumer Data File “Unknowns, Data Errors and Correction
Instructions”
"Unknown" and "Not Applicable" Instructions-Very few data elements may be
legitimately left blank. Most of the data elements defined in the Consumer Data Catalog
Definitions provide a code for "unknown" and many also provide a code for "not
applicable". CAU’s must make every reasonable effort to provide meaningful values for
all required items at Registration, Update and Closure. When it is necessary to use
"unknown" or "not applicable" for a data item, be sure to check the Consumer Data
Catalog Definitions for the correct code.
Child / Adult Instructions-Many data elements are "age-related". The allowable values
depend on whether the recipient is a child or an adult. The Recipient Priority Group at
Registration (MH), Recipient Priority Group at Closure (MH), and Recipient Priority
Group Update (MH) have some codes that are only valid for children and some codes
that are only valid for adults. No Priority Group codes whose description in the
Consumer Data Catalog Definitions includes the words "Child & Adol." may be used for
a recipient age 21 or over. Similarly, no Priority Group code whose description in the
Consumer Data Catalog Definitions includes the word "Adult" may be used for a
recipient under age 18. Several other data elements, such as the various "Recipient
Independence of Living" and "Recipient Vocational Educational Status" fields have
codes or values that are only valid for children, although there are no codes that are
strictly limited to adults. No values or codes whose description in the Consumer Data
Catalog Definitions includes the letters "C&A" may be used for a recipient age 21 or
over.
Data Errors- As already described under "Header Record" the entire submission will be
rejected if any of the data items in the Header Record are missing or invalid. The entire
submission will also be rejected if any record in the submission is not the correct size.
An "Import Processing Log" will be generated when the OMHSAS Import Program
processes a Consumer Data submission file. The Import Processing Log will list records
with data items that failed to satisfy the "edit" requirements described in the Consumer
Data Catalog Definitions. The Import Processing Log will describe in detail the reason
that the data item failed to satisfy requirements. If an error message includes the phrase
"Record rejected", then that record will not be added to the CCR POMS database.
Rejected submissions and rejected records should be corrected and resubmitted within 30
days.
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“Unknowns, Data Errors and Correction Instructions” (continued)
Correction Instructions-Consumer Registry and Quarterly Status records submitted in
prior Reporting Periods may be corrected or deleted by utilizing the "Correction
Indicator" (Catalog No. 2213 or 2122) and "Year Month of Correction" (Catalog No.
2214 or 2125) fields. A correction submission should be sent whenever a deletion or
correction situation is discovered. Do not wait for the next regular reporting submission.
However, correction records being prepared near the time of a regular reporting
submission may be included in the regular reporting submission. If the correction applies
to more than one quarterly submission, send a record for each quarterly submission in
which the correction is to apply.
For "corrections-only" submissions, please take note of the "Edits" section of the Header
Record's Reporting Year Month (Catalog No. 2003) and Submission Indicator (Catalog
No. 2005) in the Consumer Data Catalog Definition. For a "corrections-only" submission,
"000000" should be used for Reporting Year Month and "C" should be used for
Submission Indicator in the Header Record.
A correction record is a correction to a previous quarterly Consumer Data submission. A
record that was erroneously omitted from a previous submission would therefore be
submitted as a correction record. In this case, enter a "1" in the Correction Indicator field
and enter the quarter to which the record is to be added in Year Month of Correction.
A correction record is usually a correction of a previously submitted record. To correct a
previously submitted record, recreate the entire record with the desired changes. Then
enter "1" in Correction Indicator (Catalog Nos. 2122 or 2213) and enter the year and end
month of the reporting period to which the correction applies in Year Month of
Correction, (Catalog Nos. 2125 or 2214). All values in the previously submitted record
are overwritten with the values in the correction record. To delete a previously submitted
record, recreate the entire record, enter "2" in Correction Indicator, and enter the year
and end month of the reporting period to which the deletion applies in Year Month of
Correction.
A previously submitted Consumer Registry record targeted for deletion or correction will
be identified by Recipient Social Security Number and Recipient Registration Date.
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“Unknowns, Data Errors and Correction Instructions” (continued)
Corrections to Recipient Social Security Number (Catalog No. 2102 or 2202) and
Recipient Registration Date (Catalog no. 2110) require steps in addition to entering the
appropriate values in the Correction Indicator field and the Reporting Year Month. If the
Recipient Social Security Number is being corrected or changed, enter the previously
reported SS# in Incorrect Social Security Number (Catalog No. 2123) and the correct
number in Recipient Social Security Number (Catalog No. 2102).
If the Incorrect Social Security Number was a pseudo Social Security Number, created
because the true Social Security Number was previously unknown or unavailable, be sure
to also update the Missing Social Security Number Status field. If the Registration Date is
being corrected, enter the incorrect Registration Date in Incorrect Registration Date
(Catalog 2124) and the correct date in Recipient Registration Date (Catalog No. 2110).
Submission of a Consumer Registry record that corrects the Recipient Social Security
Number will automatically apply the same correction to Quarterly Status data and
Encounter data in the POMS data base.
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CCR POMS Consumer Data File & Record Layout Specifications
File Name
Record Name
Record Size
Rev Date
Catalog
Number
2001
2002
2003
2004
2005
2007
2008
Consumer Data
Header
300 bytes
July 16, 1999
Field Name
Record Type
CAU Code
Reporting Year
Month
File Creation
Date
Submission
Indicator
FILLER
Carriage Return
Line Feed
Field
Type
A/N
A/N
N
Field
Size
002
002
006
Start End Special Instructions
001
003
005
002
004
010
N
008
011
018
A/N
001
019
019
A/N
281
001
001
020
301
302
300
301
302
Constant ‘20’
CCYYMM (C=Century, Y=Year,
M=Month)
CCYYMMDD (C=Century, Y=Year,
M=Month, D=Day)
Blank Fill
Carriage Return control character
Line Feed control character
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CCR POMS Consumer Data File & Record Layout Specifications
File Name
Record Name
Record Size
Rev Date
Consumer Data
Consumer Registry Page 1 of 2
300 bytes
July 16, 1999
Catalog
Number
2101
2102
2103
2104
2105
Field Name
Field
Size
002
009
001
010
008
Start End Special Instructions
Record Type
Recipient SS Number
Missing SS Number Status
Recipient CIS Number
Recipient Birth Date
Field
Type
A/N
N
N
N
N
001
003
012
013
023
002
011
012
022
030
2106
2107
2108
2109
2110
Recipient Initials
Recipient Sex
Recipient Race
Recipient County of Residence
Recipient Registration Date
A/N
A/N
A/N
A/N
N
004
001
001
002
008
031
035
036
037
039
034
035
036
038
046
2111
Recipient Closure Date
N
008
047
054
CCYYMMDD
C=Century
Y=Year, M=Month,
D=Day
2112
2113
Recipient Reason for Closure
Recipient Priority Group at
Registration (MH)
A/N
A/N
002
002
055
057
056
058
Blank fill if unused
Constant ‘21’
Zero fill if unused
CCYYMMDD
C=Century
Y=Year, M=Month,
D=Day
CCYYMMDD
C=Century
Y=Year, M=Month,
D=Day
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File Name
Record Name
Record Size
Rev Date
Consumer Data
Consumer Registry Page 2 of 2
300 bytes
July 16, 1999
FILLER
2115 Recipient Priority Group at Closure
(MH)
FILLER
2117 Recipient Independence of Living
at Registration
2118 Recipient Vocational Education
Status at Registration
2119 Recipient Independence of Living
at Closure
2120 Recipient Vocational Educational
Status at Closure
2121 Date of Recipient’s Request to
Access
2122 Correction Indicator
2123 Incorrect SS Number
2124 Incorrect Registration Date
A/N 012 059 070 Blank Fill
A/N 002 071 072 Blank fill if unused
2125 Year Month of Correction
N
2129
2133
2134
2131
2132
FILLER
Recipient Race Additional Codes
Recipient Ethnicity
Recipient Special Population Code
at Registration
FILLER
Carriage Return
Line Feed
A/N 012 073 084 Blank Fill
A/N 002 085 086
A/N 002 087 088
A/N 002 089 090 Blank fill if unused
A/N 002 091 092 Blank fill if unused
N
A/N
N
N
A/N
A/N
A/N
A/N
008 093 100 CCYYMMDD C=Century, Y=Year,
M=Month, D=Day
001 101 101
009 102 110 Zero fill if unused
008 111 118 CCYYMMDD C=Century, Y=Year,
M=Month, D=Day
006 119 124 CCYYMM C=Century, Y=Year,
M=Month
029 125 153 Blank Fill
001 154 157 Occurs 4 Times, see “Edits”
001 158 158
004 159 162 Occurs 4 Times, see “Edits”
A/N 138 163 300 Blank Fill
001 301 301 Carriage Return control character
001 302 302 Line Feed control character
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CCR POMS Consumer Data File & Record Layout Specifications
File Name
Record Name
Record Size
Rev Date
Catalog
Number
2201
2202
2203
2204
2205
2206
2207
2208
2209
2210
2213
2214
2217
2221
2219
2220
Consumer Data
Quarterly Status (Page 1 of 1)
300 bytes
January 24, 2003
Field Name
Record Type
Recipient SS Number
Recipient
Independence of
Living
Recipient Residential
Movement
Recipient (Child)
School Attendance
Recipient (Child)
School Performance
Recipient (Child)
School Behavior
Recipient Vocational
Educational Status
Recipient Priority
Group Update (MH)
Recipient Priority
Group (MH) Update
Date
FILLER
Correction Indicator
Year Month of
Correction
FILLER
Source for Recipient
(Child) School Data
Elements
Recipient Special
Population Code
FILLER
Carriage Return
Line Feed
Field
Type
A/N
N
A/N
Field
Size
002
009
002
Start End Special Instructions
001
003
012
002
011
013
Constant Value ‘22’
N
002
014
015
Right-justified, zero fill
A/N
001
016
016
A/N
001
017
017
A/N
001
018
018
A/N
002
019
020
A/N
002
021
022
N
008
023
030
CCYYMMDD C=Century, Y=Year,
M=Month, D=Day
A/N
A/N
N
020
001
006
031
051
052
050
051
057
Blank Fill
A/N
A/N
015
005
058
073
072
077
Blank Fill
Occurs 5 Times, see “Edits”
A/N
004
078
081
Occurs 4 Times, see “Edits”
A/N
219
001
001
082
301
302
300
301
302
Blank Fill
Carriage Return control character
Line Feed control character
CCYYMM, Zero fill if unused
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CCR POMS Consumer Data File & Record Layout Specifications
File Name
Record Name
Record Size
Rev Date
Catalog
Number
2901
2902
2903
2904
2905
2906
2908
2909
Consumer Data
Trailer (Page 1 of 1)
300 bytes
July 16, 1999
Field Name
Record Type
CAU Code
Reporting Year
Month
File Creation Date
Number of Record
Type 21 records
Number of Record
Type 22 records
FILLER
Carriage Return
Line Feed
Field
Type
A/N
A/N
N
Field
Size
002
002
006
Start End Special Instructions
001
003
005
002
004
010
N
008
011
018
N
005
019
023
CCYYMM (C=Century, Y=Year,
M=Month)
CCYYMMDD (C=Century,
Y=Year, M=Month, D=Day)
Right justified, zero filled
N
005
024
028
Right justified, zero filled
A/N
272
001
001
029
301
302
300
301
302
Blank Fill
Carriage Return control character
Line Feed control character
Constant value ‘29’
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Consumer Data Catalog Definitions
CONSUMER DATA CATALOG DEFINITIONS
Picture
X(002)
Format
Constant ‘20’
Positions
001-002
Revision Date
9/25/96
Catalog No. 2001
Data Name Record Type
Header
DEFINITION: A code identifying the record type.
Edits: This is a required field.
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CONSUMER DATA CATALOG DEFINITIONS
Picture
X(002)
Format
Positions
003-004
Revision Date
09/01/05
Catalog No. 2002
Data Name CAU Code
Header
DEFINITION: A unique identifier assigned by the Department for each CAU.
AL = Allegheny
AI = Armstrong/Indiana
BE = Beaver
BS = Bedford/Somerset
BK = Berks
BL = Blair
BN = Bradford/Sullivan
BU = Bucks
BT = Butler
CM = Cambria
CN = Cameron/Elk/McKean
(Dissolved 9/30/2005)
CK = Carbon/Monroe/Pike
CE = Centre
CH = Chester
CL = Clarion
CJ = Clearfield/Jefferson
CR=Cameron/Elk
(Effective 10/1/05)
CS = Col./Mon./Sny./Un.
CW = Crawford
CP = Cumberland/Perry
DA = Dauphin
DE = Delaware
ER = Erie
FA = Fayette
FW = Forest/Warren
FF = Franklin/Fulton
GR = Greene
HJ = Hunt./Miff./Jun.
LS = Lack./Sus./Wayne
(Dissolved 6/30/2005)
LQ=Lackawanna/Susquehanna
(Effective 7/1/2005)
LA = Lancaster
LW = Lawrence
LB = Lebanon
LE = Lehigh
LG = Luzerne/Wyoming
LC = Lycoming/Clinton
MC=McKean
(Effective 10/1/05)
ME = Mercer
MO = Montgomery
NH = Northampton
NU = Northumberland
PH = Philadelphia
PO = Potter
SC = Schuylkill
TI = Tioga
VE = Venango
WE = Westmoreland
WN=Wayne
(Effective 7/1/2005)
WS = Washington
YA = York/Adams
Edits: This is a required field. Codes will be validated against a list maintained by the
DPW.
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CONSUMER DATA CATALOG DEFINITIONS
Picture
9(006)
Format
CCYYMM
Positions
005-010
Revision Date
3/17/97
Catalog No. 2003
Data Name Reporting Year Month
Header
DEFINITION: The reporting period year and end month of the quarter.
Edits: This is a required field. This field must contain a value that corresponds to an end
to a calendar quarter, i.e., 199703, 199712, etc. when Submission Indicator =”I”. Zero fill
when Submission Indicator = “C”.
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CONSUMER DATA CATALOG DEFINITIONS
Picture
9(008)
Format
CCYYMMDD
Positions
011-018
Revision Date
3/17/97
Catalog No. 2004
Data Name File Creation Date
Header
DEFINITION: Date of creation of the file.
Edits: This is a required field. This field must be numeric and a valid calendar date
greater than the last day of “Reporting Year Month”.
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CONSUMER DATA CATALOG DEFINITIONS
Picture
X(001)
Format
Positions
019-019
Revision Date
12/2/96
Catalog No. 2005
Data Name Submission Indicator
Header
DEFINITION: A code identifying the input file as either an initial quarterly submission
or a submission containing only corrections to previous submission(s). An initial
quarterly submission may also contain corrections to previous submissions.
I = Initial Submission
C = Correction Submission
Edits: This is a required field. The code must be one that is described in the data
definition.
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CONSUMER DATA CATALOG DEFINITIONS
Picture
Format
Positions
Carriage Return control
character
301-301
Revision Date
3/17/97
Catalog No. 2007
Data Name Carriage Return
Header
DEFINITION:
Edits: This must be the binary code equivalent of decimal code 13 from the IBM ASCII
control character table.
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CONSUMER DATA CATALOG DEFINITIONS
Picture
Format
Positions
Line feed control
character
302-302
Revision Date
3/17/97
Catalog No. 2008
Data Name Line Feed
Header
DEFINITION:
Edits: This must be the binary code equivalent of decimal code 10 from the IBM ASCII
control character table.
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CONSUMER DATA CATALOG DEFINITIONS
Picture
X(002)
Format
Constant ‘21’
Positions
001-002
Revision Date
9/25/96
Catalog No. 2101
Data Name Record Type
Consumer Registry
DEFINITION: A code identifying the record type.
Edits: This is a required field.
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CONSUMER DATA CATALOG DEFINITIONS
Picture
9(009)
Format
Positions
003-011
Revision Date
1/1/05
Catalog No. 2102
Data Name Recipient Social Security
Number
Consumer Registry
DEFINITION: The unique Social Security Number of the Recipient.
Positions 1 through 3 must be:
greater than “000” and less than “666”
OR
greater than “666” and less than “734”
OR
greater than “749” and less than “773”
Positions 4 through 5 must be greater than “00”.
Positions 6 through 9 must be greater than “0000”.
Edits: This is a required field. If known, the number must match the number assigned by
the Social Security Administration (without hyphens). If unknown, a pseudo Social
Security Number must be created. The format for a pseudo Social Security Number is
“0999”in the four left-most positions, followed by a five digit identifier that is unique
within the CAU. The value "00000" as the final five digits is NOT considered valid.
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CONSUMER DATA CATALOG DEFINITIONS
Picture
9(001)
Format
Zero fill if unused
Positions
012-012
Revision Date
9/1/05
Catalog No. 2103
Data Name Missing Social Security
Number Status
Consumer Registry
DEFINITION: A code to indicate the social security number status of a recipient who is
registered under a pseudo Social Security Number. If no pseudo number is reported in
element 2102, this element is zero filled.
1 = Recipient has no SSN; SSN application initiated.
2 = Unable to obtain valid SSN; investigating further
3 = Unable to obtain valid SSN; no further action planned.
4 = Valid Social Security Number identified
A value of “1” – “3” is to be used if a pseudo SSN is being reported in 2102. The value
of “4” is used in a correction record when reporting a valid SSN to replace a pseudo SSN.
Edits: This field is required if the consumer is registered under a pseudo Social Security
Number. If used, the code must be one that is listed in the data definition. If codes “1”
through “3” are used, then there must be a pseudo Social Security Number in “Recipient
Social Security Number”. Use Code “4” in a correction record when reporting a valid
SS# to replace a pseudo Social Security Number.
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CONSUMER DATA CATALOG DEFINITIONS
Picture
9(010)
Format
RJ, zero fill
Positions
013-022
Revision Date
5/1/00
Catalog No. 2104
Data Name Recipient CIS Number
Consumer Registry
DEFINITION: The unique number assigned to the recipient by DPW and recorded on
CIS (Client Information System). This number should not change and is the same
number that appears on the recipient’s ACCESS card.
Edits: This is a required field. Zero fill if the individual is not receiving, and never has
received Medical Assistance. If a non-zero value is entered it must be numeric and the
right-most digit (the check digit) must equal the result of the check digit calculation
described in Catalog #077 (“Recipient CIS Number”) of the Encounter/Subcapitation
Financial Data Reporting Requirements - Data Catalog Definitions.
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CONSUMER DATA CATALOG DEFINITIONS
Picture
9(008)
Format
CCYYMMDD
Positions
023-030
Revision Date
9/25/96
Catalog No. 2105
Data Name Recipient Birth Date
Consumer Registry
DEFINITION: The birth date of the recipient.
Edits: This is a required field. It must be numeric and a valid calendar date. It must be
prior or equal to the last day of “Reporting Year Month” in the Header Record. If birth
date is unknown, estimate CC, YY, and MM; fill DD with “99”.
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CONSUMER DATA CATALOG DEFINITIONS
Picture
X(004)
Format
Positions
031-034
Revision Date
5/1/00
Catalog No. 2106
Data Name Recipient Initials
Consumer Registry
DEFINITION: The first three letters of last name at birth and the first letter of the first
name. Do not use apostrophes, hyphens, or other punctuation characters. No one may
ever have more than one Recipient Initials within a County Program. Be sure to use a
woman’s maiden name.
Edits: This is a required field. There may be no spaces and unused positions are to be
filled with a “Q” (as in quiet). If name at birth is unknown, enter XXXX.
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CONSUMER DATA CATALOG DEFINITIONS
Picture
X(001)
Format
Positions
035-035
Revision Date
9/25/96
Catalog No. 2107
Data Name Recipient Sex
Consumer Registry
DEFINITION: The gender of the recipient.
M=Male
F=Female
Edits: This is a required field. If problematic, ask recipient.
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CONSUMER DATA CATALOG DEFINITIONS
Picture
X(001)
Format
Positions
036-036
Revision Date
1/1/03
Catalog No. 2108
Data Name Recipient Race
Consumer Registry
DEFINITION: Codes to indicate the race of the recipient. Additional codes may be
reported using Catalog #2129 – Recipient Race Additional Codes.
1 = Black or African American
3 = American Indian or Alaskan Native
4 = Asian
5 = White
6 = Other or Not Volunteered by the Recipient
7 = Native Hawaiian or Other Pacific Islander
If unclear, use Recipient’s self-report.
Edits: This is a required field. The code must be one that is listed in the data definition.
As many as five Race Codes may be reported using Catalog #2108 and #2129.
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CONSUMER DATA CATALOG DEFINITIONS
Picture
X(002)
Catalog No. 2109
Data Name Recipient County of
Residence
Format
Positions
037-038
Revision Date
1/1/05
Consumer Registry
DEFINITION: A code to indicate the county in which the recipient resides.
01 = Adams
02 = Allegheny
03 = Armstrong
04 = Beaver
05 = Bedford
06 = Berks
07 = Blair
08 = Bradford
09 = Bucks
10 = Butler
11 = Cambria
12 = Cameron
13 = Carbon
14 = Centre
15 = Chester
16 = Clarion
17 = Clearfield
18 = Clinton
19 = Columbia
20 = Crawford
21 = Cumberland
22 = Dauphin
23 = Delaware
24 = Elk
25 = Erie
26 = Fayette
27 = Forest
28 = Franklin
29 = Fulton
30 = Greene
31 = Huntington
32 = Indiana
33 = Jefferson
34 = Juniata
35 = Lackawanna
36 = Lancaster
37 = Lawrence
38 = Lebanon
39 = Lehigh
40 = Luzerne
41 = Lycoming
42 = McKean
43 = Mercer
44 = Mifflin
45 = Monroe
46 = Montgomery
47 = Montour
48 = Northampton
49 = Northumberland
50 = Perry
51 = Philadelphia
52 = Pike
53 = Potter
54 = Schuylkill
55 = Snyder
56 = Somerset
57 = Sullivan
58 = Susquehanna
59 = Tioga
60 = Union
61 = Venango
62 = Warren
63 = Washington
64 = Wayne
65 = Westmoreland
66 = Wyoming
67 = York
Edits: This is a REQUIRED field. The code used must be one that is listed in the data
definition, and it must be a code for the county or counties that comprise the County
Administrative Unit (CAU). If the county of residence is unknown, or if the recipient
resides outside of the county or counties that comprise the CAU, use the code for the
county which has financial responsibility for services rendered.
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CONSUMER DATA CATALOG DEFINITIONS
Picture
9(008)
Format
CCYYMMDD
Positions
039-046
Revision Date
1/1/98
Catalog No. 2110
Data Name Recipient Registration Date
Consumer Registry
DEFINITION: The date of the recipient’s Registration for a specific course of behavioral
health treatment. “Recipient Registration Date” may precede the date of implementation
of POMS reporting.
Edits: This is a required field. It must be numeric and a valid calendar date. It must be
prior or equal to the last day of “Reporting Year Month” in the Header Record.
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CONSUMER DATA CATALOG DEFINITIONS
Picture
9(008)
Format
CCYYMMDD
Positions
047-054
Revision Date
10/25/96
Catalog No. 2111
Data Name Recipient Closure Date
Consumer Registry
DEFINITION: Closure date of recipient from a specific course of behavioral health
treatment.
Edits: This field is required if the recipient was terminated from a specific course of
behavioral health treatment during the quarter. If used, it must be numeric, a valid
calendar date, and prior or equal to the last day of “Reporting Year Month” in the Header
Record. Blank fill if unused.
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CONSUMER DATA CATALOG DEFINITIONS
Picture
X(002)
Format
Blank fill if unused
Positions
055-056
Revision Date
12/1/01
Catalog No. 2112
Data Name Recipient Reason for
Closure
Consumer Registry
DEFINITION: A code to indicate the reason the recipient was terminated from a specific
course of behavioral health treatment.
01 = Consumer rejected further services orally or in writing
02 = CAU is unable to contact/locate the consumer
03 = The consumer and the CAU agree that the consumer no longer needs mental
health services
04 = The CAU has determined that the consumer no longer needs mental health
services.
05 = Parent of Consumer withdrew the consumer from mental health services
06 = Agency (C&Y or Juvenile Justice) withdrew consumer from services
96 = Consumer moved from service area
97 = Consumer deceased
98 = Unknown reason why recipient was terminated from a specific course
of behavioral health treatment
99 = Terminated from behavioral health treatment due to enrollment in a
HMO/MCO
Edits: This field is required if “Recipient Closure Date” contains a value. If used, the
code must be one that is described in the data definition.
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CONSUMER DATA CATALOG DEFINITIONS
Picture
X(002)
Format
Positions
057-058
Revision Date
1/1/98
Catalog No. 2113
Data Name Recipient Priority Group at
Registration
Consumer Registry
DEFINITION: A code to indicate the Mental Health Priority Group of the recipient at
time of registration for behavioral health services. Mental Health Priority Group
Classifications are described in Appendix A and Appendix B of the “CCR POMS
Reporting Manual for Consumer Data and Encounter Data.”
Pick one:
03 = Adult Target Population #1
04 = Adult Target Population #2
05 = Adult Target Population #3
54 = Child & Adol. Target Pop. #1
55 = Child & Adol. Target Pop. #2
56 = Child & Adol. Target Pop. #3
98 = None of the above but receiving Mental Health Services
99 = Not receiving Mental Health Services
Edits: This is a required field. The code must be one that is described in the data
definition.
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CONSUMER DATA CATALOG DEFINITIONS
Picture
X(002)
Format
Blank fill if unused
Positions
071-072
Revision Date
7/1/02
Catalog No. 2115
Data Name Recipient Priority Group at
Closure
Consumer Registry
DEFINITION: A code to indicate the Mental Health Priority Group of the recipient at
time of closure for behavioral health services. Mental Health Priority Group
Classifications are described in Appendix A and Appendix B of the “CCR POMS
Reporting Manual for Consumer Data and Encounter Data.”
Pick one:
03 = Adult Target Population #1
04 = Adult Target Population #2
05 = Adult Target Population #3
54 = Child & Adol. Target Pop. #1
55 = Child & Adol. Target Pop. #2
56 = Child & Adol. Target Pop. #3
98 = None of the above but receiving Mental Health Services
99 = Not receiving Mental Health Services
Edits: This field is required if “Recipient Closure Date” contains a value. If used, the
code must be one that is described in the data definition.
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CONSUMER DATA CATALOG DEFINITIONS
Picture
X(002)
Format
Positions
085-086
Revision Date
1/1/03
Catalog No. 2117
Data Name Recipient Independence of
Living at Registration
Consumer Registry
DEFINITION: A code to indicate the recipient’s independence of living at time of
registration. These codes were revised to make them less detailed effective 01/01/2001,
and separate codes for children were eliminated effective 01/01/2003. Effective 1/1/01,
54 codes were collapsed into the following codes:
70 = Living Independently
71 = Family Setting
72 = Living Dependently
73 = Supervised Setting
74 = Restrictive Setting
75 = Homeless
99 = Unknown
Edits: This is a required field. The code must be one that is listed in the data definition.
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CONSUMER DATA CATALOG DEFINITIONS
Picture
X(002)
Format
Positions
087-088
Revision Date
1/1/03
Catalog No. 2118
Data Name Recipient Vocational
Educational Status at Registration
Consumer Registry
DEFINITION: A code to indicate the vocational educational status of the recipient at
time of registration. These codes were revised to make them less detailed effective
01/01/2001, and separate codes for children were eliminated effective 01/01/2003.
Effective 1/1/2001, 36 codes were collapsed into the following codes:
70 = Competitive Employment
71 = Training/Education
72 = Work Program
73 = Meaningful Activity
74 = No Activity
99 = Unknown
Edits: This is a required field. The code must be one that is listed in the data definition.
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CONSUMER DATA CATALOG DEFINITIONS
Picture
X(002)
Format
Blank fill if unused
Positions
089-090
Revision Date
1/1/03
Catalog No. 2119
Data Name Recipient Independence of
Living at Closure
Consumer Registry
DEFINITION: A code to indicate the recipient’s independence of living at time of
closure. These codes were revised to make them less detailed effective 01/01/2001 and
separate codes for children were eliminated effective 01/01/2003. Valid codes are:
70 = Living Independently
71 = Family Setting
72 = Living Dependently
73 = Supervised Setting
74 = Restrictive Setting
75 = Homeless
99 = Unknown
Edits: This field is required if “Recipient Closure Date” contains a value. If used, the
code must be one that is listed in the data definition.
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CONSUMER DATA CATALOG DEFINITIONS
Picture
X(002)
Format
Blank fill if unused
Positions
091-092
Revision Date
1/1/03
Catalog No. 2120
Data Name Recipient Vocational
Educational Status at Closure
Consumer Registry
DEFINITION: A code to indicate the vocational educational status of the recipient at
time of closure. These codes were revised to make them less detailed effective
01/01/2001 and separate codes for children were eliminated effective 01/01/2003.
70 = Competitive Employment
71 = Training/Education
72 = Work Program
73 = Meaningful Activity
74 = No Activity
99 = Unknown
Edits: This field is required if “Recipient Closure Date” contains a value. The code must
be one that is listed in the data definition.
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CONSUMER DATA CATALOG DEFINITIONS
Picture
9(008)
Format
CCYYMMDD
Positions
093-100
Revision Date
12/2/96
Catalog No. 2121
Data Name Date of Recipient’s Request
to Access Services
Consumer Registry
DEFINITION: Date the recipient, or agency on behalf of the recipient, submitted an
application for the specific course of Behavioral Health treatment which is opened on the
Registry record.
Edits: This is a required field. It must be numeric and a valid calendar date. It must be
prior or equal to both the “Recipient Registration Date” and the last day of “Reporting
Year Month” in the Header Record.
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CONSUMER DATA CATALOG DEFINITIONS
Picture
X(001)
Format
Positions
101-101
Revision Date
9/11/98
Catalog No. 2122
Data Name Correction Indicator
Consumer Registry
DEFINITION: A code used to determine if record is a correction to previous submission.
A correction record can be either a change to a previously submitted record or a record
that was erroneously omitted from a previous submission.
0 = Original record
1 = Correction record
2 = Deletion record
Edits: This is a required field. The code must be one that is described in the definition. If
this field contains a non-zero value, then there must be a non-zero value in the “Year
Month of Correction” field.
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CONSUMER DATA CATALOG DEFINITIONS
Picture
9(009)
Format
Zero fill if unused
Positions
102-110
Revision Date
3/17/97
Catalog No. 2123
Data Name Incorrect Social Security
Number
Consumer Registry
DEFINITION: This field is used to indicate a previously reported “Recipient Social
Security Number” that is to be changed or corrected. The corrected, or “new” number, is
placed in the “Recipient Social Security Number” field.
Edits: If this field is used, then “Correction Indicator” field must contain a “1”, there
must be a valid value in “Year Month of Correction”, and the value in “Incorrect Social
Security Number” must match the “Recipient Social Security Number” reported in the
submission designated by “Year Month of Correction”. If a valid SS# is being reported to
replace a pseudo Social Security Number, there must be a “4” in “Missing Social
Security Number Status”.
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CONSUMER DATA CATALOG DEFINITIONS
Picture
9(008)
Format
CCYYMMDD
Positions
111-118
Revision Date
3/17/97
Catalog No. 2124
Data Name Incorrect Registration Date
Consumer Registry
DEFINITION: This field is used to indicate a previously reported “Recipient
Registration Date” that is to be corrected. The corrected, or “new”, Registration Date is
placed in the Recipient Registration Date” field.
Edits: If this field is used, the “Correction Indicator” field must contain a “1”, there must
be a valid value in “Year Month of Correction”, and the value in “Incorrect Registration
Date” must match the “Recipient Registration Date” reported in the submission
designated by “Year Month of Correction”. Zero-fill if unused.
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CONSUMER DATA CATALOG DEFINITIONS
Picture
9(006)
Format
CCYYMM
Positions
119-124
Revision Date
9/11/98
Catalog No. 2125
Data Name Year Month of Correction
Consumer Registry
DEFINITION: Indicates the reporting year and end month of the submission to which
the correction applies.
Edits: If the “Correction Indicator” field contains a non-zero value, then this field must
contain a value that corresponds to an end of a calendar quarter, i.e., 199703, 199712, etc.
This value cannot equal the value contained in the “Reporting Year Month” of the Header
Record. Zero fill if unused.
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CONSUMER DATA CATALOG DEFINITIONS
Picture
X(001)
Format
Occurs 4 times, see edits
Positions
154-157
Revision Date
1/1/03
Catalog No. 2129
Data Name Recipient Race Additional
Codes
Consumer Registry
DEFINITION: A code to indicate race components in addition to what is reported in
Recipient Race (Catalog #2108). Pick all that apply:
1 = Black or African American
3 = American Indian or Alaskan Native
4 = Asian
5 = White
6 = Other or not volunteered by the recipient
7 = Native Hawaiian or other Pacific Islander
Edits: If used, the codes must be ones that are listed in the data definition. Left justify
and blank-fill unused positions. Blank-fill all four positions if there are no additional race
components to report.
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CONSUMER DATA CATALOG DEFINITIONS
Picture
Format
Positions
Carriage return control
character
301-301
Revision Date
3/17/97
Catalog No. 2131
Data Name Carriage Return
Consumer Registry
DEFINITION:
Edits: This must be the binary code equivalent of decimal code 13 from the IBM ASCII
control character table.
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CONSUMER DATA CATALOG DEFINITIONS
Picture
Format
Positions
Line feed control
character
302-302
Revision Date
3/17/97
Catalog No. 2132
Data Name Line Feed
Consumer Registry
DEFINITION:
Edits: This must be the binary code equivalent of decimal code 10 from the IBM ASCII
control character table.
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CONSUMER DATA CATALOG DEFINITIONS
Picture
X(001)
Format
Positions
158-158
Revision Date
1/1/03
Catalog No. 2133
Data Name Recipient Ethnicity
Consumer Registry
DEFINITION: Codes to indicate the ethnicity of the recipient.
1=Not Hispanic or Latino
2=Hispanic or Latino
Edits: This is a required field.
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CONSUMER DATA CATALOG DEFINITIONS
Picture
X(001)
Format
Positions
Occurs 4 Times, see
“Edits”
159-162
Revision Date
1/24/03
Catalog No. 2134
Data Name Recipient Special Population
Code at Registration
Consumer Registry
DEFINITION: A code used to identify whether the consumer was authorized for use of
special county allocation funds at the time of registration. Pick all that apply.
1 = CHIPP (Community Hospital Integration Projects Program) - Hospital
2 = CHIPP - Diversion, Non-Hospital
3 = SIPP – Southeast Initiative Projects Program
4 = Mental Health BHSI – Behavioral Health Services Initiative
Edits: If used, the codes must be ones that are listed in the data definition. Left justify
and blank-fill unused positions. Blank-fill all four positions if there are no Special
Population Codes to report.
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CONSUMER DATA CATALOG DEFINITIONS
Picture
X(002)
Format
Constant Value ‘22’
Positions
001-002
Revision Date
9/25/96
Catalog No. 2201
Data Name Record Type
Quarterly Status
DEFINITION: A code identifying the record type.
Edits: This is a required field.
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CONSUMER DATA CATALOG DEFINITIONS
Picture
9(009)
Format
Positions
003-011
Revision Date
12/23/98
Catalog No. 2202
Data Name Recipient Social Security
Number
Quarterly Status
DEFINITION: The Social Security Number of the recipient as reported in the recipient’s
Consumer Registry record.
Edits: This is a required field. The number must match the “Recipient Social Security
Number” in the recipient’s Consumer Registry Record (Catalog 2102).
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CONSUMER DATA CATALOG DEFINITIONS
Picture
X(002)
Format
Positions
012-013
Revision Date
1/1/03
Catalog No. 2203
Data Name Recipient Independence of
Living
Quarterly Status
DEFINITION: A code to indicate the recipient’s independence of living at the end of the
reporting quarter. These codes were revised to make them less detailed effective
01/01/2001, and separate codes for children were eliminated effective 01/01/2003.
70 = Living Independently
71 = Family Setting
72 = Living Dependently
73 = Supervised Setting
74 = Restrictive Setting
75 = Homeless
99 = Unknown
Edits: This is a required field. The code must be one that is listed in the data definition.
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CONSUMER DATA CATALOG DEFINITIONS
Picture
9(002)
Format
RJ, zero fill
Positions
014-015
Revision Date
10/25/96
Catalog No. 2204
Data Name Recipient Residential
Movement
Quarterly Status
DEFINITION: The number of times the recipient moved their residence during the
quarter.
99=unknown
Edits: This is a required field. This field must be an integer.
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CONSUMER DATA CATALOG DEFINITIONS
Picture
X(001)
Format
Positions
016-016
Revision Date
5/1/00
Catalog No. 2205
Data Name Recipient (Child) School
Attendance
Quarterly Status
DEFINITION: A code to indicate the school attendance of a child recipient.
1 = Regular attendance
2 = Sporadic attendance
3 = Enrolled but rarely attends
4 = Dropped out this quarter
5 = Dropped out in a previous quarter
6 = Pre-school age child
8 = Unknown
9 = Not applicable
Edits: This is a required field. The code must be one that is listed in the data definition.
Codes 1 through 6, or code 8, must be used if the recipient is a child. Use code 9 (“Not
applicable”) if the Recipient is not a child. See “Child/Adult Instructions” in Section 2 of
the Reporting Manual for age criteria.
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CONSUMER DATA CATALOG DEFINITIONS
Picture
X(001)
Format
Positions
017-017
Revision Date
5/1/00
Catalog No. 2206
Data Name Recipient (Child) School
Performance
Quarterly Status
DEFINITION: A code to indicate the academic performance of a child recipient:
1 = Above average
2 = Average
3 = Below average
4 = Failing
5 = Pre-school age child
8 = Unknown
9 = Not applicable
Edits: This is a required field. The code must be one that is listed in the data definition.
Codes 1 through 5, or code 8, must be used if the recipient is a child. Use code 9 (“Not
applicable”) if the Recipient is not a child. See “Child/Adult Instructions” in Section 2 of
the Reporting Manual for age criteria.
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CONSUMER DATA CATALOG DEFINITIONS
Picture
X(001)
Format
Positions
018-018
Revision Date
5/1/00
Catalog No. 2207
Data Name Recipient (Child) School
Behavior
Quarterly Status
DEFINITION: A code to indicate the behavior in school of a child recipient:
1 = Presents no behavior problems
2 = Presents occasional behavior problems
3 = Presents behavior problems on a constant basis
4 = Pre-school age child
8 = Unknown
9 = Not applicable
Edits: This is a required field. The code must be one that is listed in the data definition.
Codes 1 through 4, or code 8, must be used if the recipient is a child. Use code 9 (“Not
applicable”) if the Recipient is not a child. See “Child/Adult Instructions” in Section 2 of
the Reporting Manual for age criteria.
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CONSUMER DATA CATALOG DEFINITIONS
Picture
X(002)
Format
Positions
019-020
Revision Date
1/1/03
Catalog No. 2208
Data Name Recipient Vocational
Educational Status
Quarterly Status
DEFINITION: A code to indicate the vocational educational status of the recipient at end
of quarter. These codes were revised to make them less detailed effective
01/01/2001, and separate codes for children were eliminated effective 01/01/2003.
70 = Competitive Employment
71 = Training/Education
72 = Work Program
73 = Meaningful Activity
74 = No Activity
99 = Unknown
Edits: This is a required field. The code must be one that is listed in the data definition.
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CONSUMER DATA CATALOG DEFINITIONS
Picture
X(002)
Format
Positions
021-022
Revision Date
1/1/98
Catalog No. 2209
Data Name Recipient Priority Group
Update (MH)
Quarterly Status
DEFINITION: A code to indicate the current Priority Group (MH) of the recipient.
Mental Health Priority Group classifications are described in Appendix A and Appendix
B of the “CCR POMS Reporting Manual for Consumer Data and Encounter Data”.
Mental Health (Pick ONE):
03 = Adult Target Population #1
04 = Adult Target Population #2
05 = Adult Target Population #3
54 = Child & Adol. Target Pop. #1
55 = Child & Adol. Target Pop. #2
56 = Child & Adol. Target Pop. #3
98 = None of the above but receiving Mental Health Services
99 = Not receiving Mental Health Services
Edits: This is a required field. The code must be one that is described in the data
definition.
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CONSUMER DATA CATALOG DEFINITIONS
Picture
9(008)
Format
CCYYMMDD
Positions
023-030
Revision Date
7/16/99
Catalog No. 2210
Data Name Recipient Priority Group
(MH) Update Date
Quarterly Status
DEFINITION: The effective date of the reported “Recipient Priority Group Update
(MH)”.
If the reported “Recipient Priority Group Update (MH)” is a change from that most
recently reported, then the “Recipient Priority Group (MH) Update” should indicate the
date of the change.
If the “Recipient Priority Group Update (MH)” is unchanged from that most recently
reported, then the “Recipient Priority Group (MH) Update Date” should remain the same
as the most recently reported.
If the “Recipient Priority Group Update (MH)” is unchanged from that reported at
the most recent registration, use the “Recipient Registration Date” for the
“Recipient Priority Group (MH) Update Date”.
If there is a Consumer Registry record reporting closure in the same reporting
period, use the “Recipient Priority Group (MH) at Closure” for “Recipient Priority
Group Update (MH)” and use the “Recipient Closure Date” for “Recipient Priority
Group (MH) Update Date”, unless there is a subsequent registration in the reporting
period.
Edits: This is a required field. It must be numeric and a valid calendar date. If
Correction Indicator = “0”, then the Recipient Priority Group (MH) Update Date must be
<= the last day of “Reporting Year Month” in the Header Record and >= the most recent
“Recipient Registration Date.” If Correction Indicator = “1” or “2”, then the Recipient
Priority Group (MH) Update Date must be <= the last day of “Year Month of
Correction”.
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CONSUMER DATA CATALOG DEFINITIONS
Picture
X(001)
Format
Positions
051-051
Revision Date
9/11/98
Catalog No. 2213
Data Name Correction Indicator
Quarterly Status
DEFINITION: A code used to determine if record is a correction to a previous
submission. A correction record can be either a change to a previously submitted record
or a record that was erroneously omitted from a previous submission.
0 = Original record
1 = Correction record
2 = Deletion record
Edits: This is a required field. The code must be one that is described in the definition.
If this field contains a non-zero value, then there must be a non-zero value in the “Year
Month of Correction” field.
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CONSUMER DATA CATALOG DEFINITIONS
Picture
9(006)
Format
Positions
CCYYMM, zero fill if
unused
052-057
Revision Date
9/11/98
Catalog No. 2214
Data Name Year Month of Correction
Quarterly Status
DEFINITION: Indicates the reporting period year and end month of the submission to
which the correction applies.
Edits: If the “Correction Indicator” field contains a non-zero value, then this field must
contain a value that corresponds to an end of a calendar quarter, i.e., 199703, 199712, etc.
This value cannot equal the value contained in the “Reporting Year Month” of the Header
Record. Zero-fill if unused.
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CONSUMER DATA CATALOG DEFINITIONS
Picture
X(001)
Format
Occurs 5 times, see edits
Positions
073-077
Revision Date
5/1/00
Catalog No. 2217
Data Name Source for Recipient (Child)
School Data Elements
Quarterly Status
DEFINITION: A code to indicate the source of information for the child school-related
data elements (Catalog Numbers 2205, 2206, and 2207). Pick all that apply:
1 = Child
2 = Parent/guardian
3 = School system
4 = Interagency meeting
5 = Other
6 = Pre-school age child
8 = Unknown
9 = Not applicable
Edits: This is a required field in position 073. Additional codes (no repeats) may be
entered in positions 074-077. The codes must be ones that are listed in the definition. Left
justify and blank-fill unused positions. Codes 1 through 6, or code 8, can only be used if
the recipient is a child. Use code “9” (“Not applicable”) if the recipient is not a child. See
“Child/Adult Instructions” in Section 2 of the Reporting Manual for age criteria.
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CONSUMER DATA CATALOG DEFINITIONS
Picture
Format
Positions
Carriage return control
character
301-301
Revision Date
3/17/97
Catalog No. 2219
Data Name Carriage Return
Quarterly Status
DEFINITION:
Edits: This must be the binary code equivalent of decimal code 13 from the IBM ASCII
control character table.
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CONSUMER DATA CATALOG DEFINITIONS
Picture
Format
Positions
Line feed control
character
302-302
Revision Date
3/17/97
Catalog No. 2220
Data Name Line Feed
Quarterly Status
DEFINITION:
Edits: This must be the binary code equivalent of decimal code 10 from the IBM ASCII
control character table.
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CONSUMER DATA CATALOG DEFINITIONS
Picture
X(001)
Format
Positions
Occurs 4 Times, see
“Edits”
078-081
Revision Date
1/24/03
Catalog No. 2221
Data Name Recipient Special Population
Code
Quarterly Status
DEFINITION: A code used to report whether the consumer was authorized for use of
special county allocation funds during the reporting quarter. Pick all that apply.
1 = CHIPP (Community Hospital Integration Projects Program) - Hospital
2 = CHIPP – Diversion, Non-Hospital
3 = SIPP (Southeast Initiative Projects Program)
4 = Mental Health BHSI – (Behavioral Health Services Initiative)
The special funding information reported is considered ongoing until a subsequent record
is submitted indicating a change. All currently applicable codes must be reported when
submitting an update.
Edits: If used, the codes must be ones that are listed in the data definition. Left justify
and blank-fill unused portions. Blank-fill all four positions if there are no Special
Population Codes to report.
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CONSUMER DATA CATALOG DEFINITIONS
Picture
X(002)
Format
Constant value ‘29’
Positions
001-002
Revision Date
9/25/96
Catalog No. 2901
Data Name Record Type
Trailer
DEFINITION: A code identifying the record type.
Edits: This is a required field.
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CONSUMER DATA CATALOG DEFINITIONS
Picture
X(002)
Format
Positions
003-004
Revision Date
9/1/05
Catalog No. 2902
Data Name CAU Code
Trailer
DEFINITION: A unique identifier assigned by the Department for each CAU.
AL = Allegheny
AI = Armstrong/Indiana
BE = Beaver
BS = Bedford/Somerset
BK = Berks
BL = Blair
BN = Bradford/Sullivan
BU = Bucks
BT = Butler
CM = Cambria
CN = Cameron/Elk/McKean
(Dissolved 9/30/2005)
CK = Carbon/Monroe/Pike
CE = Centre
CH = Chester
CL = Clarion
CJ = Clearfield/Jefferson
CR=Cameron/Elk
(Effective 10/1/05)
CS = Col./Mon./Sny./Un.
CW = Crawford
CP = Cumberland/Perry
DA = Dauphin
DE = Delaware
ER = Erie
FA = Fayette
FW = Forest/Warren
FF = Franklin/Fulton
GR = Greene
HJ = Hunt./Miff./Jun.
LS = Lack./Sus./Wayne
(Dissolved 6/30/2005)
LQ=Lackawanna/Susquehanna
(Effective 7/1/2005)
LA = Lancaster
LW = Lawrence
LB = Lebanon
LE = Lehigh
LG = Luzerne/Wyoming
LC = Lycoming/Clinton
MC=McKean
(Effective 10/1/05)
ME = Mercer
MO = Montgomery
NH = Northampton
NU = Northumberland
PH = Philadelphia
PO = Potter
SC = Schuylkill
TI = Tioga
VE = Venango
WE = Westmoreland
WN=Wayne
(Effective 7/1/2005)
WS = Washington
YA = York/Adams
Edits: This is a required field. The code must be one that is described in the data
definition.
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CONSUMER DATA CATALOG DEFINITIONS
Picture
9(006)
Format
CCYYMM
Positions
005-010
Revision Date
3/17/97
Catalog No. 2903
Data Name Reporting Year Month
Trailer
DEFINITION: The reporting period year and end month of the quarter.
Edits: This is a required field. This field should contain a value that corresponds to an
end to a calendar quarter, i.e., 199703, 199712, etc. The value must match the “Reporting
Year Month” in the Header Record.
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CONSUMER DATA CATALOG DEFINITIONS
Picture
9(008)
Format
CCYYMMDD
Positions
011-018
Revision Date
3/17/97
Catalog No. 2904
Data Name File Creation Date
Trailer
DEFINITION: File creation date (system date file was created would be appropriate).
Edits: This is a required field. The value must be numeric, a valid calendar date, and
greater than the last day of “Reporting Year Month”. The value must match the
File Creation Date” in the Header Record.
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CONSUMER DATA CATALOG DEFINITIONS
Picture
9(005)
Format
RJ, zero fill
Positions
019-023
Revision Date
9/25/96
Catalog No. 2905
Data Name Number of Record Type 21
records
Trailer
DEFINITION: The number of Consumer Registry (type 21) records contained in the file.
Edits: This is a required field. Data must be numeric.
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CONSUMER DATA CATALOG DEFINITIONS
Picture
9(005)
Format
RJ, zero fill
Positions
024-028
Revision Date
9/25/96
Catalog No. 2906
Data Name Number of Record Type 22
Records
Trailer
DEFINITION: The number of Quarterly Status (Type 22) records contained in the file.
Edits: This is a required field. Data must be numeric.
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CONSUMER DATA CATALOG DEFINITIONS
Picture
Format
Positions
Carriage Return control
character
301-301
Revision Date
3/17/97
Catalog No. 2908
Data Name Carriage Return
Trailer
DEFINITION:
Edits: This must be the binary code equivalent of decimal code 13 from the ASCII
standard character set.
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CONSUMER DATA CATALOG DEFINITIONS
Picture
Format
Positions
Line feed control
character
302-302
Revision Date
3/17/97
Catalog No. 2909
Data Name Line Feed
Trailer
DEFINITION:
Edits: This must be the binary code equivalent of decimal code 10 from the ASCII
standard character set.
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Revision Dates for Consumer Data Elements
Current 09/01/05
Catalog Number
2001
2002
2003
2004
2005
2007
2008
2101
2102
2103
2104
2105
2106
2107
2108
2109
2110
2111
2112
2113
2114
2115
2116
2117
2118
2119
2120
2121
2122
2123
2124
2125
2126
2127
2128
Last Revision
Date
09/25/96
09/01/05
03/17/97
03/17/97
12/02/96
03/17/97
03/17/97
09/25/96
01/01/05
09/01/05
05/01/00
09/25/96
05/01/00
09/25/96
01/01/03
01/01/05
01/01/98
10/25/96
12/01/01
01/01/98
Deleted 2/1/05
07/01/02
Deleted 2/1/05
01/01/03
01/01/03
01/01/03
01/01/03
12/02/96
09/11/98
03/17/97
03/17/97
09/11/98
Deleted 2/1/05
Deleted 2/1/05
Deleted 2/1/05
Catalog Number
2129
2131
2132
2133
2134
2201
2202
2203
2204
2205
2206
2207
2208
2209
2210
2211
2212
2213
2214
2215
2216
2217
2219
2220
2221
2901
2902
2903
2904
2905
2906
2908
2909
Last Revision
Date
01/01/03
03/17/97
03/17/97
01/01/03
02/01/07
09/25/96
12/23/98
01/01/03
10/25/96
05/01/00
05/01/00
05/01/00
01/01/03
01/01/98
07/16/99
Deleted 2/1/05
Deleted 2/1/05
09/11/98
09/11/98
Deleted 2/1/05
Deleted 2/1/05
05/01/00
03/17/97
03/17/97
02/01/07
09/25/96
09/01/05
03/17/97
03/17/97
09/25/96
09/25/96
03/17/97
03/17/97
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CCR Poms Consumer Data Import Errors Error Error Message
Code
1.0
Invalid 'Record Type' in Header Record. Submission rejected.
2.0
Invalid or missing 'HMO Code' in Header Record. Submission rejected.
3.0
Invalid or missing 'Reporting Year Month' in Header Record. Submission rejected.
4.0
Invalid or missing 'File Creation Date' in Header Record. Submission rejected.
4.1
'File Creation Date' <= 'Reporting Year Month'. Submission rejected.
4.2
'File Creation Date' > today's date. Submission rejected.
5.0
Invalid or missing 'Submission Indicator'. Submission rejected.
6.0
Incorrect record length.
10.0
Invalid or missing 'Record Type'. Record rejected.
10.1
Record out of sequence on Record Type. Record rejected.
10.3
Blank line in file
11.0
Invalid or missing 'Recipient Social Security Number'. Record rejected.
12.0
Invalid or missing 'Missing Social Security Number Status' with pseudo Social Security Number
used for 'Recipient Social Security Number'. Record rejected.
12.1
Invalid or missing 'Missing Social Security Number Status'. Record rejected.
13.0
Invalid or missing 'Recipient CIS Number'. Record rejected.
14.0
Invalid or missing 'Recipient Birth Date'. Unable to evaluate fields dependent on DOB and Age.
Record rejected.
14.1 'Recipient Birth Date' > 'Reporting Year Month'. Unable to evaluate fields dependent on DOB and
Age. Record rejected.
15.0
Invalid or missing 'Recipient Initials'. Record rejected.
16.0
Invalid or missing 'Recipient Sex'. Record rejected.
17.0
Invalid or missing 'Recipient Race'. Record rejected.
17.1
Invalid Additional Recipient Race. Record rejected.
18.0
Invalid or missing 'Recipient County of Residence'. Record rejected.
19.0
Invalid or missing 'Recipient Registration Date'. Record rejected.
19.1
‘Recipient Registration Date’ > "Reporting Year Month”. Record rejected.
19.2
'Recipient Registration Date' prior to start of program. Record rejected.
19.3
Recipient already registered with this date, not closure & not correction. Record rejected.
19.4
New registration for recipient but previous registration not closed. Record rejected.
19.5
Registration/closure period overlaps registration/closure period of record already in database.
Record rejected.
19.6
Registration Date correction record - recipient already registered with this date. Record rejected
20.0
Invalid Recipient Closure Date. Record rejected.
20.1
'Recipient Closure Date' > 'Reporting Year Month'. Record rejected.
20.2
'Recipient Closure Date' < 'Recipient Registration Date'. Record rejected.
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CCR POMS Consumer Data Import Errors Error
Code
20.3
21.0
21.1
22.0
22.1
22.2
23.0
24.0
26.0
27.0
30.0
30.1
30.2
30.3
Error Message
35.2
Closure data reported but no Recipient closure date. Record rejected.
Invalid Recipient Reason for Closure. Record rejected.
Invalid Recipient Reason for Closure for Recipient age 22 or over. Record Rejected
Invalid or missing 'Recipient Priority Group'. Record rejected.
Invalid 'Recipient Priority Group (MH)' for Recipient under age 18. Record rejected.
Invalid Recipient Priority Group (MH) for Recipient age 22 or over. Record rejected.
Invalid or missing Recipient Ethnicity. Record rejected
Invalid Recipient Special Population. Record rejected.
Invalid or missing 'Recipient Independence of Living'. Record rejected.
Invalid or missing 'Recipient Vocational Educational Status'. Record rejected.
Invalid or missing 'Date of Recipient's Request to Access Services. Record rejected.
'Date of Recipient's Request to Access Services' > 'Recipient Registration Date'. Record rejected.
'Request to Access Services Date' > 'Reporting Year Month'. Record rejected.
Unable to evaluate 'Date of Recipient's Request to Access Services' due to invalid 'Recipient
Registration Date'. Record rejected.
Invalid or missing 'Correction Indicator’. Record rejected.
Invalid or missing 'Incorrect Social Security Number'. Record rejected.
'Incorrect Social Security Number' used and 'Correction Indicator' not equal to '1'. Record rejected.
No match found for 'Incorrect Social Security Number' in POMS Data Base. Record rejected.
SSN correction record attempting to use SSN and REG. DATE already in database. Record
rejected.
Invalid or missing 'Year Month of Correction'. Record rejected.
'Year Month of Correction' used with 'Correction Indicator' of '0'. Record rejected.
Correction year month >= reporting year month. Record Rejected.
Invalid or missing 'Incorrect Registration Date'. Record rejected.
'Incorrect Registration Date' used and 'Correction Indicator' not equal to '1'. Record rejected.
No match found for 'Incorrect Registration Date' in POMS Data Base. Record rejected.
No matching 'Recipient Social Security Number' found in POMS Data Base. Record rejected.
No matching 'Recipient Registration Date' found in POMS Data Base for correction. Record
rejected.
No matching record found for this Consumer Registry deletion record
52.0
53.0
53.1
53.2
54.0
54.1
54.2
55.0
55.1
55.2
Invalid or missing 'Recipient Residential Movement'. Record rejected.
Invalid or missing 'Recipient School Attendance'. Record rejected.
Invalid Recipient School Attendance for Recipient age 22 or over. Record rejected.
Invalid "Recipient School Attendance" for Recipient over age 6.Record Rejected
Invalid or missing 'Recipient School Performance'. Record rejected.
Invalid Recipient School Performance for Recipient age 22 or over. Record rejected.
Invalid "Recipient School Performance" for Recipient over age 6.Record Rejected
Invalid or missing 'Recipient School Behavior'. Record rejected.
Invalid Recipient School Behavior for Recipient age 22 or over. Record rejected.
Invalid "Recipient School Behavior" for Recipient over age 6.Record Rejected
31.0
32.0
32.1
32.2
32.3
33.0
33.1
33.2
34.0
34.1
34.2
35.0
35.1
Page 78 of 179
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Performance Outcome Management System
Reporting Manual for Encounter & Subcapitation Data
Error Error Message
Code
56.0
56.1
56.2
59.0
59.1
59.2
59.3
60.0
61.0
61.1
62.0
80.0
81.0
81.1
82.0
82.1
83.0
83.1
84.0
84.1
85.0
85.1
Invalid or missing 'Source for Recipient School Data Elements'. Record rejected.
Invalid Source for Recipient School Data Elements for Recipient age 22 or over. Record rejected.
Invalid Source for Recipient School Data Elements for Recipient over age 6. Record Rejected.
Invalid or missing 'Recipient Priority Group Update Date'. Record rejected.
Recipient Priority Group Update Date > Reporting Year Month. Record rejected.
Recipient not open at time of 'Recipient Priority Group Update Date'. Record rejected.
Recipient not open at the time of Reporting Quarter. Record rejected.
Quarterly Status record already reported this quarter (record submitted not correction). Record
rejected.
No matching 'Recipient Social Security Number' in Consumer Registry File for this Quarterly
Status deletion record. Record rejected.
No matching "Recipient Social Security Number" in Quarterly Status File for this Quarterly Status
deletion record. Record rejected.
Quarterly Status record submitted for Recipient who is not a behavioral health priority group
enrollee. Record rejected.
Invalid 'Record Type' in last record ('29' expected). Submission rejected.
Invalid or missing 'HMO Code' in Trailer Record.
'HMO Code' in Trailer Record does not match Header Record.
Invalid or missing 'Reporting Year Month' in Trailer Record.
'Reporting Year Month' in Trailer Record does not match Header Record.
Invalid or missing 'File Creation Date' in Trailer Record.
'File Creation Date' in Trailer Record does not match Header Record.
Invalid or missing 'Number of Record Type 21 Records' in Trailer Record.
'Number of Record Type 21 Records' in Trailer Record does not match file.
Invalid or missing 'Number of Record Type 22 Records' in Trailer Record.
'Number of Record Type 22 Records' in Trailer Record does not match file.
Page 79 of 179
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Reporting Manual for Encounter & Subcapitation Data
Section 3
Encounter Data Files and Record Types
Header Record-The Encounter header record will identify your CAU, the provider MA ID number, the
date the submission file was created, the submission type, and the reporting period for which you are
submitting records. If the Record Type is not "0", or if the CAU Code, Provider MA ID Number, File
Creation Date, Submission Indicator, or Adjudication Dates are invalid or missing, the entire submission
will be rejected.
Encounter Record-For mental health services funded by county-base and CHIPP allocations the
Encounter Record documents each procedure or service performed during, or as a result of, a face-to-face
contact between a consumer and a provider or subcontractor who renders the service. Services directly
provided by the CAU are also to be reported via encounter records. The following are Encounter Data
record types that are valid for CCR POMS reporting:
 Medical Services (Record Type 6)
 Inpatient (Record Type 8)
The Medical Services Encounter Record (Record Type 6) can be used to report services provided to a
consumer over a monthly period rather than being limited to services provided on consecutive days.
All CCR POMS Encounter Record types (Record Types 6 - 8) can be used to report Services in the
Aggregate Provided to Unidentified Consumers. Aggregate reporting of Encounter data for unidentified
consumers is to be done at the "Procedure Code" level. Although no corresponding Consumer Registry
record will be submitted for these aggregated Encounter records, a "Recipient Social Security Number"
must be created, according to the following format:
 Positions 1-2 = Provider Type
 Positions 3-9 = "0000000"
Trailer Record-The trailer record will contain the number of records of each type submitted. If the number
of records indicated in the trailer record does not agree with the actual count, the submission will not be
accepted.
Correction Instructions- Records that are rejected need only be corrected and resubmitted in a new
"initial" submission file. Correction submissions are not used in CCR POMS Encounter reporting.
GENERAL INFORMATION All files will include header and trailer records.
 Character coding must be ANSI ASCII.
 Quantity and dollar fields are “sign leading separate character”. The appropriate fields are noted as
such on the record layouts.
The file is to be sorted in ascending sequence on Record Type. This will cause the header record to be first
on the file, followed by the encounter records (grouped by “invoice type”), and concludes with the trailer
record.
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Reporting Manual for Encounter & Subcapitation Data
Subcapitation Financial Data File
Header Record-The Subcapitation Financial header record will identify your CAU, the provider MA ID
number, the date the submission file was created, and the submission type. If the Record Type is not "0", or
if the CAU Code, Provider MA ID Number, File Creation Date, or Submission Indicator are invalid or
missing, the entire submission will be rejected.
Financial Detail Record-The Financial Detail record is used to report payments to providers for services
to consumers not individually identified. Instructions for preparing the Financial Detail record are provided
in Appendix C.
Trailer Record-The trailer record will contain the number of Financial Detail records submitted. If the
number of records indicated in the trailer record does not agree with the actual count, the submission will
not be accepted.
Correction Instructions
Records that are rejected need only be corrected and resubmitted in a new "initial" submission file.
Correction submissions are not used in CCR POMS Subcapitation Financial Data reporting.
GENERAL INFORMATION All files will include header and trailer records.
 Character coding must be ANSI ASCII.
 Quantity and dollar fields are “sign leading separate character”. The appropriate fields are noted as
such on the record layouts.
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Reporting Manual for Encounter & Subcapitation Data
Encounter Data File & Record Layout Specifications
File Name
CCR POMS Encounter Data
Record Name
Header
Specific Record Size
53 Characters
Rev Date
01/01/05 (Corrected 9/1/05)
Page 1 of 1
NOTE: All signed fields are SIGN LEADING SEPARATE CHARACTER
Catalog
Field Name
Field
Field
Start End Special instructions
number
Type
Size
081
Record Type
A/N
001
1
1
Constant ‘0’
037
CAU Code
A/N
002
2
3
073
CAU Provider ID
N
009
4
12
RJ, Zero-fill
Number
033
File Creation Date
N
008
13
20
RJ, CCYYMMDD (C=Century,
Y=Year, M=Month, D=Day
092
Submission Indicator
A/N
001
21
21
Possible value “I”
ADJUDICATION
PERIOD
001
Adjudication From
N
008
22
29
RJ, CCYYMMDD (C=Century,
Date
Y=Year, M=Month, D=Day
002
Adjudication To Date N
008
30
37
RJ, CCYYMMDD (C=Century,
Y=Year, M=Month, D=Day
Filler
A/N
016
38
53
Blank Fill
CR
001
54
54
Carriage Return Control Character
LF
001
55
55
Line Feed Control Character
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Reporting Manual for Encounter & Subcapitation Data
Encounter Data File & Record Layout Specifications
File Name
Record Name
Specific Record Size
Rev Date
Page 1 of 2
CCR POMS Encounter Data
Record Type 6 MEDICAL Services
308 Characters
09/01/05
NOTE: All signed fields are SIGN LEADING SEPARATE CHARACTER
Catalog
Number
081
037
063
Field
Type
A/N
A/N
N
Field
Size
001
002
008
Start
End
Special instructions
1
2
4
1
3
11
Constant value “6”
A/N
001
12
12
N
001
13
13
Claim Reference
Number
Adjustment CRN
A/N
020
14
33
A/N
020
34
53
N
A/N
A/N
010
010
002
54
64
74
63
73
75
N
N
009
004
76
85
84
88
N
003
89
91
RJ, zero fill
007
Recipient CIS Number
FILLER
Recipient County of
Residence
MA Provider Number
Provider Service
Location
Provider Specialty
Code
FILLER
Begin Date of Service
LJ, Blank fill, blank
if not present
RJ, zero fill
Blank fill
RJ, zero fill, blank if
not present
RJ, zero fill
RJ, zero fill
A/N
A/N
009
008
92
101
100
108
031
End Date of Service
N
008
109
116
070
Procedure Code
A/N
005
117
121
Blank fill
RJ, Format
CCYYMMDD,
Blank if not present
RJ, Format
CCYYMMDD
LJ
012
003
009
004
077
124
050
125
126
Field Name
Record Type
CAU Code
Payment/Adjudication
Date
FILLER or ‘L’ for
lab
Adjustment Code
RJ, Format
CCYYMMDD
Blank-fill
Possible value 0,1 or
3
LJ, Blank fill
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File Name
Record Name
Specific Record Size
Rev Date
Page 2 of 2
CCR POMS Encounter Data
Record Type 6 MEDICAL Services
308 Characters
09/01/05
NOTE: All signed fields are SIGN LEADING SEPARATE CHARACTER
064
074
Place of Service
Quantity
N
N
002
006
122
124
123
129
A/N
N
A/N
004
001
002
130
134
135
133
134
136
A/N
006
137
142
A/N
002
067
FILLER
FILLER
Procedure Code Pricing
Modifier
Procedure Code
Information Modifier
Section – Modifier
Occurs 3 times
Procedure Code
Information
Modifier
Primary Diagnosis
A/N
005
143
147
085
Secondary Diagnosis
A/N
005
148
152
006
FILLER
Amount Reimbursed
A/N
N
012
010
153
165
164
174
A/N
A/N
076
001
175
251
250
251
080
076
FILLER
Capitation FFS
Indicator
Recipient SS #
Recipient Birth Date
N
A/N
009
008
252
261
260
268
111
FILLER
Missing SS# Status
A/N
N
027
001
269
296
295
296
FILLER
CR
A/N
012
001
297
309
308
309
001
310
310
071
072
109
LF
RJ, zero fill
RJ, zero fill, Format
S9(05)
blank fill
blank fill
LJ, blank fill, blank
if not present
LJ, blank fill, blank
if not present
LJ, blank fill, blank
if not present
LJ, blank fill, blank
if not present
Blank fill
RJ, zero fill, Format
S9(07)V99
Blank fill
RJ
RJ, Format
CCYYMMDD
Blank fill
Possible value 0,1,2
or 3
Blank fill
Carriage Return
Control Character
Line Feed Control
Character
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Reporting Manual for Encounter & Subcapitation Data
Encounter Data File & Record Layout Specifications
File Name
CCR POMS Encounter Data
Record Name
Record Type 8 INPATIENT
Specific Record Size
864 Characters
Rev Date
01/01/05 (Corrected 9/1/05)
Page 1 of 2
NOTE: All signed fields are SIGN LEADING SEPARATE CHARACTER
Catalog
Number
081
037
063
003
009
004
077
124
050
125
126
007
031
098
064
074
032
067
Field Name
Field
Type
A/N
A/N
N
Field
Size
001
002
008
Start
End
Special instructions
1
2
4
1
3
11
Constant value “8”
A/N
N
A/N
001
001
020
12
13
14
12
13
33
Blank-fill
Possible value 0,1 or 3
LJ, Blank fill
A/N
020
34
53
Recipient CIS Number
FILLER
Recipient County of
Residence
MA Provider Number
Provider Service
Location
Provider Specialty
Code
FILLER
Begin Date of Service
N
A/N
A/N
010
010
002
54
64
74
63
73
75
N
N
009
004
76
85
84
88
LJ, Blank fill, blank if not
present
RJ, zero fill
Blank fill
RJ, zero fill, blank if not
present
RJ, zero fill
RJ, zero fill
N
003
89
91
RJ, zero fill
A/N
A/N
009
008
92
101
100
108
End Date of Service
Type of Admission
FILLER
Place of Service
Quantity
FILLER
Fifth Diagnosis
Primary Diagnosis
N
N
A/N
N
N
A/N
A/N
A/N
008
001
004
002
006
004
005
005
109
117
118
122
124
130
134
139
116
117
121
123
129
133
138
143
Blank fill
RJ, Format CCYYMMDD,
Blank if not present
RJ, Format CCYYMMDD
Possible value 1, 2 or 3
Blank Fill
Constant value 21
RJ, zero fill, Format S9(05)
Blank fill
LJ, Blank fill
LJ, Blank fill
Record Type
CAU Code
Payment/Adjudication
Date
FILLER
Adjustment Code
Claim Reference
Number
Adjustment CRN
RJ, Format CCYYMMDD
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Reporting Manual for Encounter & Subcapitation Data
File Name
CCR POMS Encounter Data
Record Name
Record Type 8 INPATIENT
Specific Record Size
864 Characters
Rev Date
01/01/05 (Corrected 9/1/05)
Page 2 of 2
NOTE: All signed fields are SIGN LEADING SEPARATE CHARACTER
085
093
034
006
005
062
082
084
083
105
080
076
109
111
Secondary Diagnosis
Tertiary Diagnosis
Fourth Diagnosis
FILLER
Amount Reimbursed
A/N
A/N
A/N
A/N
N
005
005
005
002
010
144
149
154
159
161
148
153
158
160
170
FILLER
Admission Date
FILLER
Patient Discharge
Status
FILLER
REVENUE CODE
SECTIONREVENUE CODE
DATA OCCURS 22
TIMES
Revenue Code
A/N
A/N
N
N
060
008
014
002
171
231
239
253
230
238
252
254
A/N
A/N
129
418
255
384
383
801
A/N
019
A/N
004
Revenue Code
Service Units
Revenue Code
Charges
DRG Number
Recipient SS#
Recipient Birth Date
FILLER
Capitation FFS
Indicator
Missing SS# Status
FILLER
CR
N
005
N
010
N
N
A/N
A/N
A/N
003
009
008
027
001
802
805
814
822
849
804
813
821
848
849
N
A/N
001
014
001
850
851
865
850
864
865
001
866
866
LF
LJ, Blank fill
LJ, Blank fill
LJ, Blank fill
Blank fill
RJ, zero fill, Format
S9(07)V99
Blank fill
RJ, Format CCYYMMDD
Blank fill
RJ, zero fill
Blank fill
RJ, zero fill, Blank if not
present
RJ, zero fill, Format S9(04)
RJ, zero fill, Format
S9(07)V99
RJ, zero fill
RJ
RJ, Format CCYYMMDD
Blank fill
Possible value 0,1,2 or 3
Blank fill
Carriage Return Control
Character
Line Feed Control
Character
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Reporting Manual for Encounter & Subcapitation Data
Encounter Data File & Record Layout Specifications
File Name
Record Name
Specific Record Size
Blocking Factor
Rev Date
Page 1 of 1
CCR POMS Encounter Data
TRAILER
80 Characters (Minimum 52/Maximum 864)
35 RPB Variable Length Block
01/01/05
NOTE: All signed fields are SIGN LEADING SEPARATE CHARACTER
Catalog
number
081
029
025
030
Field Name
Record Type
Encounter Input Counts
FILLER
Encounter Count Medical
Services Type 6
FILLER
Encounter Count Inpatient
Services Type 8
Total Encounters
FILLER
CR
LF
Field
Type
A/N
Field
Size
001
Start End Special instructions
1
1
Constant value “9”
A/N
N
035
007
2
37
36
43
Blank fill
RJ, Zero Fill
AN
N
007
007
44
51
50
57
Blank fill
RJ, Zero Fill
N
A/N
008
015
001
58
66
81
65
80
81
001
82
82
RJ, Zero Fill
Blank Fill
Carriage Return Control
Character
Line Feed Control
Character
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Reporting Manual for Encounter & Subcapitation Data
Subcapitation Data File & Record Layout Specifications
File Name
Record Name
Specific Record Size
Rev Date
Page 1 of 1
CCR POMS Subcapitation Data
Header
61 Character Fixed
02/01/05 (Corrected 9/26/05)
NOTE: All signed fields are SIGN LEADING SEPARATE CHARACTER
Catalog
number
081
037
073
033
092
Field Name
Record Type
CAU Code
CAU Provider ID
Number
File Creation Date
Submission
Indicator
FILLER
CR
LF
Field
Type
A/N
A/N
N
Field
Size
001
002
009
Start
End
Special instructions
1
2
4
1
3
12
Constant H
N
008
13
20
A/N
001
21
21
RJ, zero fill, Format
CCYYMMDD
Possible value I
A/N
040
001
22
62
61
62
001
63
63
RJ, zero fill
Blank-fill
Carriage Return Control
Character
Line Feed Control
Character
Page 88 of 179
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Reporting Manual for Encounter & Subcapitation Data
Subcapitation Data File & Record Layout Specifications
File Name
Record Name
Specific Record Size
Rev Date
CCR POMS Subcapitation Data
Financial Detail
100 Character Fixed
02/01/05 (Corrected 9/1/05)
Revised 3/1/07 for file submissions after 3/31/07.
Page 1 of 1
NOTE: All signed fields are SIGN LEADING SEPARATE CHARACTER
Catalog
number
081
037
050
125
126
012
091
013
014
008
063
003
070
071
072
Field Name
Record Type
CAU Code
MA Provider Number
Provider Service
Location
Provider Specialty
Code
Filler or “L” for lab
FILLER
Subcapitation
Payment
Coverage Begin Date
Coverage End Date
Category of Provider
FILLER
Payment/Adjudication
Date
FILLER
Adjustment Code
Procedure Code
Procedure Code
Pricing Modifier
Procedure Code
Information Modifier
Section – Modifier
Occurs 3 times
Procedure Code
Information Modifier
FILLER
CR
LF
Field
Type
A/N
A/N
N
N
Field
Size
001
002
009
004
Start End
Special instructions
1
2
4
13
1
3
12
16
Constant S
N
003
17
19
RJ, zero fill
A/N
A/N
N
001
006
010
20
21
27
20
26
36
N
N
N
A/N
N
008
008
001
10
008
37
45
53
54
64
44
52
53
63
71
Blank-fill
Blank fill
RJ, zero fill,
Format S9(07)V99
Format CCYYMMDD
Format CCYYMMDD
A/N
A/N
A/N
A/N
010
001
005
002
72
82
83
88
81
82
87
89
A/N
006
90
95
A/N
002
A/N
005
001
96
101
100
101
001
102
102
RJ, zero fill
RJ, zero fill
Blank fill
RJ, Format
CCYYMMDD
Blank fill
Must equal 1,3 or 0
LJ, blank fill
LJ, blank if not present
LJ, blank fill, blank if
not present
Blank fill
Carriage Return
Control Character
Line Feed Control
Character
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Reporting Manual for Encounter & Subcapitation Data
Subcapitation Data File & Record Layout Specifications
File Name
CCR POMS Subcapitation Data
Record Name
Trailer
Specific Record Size
60 Character Fixed
Blocking Factor
500 RPB Fixed Length Block
Rev Date
01/01/05
Page 1 of 1
NOTE: All signed fields are SIGN LEADING SEPARATE CHARACTER
Catalog
Field Name
Field
Field
Start End
number
Type
Size
081
Record Type
A/N
001
1
1
090
Subcapitation Record
N
008
2
9
Count
Filler
A/N
051
10
60
CR
001
61
61
LF
001
62
62
Special instructions
Constant Value “T”
RJ, Zero Fill
Blank Fill
Carriage Return Control
Character
Line Feed Control Character
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Reporting Manual for Encounter & Subcapitation Data
Encounter and Subcapitation Data Catalog Summary
Catalog
Number
001
002
003
004
005
006
007
109
008
037
073
009
013
014
105
025
029
031
032
033
034
012
050
111
062
063
064
067
070
071
072
125
126
074
076
077
124
080
081
082
083
084
Data Name
ENCOUNTER
RECORD TYPE
H
6
8
T
SUBCAPITATION
FILE
H
S
T
Adjudication From Date
Adjudication To Date
Adjustment Code
Adjustment CRN
Admission Date
Amount Reimbursed
Begin Date of Service
Capitation FFS Indicator
Category of Provider
CAU Code
CAU Provider ID Number
Claim Reference Number
Coverage Begin Date
Coverage End Date
DRG Number
Encounter Count Inpatient Type 8
Encounter Count Medical Services
Type 6
End Date of Service
Fifth Diagnosis
File Creation Date
Fourth Diagnosis
Lab Indicator
MA Provider Number
Missing Social Security Number Status
Patient Discharge Status
Payment Adjudication Date
Place of Service
Primary Diagnosis
Procedure Code
Procedure Code Pricing Modifier
Procedure Code Information Modifier
Provider Service Location
Provider Specialty Code
Quantity
Recipient Birth date
Recipient CIS Number
Recipient County of Residence
Recipient Social Security No.
Record Type
Revenue Code
Revenue Code Charges
Revenue Code Service Units
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Reporting Manual for Encounter & Subcapitation Data
Catalog
Number
085
090
091
092
093
030
098
Data Name
ENCOUNTER
RECORD TYPE
H
6
8
T
SUBCAPITATION
FILE
H
S
T
Secondary Diagnosis Code
Subcapitation Record Count
Subcapitation Payment
Submission Indicator
Tertiary Diagnosis
Total Encounters
Type of Admission
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Reporting Manual for Encounter & Subcapitation Data
Encounter and Subcapitation Data Catalog Definitions
ENCOUNTER AND SUBCAPITATION DATA CATALOG DEFINITIONS
Picture 9(08)
Format RJ;CCYYMMDD
Positions 021-028
Catalog No. 001
Data Name Adjudication From Date
Revised 9/1/05
Page 1 of 1
HEADER
Field Required
Field Optional
Field N/A
Type 6 Medical Services
Type 8 Inpatient
Subcapitation
DEFINITION: CAU’s are required to submit encounter data to the Department on a
quarterly basis. The file should be received by the Department no later than 60 days
following the end of the quarter.
The Adjudication From Date represents the first day of the first month of the quarter for
which the encounter data is being submitted. Example: “19990701”
Editing Criteria: Must be numeric. Must be less than the system processing date.
The Adjudication From Date must be less than the File Header's Adjudication To Date
(Catalog No.002). The Adjudication From Date must be a valid calendar date on or after
July 1, 1999. Adjudication From Date must be less than, or equal to the File Creation
Date (Catalog No. 033).
Page 93 of 179
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Performance Outcome Management System
Reporting Manual for Encounter & Subcapitation Data
ENCOUNTER AND SUBCAPITATION DATA CATALOG DEFINITIONS
Picture 9(08)
Format RJ; CCYYMMDD
Positions 029-036
Catalog No. 002
Data Name Adjudication To Date
Revised 9/1/05
Page 1 of 1
HEADER
Field Required
Field Optional
Field N/A
Type 6 Medical Services
Type 8 Inpatient
Subcapitation
DEFINITION: CAU’s are required to submit encounter data to the Department on a
quarterly basis. The file should be received by the Department no later than 60 days
following the end of the quarter.
The Adjudication To Date represents the last day of the third month of the quarter for
which the encounter data is being submitted. Example: “19990930”
SPECIAL INSTRUCTIONS:
Editing Criteria: Must be numeric. Must be less than the system processing date.
The Adjudication To Date must be greater than, or equal to the File Header's
Adjudication From Date (Catalog No. 001). The Adjudication To Date must be a valid
calendar date after July 1, 1999. Adjudication To Date must be less than, or equal to the
File Creation Date (Catalog No. 033).
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Reporting Manual for Encounter & Subcapitation Data
ENCOUNTER AND SUBCAPITATION DATA CATALOG DEFINITIONS
Picture 9(01)
Format
Positions 013-013 (Encounter)
077-077 (Subcapitation)
Revised 4/1/01
Page 1 of 3
Type 6 Medical Services
Type 8 Inpatient
Subcapitation
Field Required
X
X
X
Catalog No. 003
Data Name Adjustment Code
Field Optional
Field N/A
DEFINITION: A code to indicate whether the encounter/subcapitation record is to report
a service to DPW for the first time or to change an encounter record previously accepted
by DPW.
Valid codes are:
1 -- First time submission of an encounter/subcapitation record
0 -- Cancellation of a previously submitted encounter/subcapitation record
3 -- Replacement of a cancelled encounter/subcapitation record
SPECIAL INSTRUCTIONS – Encounter records: If the record is for an initial
submission rather than an adjustment of a record previously accepted by OMHSAS, use
Adjustment Code value "1".
An adjustment record should be sent if any of the data on an encounter record previously
accepted by OMHSAS has changed or was submitted incorrectly. Adjustments use a twostep process to cancel and, if applicable, replace an encounter record.
1. Cancel the incorrect record by submitting an adjustment (Adjustment Code
value "0") with all fields exactly as they were submitted on the record being
adjusted, with the following exceptions:
a. All quantity, dollar, and count fields with non-zero values must have a
negative sign.
b. Payment/Adjudication Date (Catalog No. 063) -- If the cancellation
impacted the payment to the provider, use a date applicable to the
cancellation; not the date originally assigned by the CAU to the record
being adjusted. If a replacement record will be submitted for this
cancellation record, use the same date assigned to the replacement record.
If the cancellation is submitted to correct a non-payment related error and
did not cancel the payment to the provider, use the Payment/Adjudication
Date as it appeared on the encounter record which is being cancelled.
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Reporting Manual for Encounter & Subcapitation Data
c. Adjustment Code (Catalog No. 003) -- Use the value "0".
d. Claim Reference Number (Catalog No. 009) -- Assign a new number; do
not use Claim Reference Number previously assigned by the CAU to the
encounter record being adjusted.
e. Adjusted Claim Reference Number (Catalog No. 004) -- The Claim
Reference Number (Catalog No. 009) originally assigned by the
HMO/MCO to the encounter record being adjusted. For an adjustment to
an adjustment, use the Claim Reference Number (Catalog No. 009)
assigned to the most recent encounter record being adjusted.
2. If applicable, submit a replacement record (Adjustment Code value "3")
with corrected data in all fields except as noted below:
a. Payment/Adjudication Date (Catalog No. 063) -- If the replacement
record impacts the payment to the provider, use the date applicable to the
adjustment; not the date originally assigned by the CAU to the encounter
record being adjusted. If the replacement is submitted to correct a nonpayment related error and does not impact the payment to the provider, use
the Payment/Adjudication Date as it appeared on the encounter record
which is being corrected.
b. Adjustment Code (Catalog No. 003) -- Use the value "3".
c. Claim Reference Number (Catalog No. 009) -- Assign a new number; do
not use the Claim Reference Number previously assigned by the CAU to
the encounter record being adjusted.
d. Adjusted Claim Reference Number (Catalog No. 004) -- The Claim
Reference Number (Catalog No. 009) originally assigned by the CAU to
the encounter record being adjusted. For an adjustment to an adjustment,
use the Claim Reference Number (Catalog No. 009) assigned to the most
recent record to be adjusted.
For each encounter record having Adjustment Code value "3", there must be a
corresponding encounter record with an Adjustment Code value "0".
If both the adjustment and the record to be adjusted are adjudicated in the same reporting
period and would be submitted to DPW on the same file, the contractor has the option of
sending both records or only one record with the "correct" data. If only the "correct"
encounter is sent to DPW, it would not be considered an adjustment and, consequently,
would be submitted with an Adjustment Code value "1".
SPECIAL INSTRUCTIONS – Subcapitation records: If the record is for an initial
submission rather than an adjustment of a record previously accepted by DPW, use
Adjustment Code value "1".
An adjustment record should be sent if any of the data on a subcapitation record
previously accepted by DPW has changed or was submitted incorrectly. However,
because there is no single data element that uniquely identifies a subcapitation record (as
is the case with the Encounter record and the Claim Reference Number) there are two
different two-step processes to cancel and replace a subcapitation record.
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Performance Outcome Management System
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Only the Subcapitation Payment (Catalog No. 091) or the Payment/Adjudication Date
(Catalog No. 063) can be changed or corrected by submitting an adjustment with
Adjustment Code value “0” to cancel the incorrect record, followed by an adjustment with
Adjustment Code value “3” to replace the incorrect record.
To correct or change the MA Provider Number (Catalog No. 050), Provider Service
Location (Catalog No.125), Provider Specialty Code (Catalog No. 126), Coverage Begin
Date (Catalog No. 013), Coverage End Date (Catalog No. 014), Category of Provider
(Catalog No. 008), Procedure Code (Catalog No. 070), Procedure Code Pricing Modifier
(Catalog No. 071), or Procedure Code Information Modifier (Catalog No. 072), it is
necessary to submit an adjustment with Adjustment Code value “0” to cancel the incorrect
record, followed by an “initial” Subcapitation record with Adjustment Code value “1” to
replace the incorrect record.
Note that the Subcapitation Payment (Catalog No. 091) and the Payment/Adjudication
Date (Catalog No. 063) can also be changed by submitting an adjustment with Adjustment
Code value “0” to cancel the incorrect record, followed by an “initial” Subcapitation
record with Adjustment Code value “1” to replace the incorrect record.
1. Cancel an incorrect Subcapitation record by submitting an adjustment
(Adjustment Code value "0") with all fields exactly as they were submitted on the
record being cancelled, with the following exceptions:
a. Subcapitation Payment (Catalog No. 091) should have a negative sign.
b. Payment/Adjudication Date (Catalog No. 063) -- If the cancellation
impacted the payment to the provider, use a date applicable to the
cancellation; not the date originally assigned by the CAU to the record
being adjusted. If a replacement record will be submitted for this
cancellation record, use the same date assigned to the replacement record.
If the cancellation is submitted to correct a non-payment related error and
did not cancel the payment to the provider, use the Payment/Adjudication
Date as it appeared on the subcapitation record which is being cancelled.
c. Adjustment Code (Catalog No. 003) -- Use the value "0".
2. If applicable, submit a replacement record (Adjustment Code value "3")
with all fields exactly as they were submitted on the record being replaced, with
the following exceptions:
a. Subcapitation Payment (Catalog No. 091) should have a positive sign.
b. Payment/Adjudication Date (Catalog No. 063) – should reflect the date
of the payment to the provider. If the Subcapitation Payment amount was
originally reported incorrectly, but the Payment/Adjudication Date was
reported correctly, the Payment/Adjudication Date can remain the same as
it was originally reported. If some kind of payment adjustment was made
with the provider, the Payment/Adjudication Date should relate to the date
of the adjustment.
c. Adjustment Code (Catalog No. 003) -- Use the value "3".
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Reporting Manual for Encounter & Subcapitation Data
For each subcapitation record having Adjustment Code value "3", there must be a
corresponding subcapitation record with an Adjustment Code value "0".
3. If applicable, submit an “initial” Subcapitation record with Adjustment Code
value “1” to replace the incorrect record. There are no requirements that any
fields on the submitted record match any of the fields of the record being replaced.
Editing Criteria: Must be "0", "1", or "3".
For Encounters:
If equal to "1", the Adjustment CRN (Catalog No. 004) must be blank. If equal to "0" or
"3", the Adjustment CRN (Catalog No. 004) must be present (not blank).
If equal to "0", the following fields, if applicable to the Record Type (Catalog No. 081),
must be equal to or less than zero; conversely, if equal to "1" or "3", the following fields
must be equal to or greater than zero:
Amount Reimbursed (Catalog No. 006)
Revenue Code Charges (Catalog No. 083) -- Occurs 22 times
Revenue Code Service Units (Catalog No. 084) -- Occurs 22 times
For Subcapitation records:
If equal to "0" or "3", a target record in the database must be present. A Target record
matches the following data elements of the submitted record:










CAU Code (Catalog No. 081)
MA Provider Number (Catalog No. 050)
Provider Service Location (Catalog No.125)
Provider Specialty Code (Catalog No. 126)
Coverage Begin Date (Catalog No. 013)
Coverage End Date (Catalog No. 014)
Category of Provider (Catalog No. 008)
Procedure Code (Catalog No. 070) – for Reporting Option 2
Procedure Code Pricing Modifier (Catalog No. 071) – for Reporting Option 2
Procedure Code Information Modifier (Catalog No. 072) – for Reporting Option 2
If equal to "0", the Subcapitation Payment (Catalog No. 091) must be equal to or less than
zero. Conversely, if equal to "1" or "3", the Subcapitation Payment (Catalog No. 091)
must be equal to or greater than zero.
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ENCOUNTER AND SUBCAPITATION DATA CATALOG DEFINITIONS
Picture X(20)
Format LJ, blank-fill
Positions 034-053
Catalog No. 004
Data Name Adjustment CRN
Revised 9/1/05
Page 1 of 1
Field Required
Type 6 Medical Services
Type 8 Inpatient
Subcapitation
Field Optional
X
X
Field N/A
X
DEFINITION: The Claim Reference Number (Refer to Catalog No. 009) of an encounter
previously accepted by DPW for which data has changed.
SPECIAL INSTRUCTIONS: This data element is only applicable to adjustments to
previously accepted encounters. If the encounter to be reported is not an adjustment,
blank-fill this field.
Editing Criteria: Must be present (not spaces) if Adjustment Code (Catalog No. 003) is
"0" or "3". Must be spaces if Adjustment Code (Catalog No. 003) is "1". Must be
alphanumeric (numbers & letters only) and must be unique within each CAU.
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ENCOUNTER AND SUBCAPITATION DATA CATALOG DEFINITIONS
Picture X(08)
Format RJ, CCYYMMDD
Positions 231-238
Catalog No. 005
Data Name Admission Date
Revised 5/23/97
Page 1 of 1
Field Required
Type 6 Medical Services
Type 8 Inpatient
Subcapitation
Field Optional
Field N/A
X
X
X
DEFINITION: The date the recipient is admitted to either a long term care facility or
hospital.
SPECIAL INSTRUCTIONS: For record type 8, this is a required field.
Editing Criteria
Must be a valid calendar date. Admission date must be prior to end Date of Service.
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ENCOUNTER AND SUBCAPITATION DATA CATALOG DEFINITIONS
Picture S9(07)V99
Format RJ, zero-filled
Positions 161-170 Type 8
165-174 Type 6
Revised 9/1/05
Page 1 of 1
Catalog No. 006
Data Name Amount Reimbursed
Field Required
Type 6 Medical Services
Type 8 Inpatient
Subcapitation
Field Optional
X
X
Field N/A
X
DEFINITION: The amount contractor or subcontractor paid to the provider for the
service.
SPECIAL INSTRUCTIONS: Required field for CCR POMS counties who opted to
report expenditure information at the detail service level. For CCR POMS counties the
amount reported should be the total of DPW Reimbursement and County Match. Not
required for CCR POMS counties who opted to report expenditure information in an
annual subcapitation file. If no payment was made for the service because of a
subcapitation arrangement with the provider or if the claim was denied, zero-fill.
Editing Criteria: Must be numeric. Must be zero-filled with a leading sign in all cases
when reporting summary expenditure information. Must be equal to or greater than zero
if Adjustment Code (Catalog No. 003) equals "1" or "3". Must be less than or equal to
zero if Adjustment Code (Catalog No. 003) equals "0".
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Reporting Manual for Encounter & Subcapitation Data
ENCOUNTER AND SUBCAPITATION DATA CATALOG DEFINITIONS
Picture X(08)
Format RJ, CCYYMMDD
Positions 101-108
Catalog No. 007
Data Name Begin Date of Service
Revised 10/5/01
Page 1 of 1
Field Required
Type 6 Medical Services
Type 8 Inpatient
Subcapitation
Field Optional
X
Field N/A
X
X
DEFINITION: For Record Type (Catalog No. 081) "6", the first day of the service period
if the service period includes more than one consecutive day.
For Record Types (Catalog No. 081) "8", the first day of the service period.
SPECIAL INSTRUCTIONS: For Record Types (Catalog No. 081) "6", required only if
different than the End Date of Service (Catalog No. 031). Also for Record Types
(Catalog No. 081) "6", if present, a service must have been provided on all dates between
the Begin Date of Service and the End Date of Service (Catalog No. 031), inclusive.
Begin Date of Service is required for Record Types (Catalog No. 081) "8".
If not applicable, blank-fill.
Editing Criteria: If present (not spaces), must be numeric and must be a valid date.
Must be present (not spaces) if Record Type (Catalog No. 081) is "8. If present, must be
less than or equal to the End Date of Service (Catalog No. 031). Must be less than or
equal to the File Header Record's Adjudication To Date (Catalog No. 002).
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ENCOUNTER AND SUBCAPITATION DATA CATALOG DEFINITIONS
Picture X(01)
Format
Positions 53
Revised 1/1/05
Page 1 of 1
Catalog No. 008
Data Name Category of Provider
Field Required
Field Optional
Field N/A
Type 6 Medical Services
X
Type 8 Inpatient
X
Subcapitation
X
DEFINITION: A code that indicates the provider payment arrangement.
The code entered is used to create a link between Encounter records and Subcapitation
records that report services for the same provider during the same time period, so that
payments made after services were originally reported may be applied to the individual
Encounters. Matching values in the Subcapitation record’s Category of Provider and an
Encounter record’s Capitation FFS Indicator (Catalog #109) establish the link. Appendix
C describes this in detail.
Valid codes for CAU’s who opt to report expenditure information at the detail service
level (Option 1 in Appendix C) are:
C -- Cost Settlement
R -- Retainer Agreement with a retainer fee
S -- Subcapitation agreement with a capitation fee
Z -- Reinvestment funds
1, 2, 3, 4, 5, 6,7 or 8—Program Funded Services, including Gross Adjustment
payments to program funded providers
9—Gross Adjustment payment to a fee-for-service provider
A, B, D, E, G, H, I, J, K, L, M, N, P, Q, T, U, V, W, X, Y may also be used for reporting
Program Funded payment arrangements, if needed.
Valid codes for CAU’s who opt to report expenditure information in an annual summary
subcapitation file (Option 2 in Appendix C) are:
F -- Fee for Service Payment arrangement
P -- Program Funding
Z -- Reinvestment
Editing Criteria: Must be a valid code for the CAU's chosen Reporting Option, as listed
above.
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ENCOUNTER AND SUBCAPITATION DATA CATALOG DEFINITIONS
Picture X(20)
Format LJ, blank-fill
Positions 014-033
Catalog No. 009
Data Name Claim Reference Number
Revised 9/1/05
Page 1 of 1
Type 6 Medical Services
Type 8 Inpatient
Subcapitation
Field Required
X
X
Field Optional
Field N/A
X
DEFINITION: A unique control number assigned to the encounter record by the CAU.
SPECIAL INSTRUCTIONS:
Editing Criteria: Must be present (not spaces). Must be alphanumeric (numbers &
letters only) and must be unique within each CAU.
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ENCOUNTER AND SUBCAPITATION DATA CATALOG DEFINITIONS
Picture X(1)
Format LJ, blank-fill
Positions 012-012
Catalog No. 012
Data Name Lab Test
Revised 1/23/07
Page 1 of 1
Field Required
Type 6 Medical Services
Type 8 Inpatient
Subcapitation
Field Optional
X
Field N/A
X
X
DEFINITION: The presence of an “L” in this field indicates a Lab Test, otherwise,
blank-fill.
SPECIAL INSTRUCTIONS: The “L” would assure that this encounter and matching
subcapitation record if appropriate is bucketed to encounter service group ‘12’ – Lab.
Editing Criteria: Must be “L” or blank. The presence of the “L” would trigger editing to
assure that any valid provider type/specialty found in MPI or any valid CPT code would
pass editing. No editing will be done on POS.
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ENCOUNTER AND SUBCAPITATION DATA CATALOG DEFINITIONS
Picture X(08)
Format RJ, CCYYMMDD
Positions 037-044
Catalog No. 013
Data Name Coverage Begin Date
Revised 9/1/05
Page 1 of 1
Field Required
Type 6 Medical Services
Type 8 Inpatient
Subcapitation
Field Optional
Field N/A
X
X
X
DEFINITION: The first day of the period covered by the subcapitation payment.
SPECIAL INSTRUCTIONS:
Editing Criteria: Must be numeric. Must be a valid calendar date after July 1, 1999.
Must be less than or equal to the Coverage End Date (Catalog No. 014).
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Reporting Manual for Encounter & Subcapitation Data
ENCOUNTER AND SUBCAPITATION DATA CATALOG DEFINITIONS
Picture X(08)
Format RJ, CCYYMMDD
Positions 045-052
Catalog No. 014
Data Name Coverage End Date
Revised 9/1/05
Page 1 of 1
Field Required
Type 6 Medical Services
Type 8 Inpatient
Subcapitation
DEFINITION:
Field Optional
Field N/A
X
X
X
The last day of the period covered by the subcapitation payment.
SPECIAL INSTRUCTIONS:
Editing Criteria: Must be numeric. Must be a valid calendar date after July 1, 1999.
Must be equal to or greater than the Coverage Begin Date (Catalog No. 013).
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Reporting Manual for Encounter & Subcapitation Data
ENCOUNTER AND SUBCAPITATION DATA CATALOG DEFINITIONS
Picture 9(07)
Format RJ, zero-fill
Positions 051-057
Catalog No. 025
Data Name Encounter Count Inpatient
Revised
Page 1 of 1
Trailer
Field Required
Field Optional
Field N/A
Type 6 Medical Services
Type 8 Inpatient
Subcapitation
DEFINITION: Total number of Record Type 8 (Catalog No. 081) encounters included
on the quarterly file. When processing the quarterly file, the Department's validation
software will maintain record counts. These counts will be compared with the Plan's
input header record counts.
SPECIAL INSTRUCTIONS:
Editing Criteria: Must be numeric. Must equal the number of input Inpatient - BH only
encounters (Record Type = 8).
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ENCOUNTER AND SUBCAPITATION DATA CATALOG DEFINITIONS
Picture 9(07)
Format RJ, zero-fill
Positions 037-043
Catalog No. 029
Data Name Encounter Count Medical
Services
Revised
Page 1 of 1
Trailer
Field Required
Field Optional
Field N/A
Type 6 Medical Services
Type 8 Inpatient
Subcapitation
DEFINITION: Total number of Record Type 6 (Catalog No. 081) encounters included
on the quarterly file. When processing the quarterly file, the Department's validation
software will maintain record counts. These counts will be compared with the Plan's
input header record counts.
SPECIAL INSTRUCTIONS:
Editing Criteria: Must be numeric. Must equal the number of input Medical Services BH only encounters (Record Type = 6).
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ENCOUNTER AND SUBCAPITATION DATA CATALOG DEFINITIONS
Picture 9(08)
Format FJ, zero-fill
Positions 058-065
Catalog No. 030
Data Name Total Encounters
Revised
Page 1 of 1
Trailer
Field Required
Field Optional
Field N/A
Type 6 Medical Services
Type 8 Inpatient
Subcapitation
DEFINITION: Total number of Record Types 6 and 8 (Catalog No. 081) encounters
included on the quarterly file. This count does NOT include either the header or trailer
record. When processing the quarterly file, the Department's validation software will
maintain record counts. These counts will be compared with the contractor's input trailer
record counts.
SPECIAL INSTRUCTIONS:
Editing Criteria: Must be numeric. Must equal the number of input encounters (Record
Types 6 and 8) included on the quarterly file.
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ENCOUNTER AND SUBCAPITATION DATA CATALOG DEFINITIONS
Picture 9(08)
Format RJ, CCYYMMDD
Positions 109-116
Catalog No. 031
Data Name End Date of Service
Revised 9/1/05
Page 1 of 1
Type 6 Medical Services
Type 8 Inpatient
Subcapitation
Field Required
X
X
Field Optional
Field N/A
X
DEFINITION: The date the service was performed. If the service was provided on
consecutive days, this is the last day of the service period.
SPECIAL INSTRUCTIONS: If services are rendered on non-consecutive days, separate
encounter records must be submitted.
Editing Criteria: Must be numeric. Must be a valid calendar date after July 1, 1999.
Must be equal to or greater than the Begin Date of Service (Catalog No. 007), if Begin
Date of Service is present (not blank). If present (not spaces), must be less than or equal
to the File Header Record's Adjudication To Date (Catalog No. 002).
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ENCOUNTER AND SUBCAPITATION DATA CATALOG DEFINITIONS
Picture X(05)
Format LJ, blank-fill
Positions 134-138
Catalog No. 032
Data Name Fifth Diagnosis Code
Revised 5/23/97
Page 1 of 1
Field Required
Type 6 Medical Services
Type 8 Inpatient
Subcapitation
Field Optional
Field N/A
X
X
X
DEFINITION: A code to indicate, when available, a fifth condition that affects the
recipient. The most specific three, four, or five character ICD-9-CM diagnosis code must
be used.
SPECIAL INSTRUCTIONS: Do not include a decimal point.
Editing Criteria: If present (not spaces), must match the BHSRCC Attachment C.
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ENCOUNTER AND SUBCAPITATION DATA CATALOG DEFINITIONS
Picture 9(08)
Format RJ, CCYYMMDD
Positions 012-019
Catalog No. 033
Data Name File Creation Date
Revised 9/1/05
Page 1 of 1
Header
Field Required
Field Optional
Field N/A
Type 6 Medical Services
Type 8 Inpatient
Subcapitation
DEFINITION: The date the file is created.
SPECIAL INSTRUCTIONS:
Editing Criteria: Must be numeric. Must be less than or equal to the system processing
date. For Encounter Data files must be equal to, or greater than the File Header's
Adjudication To Date (Catalog No. 002). Must be a valid calendar date after
June 30, 1999.
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ENCOUNTER AND SUBCAPITATION DATA CATALOG DEFINITIONS
Picture X(05)
Format LJ, blank-fill
Positions 054-158
Catalog No. 034
Data Name Fourth Diagnosis Code
Revised 12/15/97
Page 1 of 1
Field Required
Type 6 Medical Services
Type 8 Inpatient
Subcapitation
Field Optional
Field N/A
X
X
X
DEFINITION: A code to indicate, when available, a fourth condition that affects the
recipient. The most specific three, four, or five character ICD-9-CM diagnosis code must
be used.
SPECIAL INSTRUCTIONS: Do not include a decimal point.
Editing Criteria: If present (not spaces), must match the BHSRCC Attachment C.
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ENCOUNTER AND SUBCAPITATION DATA CATALOG DEFINITIONS
Picture X(02)
Format
Positions 002-003
Catalog No. 037
Data Name CAU Code
Revised 9/1/05
Page 1 of 1
Field Required
Field Optional
Field N/A
Type 6 Medical Services
X
Type 8 Inpatient
X
Subcapitation
X
DEFINITION: A unique two position identifier assigned to each CAU by the Dept.
AL = Allegheny
AI = Armstrong/Indiana
BE = Beaver
BS = Bedford/Somerset
BK = Berks
BL = Blair
BN = Bradford/Sullivan
BU = Bucks
BT = Butler
CM = Cambria
CN = Cameron/Elk/McKean
(Dissolved 9/30/2005)
CK = Carbon/Monroe/Pike
CE = Centre
CH = Chester
CL = Clarion
CJ = Clearfield/Jefferson
CR=Cameron/Elk
(Effective 10/1/05)
CS = Col./Mon./Sny./Un.
CW = Crawford
CP = Cumberland/Perry
DA = Dauphin
DE = Delaware
ER = Erie
FA = Fayette
FW = Forest/Warren
FF = Franklin/Fulton
GR = Greene
HJ = Hunt./Miff./Jun.
LS = Lack./Sus./Wayne
(Dissolved 6/30/2005)
LQ=Lackawanna/Susquehanna
(Effective 7/1/2005)
LA = Lancaster
LW = Lawrence
LB = Lebanon
LE = Lehigh
LG = Luzerne/Wyoming
LC = Lycoming/Clinton
MC=McKean
(Effective 10/1/05)
ME = Mercer
MO = Montgomery
NH = Northampton
NU = Northumberland
PH = Philadelphia
PO = Potter
SC = Schuylkill
TI = Tioga
VE = Venango
WE = Westmoreland
WN=Wayne
(Effective 7/1/2005)
WS = Washington
YA = York/Adams
Editing Criteria: Must be present (not equal to spaces) and found on the Department's
file of valid CAU Codes. For Encounter Records, if the Record Type (Catalog No. 081) is
6 or 8, the CAU Code must equal the CAU Code of the corresponding Header Record
(Record Type 0). For Subcapitation Records, if the Record Type (Catalog No. 081) is S,
the CAU Code must equal the CAU Code of the corresponding Header Record (Record
Type H).
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ENCOUNTER AND SUBCAPITATION DATA CATALOG DEFINITIONS
Picture 9(09)
Format RJ, zero-fill
Positions 076-084 (encounter)
004-012 (subcapitation)
Revised 3/4/05
Page 1 of 1
Type 6 Medical Services
Type 8 Inpatient
Subcapitation
Catalog No. 050
Data Name MA Provider Number
Field Required
X
X
X
Field Optional
Field N/A
DEFINITION: The PROMISe Provider ID number or the OMHSAS ‘type 99’ provider
number of the service provider.
SPECIAL INSTRUCTIONS: If an MA covered service is being reported, the
PROMISe provider ID should be used. If the service being reported is not an MA
covered service, the OMHSAS provider type 99 number is appropriate.
Editing Criteria: This field is required. The number must be a valid provider number
found on the DPW provider file (PRV414) or if a non-MA provider, must be found on
the OMHSAS Provider 99 database. This element in combination with provider service
location (catalog 125) must be associated with a behavioral health provider type:
01 (Inpatient Facility)
08 (Clinic)
09 (Certified Registered
Nurse Practitioner)
11 (Mental Health/Substance Abuse)
16 (Nurse)
17 (Therapist)
19 (Psychologist)
21 (Case Manager)
28 (Laboratory)
31 (Physician)
34 (Program Exception)
52 (Community
Residential Rehab)
56 (Residential Treatment
Facility)
99-CCR POMS ONLY
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ENCOUNTER AND SUBCAPITATION DATA CATALOG DEFINITIONS
Picture 9(02)
Format RJ, zero-fill
Positions 253-254
Catalog No. 062
Data Name Patient Discharge Status
Revised 5/1/00
Page 1 of 1
Field Required
Type 6 Medical Services
Type 8 Inpatient
Subcapitation
Field Optional
Field N/A
X
X
X
DEFINITION: Valid codes for Record Type (Catalog No. 081) "8" are:
01 -- Discharged to home or self-care (routine discharge)
02 -- Discharged/transferred to a general hospital for inpatient care
03 -- Discharged/transferred to skilled nursing facility (SNF)
04 -- Discharged/transferred to intermediate care facility (ICF)
05 -- Discharged/transferred to another type of institution for inpatient care or
referred for outpatient services to another institution
06 -- Discharged/transferred to home under care of organized home health
organization
07 -- Left against medical advice or discontinued care
08 -- Discharged/transferred to home under care of a home IV provider
09 -- Admitted as an inpatient to this hospital
20 -- Expired
30 -- Still a patient
SPECIAL INSTRUCTIONS: Zero-fill if not applicable. This field is not applicable
when reporting aggregate services provided to unidentified consumers on record type 8.
Editing Criteria: If not "00", must match the list in "Definition" above. If equal to "00",
Recipient Social Security Number (Catalog No. 080) must equal "XX0000000" (where
"XX" represents the MA Provider Type).
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ENCOUNTER AND SUBCAPITATION DATA CATALOG DEFINITIONS
Picture 9(08)
Format RJ, CCYYMMDD
Positions 004-011 Encounter
064-071 Subcapitation
Revised 1/24/03
Page 1 of 1
Catalog No. 063
Data Name Payment/Adjudication Date
Field Required
Type 6 Medical Services
Type 8 Inpatient
Subcapitation
Field Optional
X
X
Field N/A
X
DEFINITION:
The date the payment was authorized or mailed.
SPECIAL INSTRUCTIONS:
Required field for CAU’s who opted to report expenditure information at the detail
service level. Not required (zero-fill) for CAU’s who opted to report expenditure
information in an annual subcapitation file.
Editing Criteria: Must be numeric. Must be a valid calendar date after June 30, 1999 for
counties who opted to report expenditure information at the detail service level. For
Encounter Data files must be equal to or less than the File Header Record's Adjudication
To Date (Catalog No. 002).
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ENCOUNTER AND SUBCAPITATION DATA CATALOG DEFINITIONS
Picture 9(02)
Format RJ, zero-fill
Positions 122-123
Catalog No. 064
Data Name Place of Service
Revised 2/1/05
Page 1 of 1
Type 6 Medical Services
Type 8 Inpatient
Subcapitation
Field Required
X
X
Field Optional
Field N/A
X
DEFINITION: A code to indicate where the service was provided.
Valid place of service codes are found in Attachment K of the BHSRCC and/or the CCR
POMS Reporting Tool.
SPECIAL INSTRUCTIONS:
Editing Criteria: Must be on the list of valid codes found in Att. K or the CCR POMS
Reporting Tool. .
If Record Type (Catalog No. 081) is "8", Place of Service must be "21".
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ENCOUNTER AND SUBCAPITATION DATA CATALOG DEFINITIONS
Picture X(05)
Format LJ, blank-fill
Positions 139-143 Type 8
143-147 Type 6
Revised 4/8/02
Page 1 of 1
Catalog No. 067
Data Name Primary Diagnosis Code
Field Required
Type 6 Medical Services
Type 8 Inpatient
Subcapitation
Field Optional
X
X
Field N/A
X
DEFINITION: The ICD-9-CM code describing the principal diagnosis. Enter the full
code, up to the fifth digit, if applicable. The code entered must relate to the service
specified on the encounter.
SPECIAL INSTRUCTIONS: Blank-fill if not applicable. If used, do not include a
decimal point. This field is not applicable for reporting of aggregated services to
unidentified consumers.
For services to identified consumers: If Record Type (Catalog No. 081) equals "6", the
field is required if applicable to the MA provider type. If Record Type equals "8", the
field is required.
If the Primary/Principal Diagnosis is unknown, code 7999 (other unknown and
unspecified cause) should be entered.
Editing Criteria: May be spaces for Record Type (Catalog No. 081) "8" only if
Recipient Social Security Number equals "XX0000000" (where "XX" represents the MA
Provider Type). May be spaces for Record Type (Catalog No. 081) "6" only if the
Recipient Social Security Number (Catalog No. 080) equals "XX0000000" (where "XX"
represents the MA Provider Type. If present (not spaces), must match the BHSRCC
Attachment C.
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ENCOUNTER AND SUBCAPITATION DATA CATALOG DEFINITIONS
Picture X(5)
Format LJ, blank-fill
Positions 117-121 Type 6
83-87 Subcapitation
Revised 1/1/05
Page 1 of 1
Type 6 Medical Services
Type 8 Inpatient
Subcapitation
Catalog No. 070
Data Name Procedure Code
Field Required
X
Field Optional
Field N/A
X
X
DEFINITION: The national procedure code that defines the service rendered.
SPECIAL INSTRUCTIONS: Required on the Subcapitation record only for CAU’s who
opted to report expenditure information in an annual summary subcapitation file.
See Attachment A of BHSRCC.
Editing Criteria: Blank-fill on the Subcapitation record for HealthChoices reporting and
for CAU’s who report expenditure information at the detail service level.
If used, must match the DPW file of valid national procedure codes. If the input
procedure code is found on the DPW file, the End Date of Service (Catalog No. 031)
must fall within DPW's procedure record's Begin/End Date range.
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ENCOUNTER AND SUBCAPITATION DATA CATALOG DEFINITIONS
Picture X(02)
Format LJ, blank-fill
Positions 135-136 Type 6
088-089 Subcapitation
Revised 2/1/05
Page 1 of 1
Catalog No. 071
Data Name Procedure Code Pricing
Modifier
Field Required
Type 6 Medical Services
Type 8 Inpatient
Subcapitation
Field Optional
X
Field N/A
X
X
DEFINITION: One of two codes (the other being Procedure Code Information Modifier,
Catalog No. 072) that may be used to further define the Procedure Code (Catalog No.
070).
SPECIAL INSTRUCTIONS: Blank-fill if not applicable.
Required on the Subcapitation record only for CCR POMS CAU’s who opted to report
expenditure information in an annual summary subcapitation file.
Editing Criteria: If present (not spaces), must be a valid Pricing Modifier in combination
with the reported Procedure Code Information Modifiers (Catalog No. 072) for the
reported Procedure Code (Catalog No. 070). For Record Type 6, End Date of Service
(Catalog No. 031) must also fall within the modifiers' Begin/End Date range, as shown
on Attachment A of the Behavioral Health Services Classification Chart. For Record
Type S, the Coverage Begin Date (Catalog No. 013) and Coverage End Date (Catalog
No. 014) must be consistent with the modifiers’ Begin/End Date range as shown on
Attachment A of the Behavioral Health Services Reporting Classification Chart. Note:
Procedure Code appears in the column labeled "HCPCS Code" on Attachment A of the
Behavioral Health Services Reporting Classification Chart.
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ENCOUNTER AND SUBCAPITATION DATA CATALOG DEFINITIONS
Picture X(02)
Format LJ, blank-fill
Positions See below
Catalog No. 072
Data Name Procedure Code Information
Modifier
Revised 2/1/05
Page 1 of 1
Field Required
Type 6 Medical Services
Type 8 Inpatient
Subcapitation
Field Optional
X
Field N/A
X
X
DEFINITION: One of two codes (the other being Procedure Code Pricing Modifier,
Catalog No. 071) that may be used to further define the Procedure Code (Catalog No.
070).
SPECIAL INSTRUCTIONS: This data element can occur up to three times for an
encounter. Record positions vary by record type:
Record Type
Positions
Type 6
137-138, 139-140, and 141-142
Type S
090-091, 092-093, and 094-095
Include all that are applicable to correctly identify the desired Local Code Description, as
shown on Attachment A of the Behavioral Health Services Classification Chart.
Required on the Subcapitation record only for CAU’s who opted to report expenditure
information in an annual summary subcapitation file.
Editing Criteria: If present (not spaces), must be a valid Information Modifier in
combination with the reported Procedure Code Pricing Modifier (Catalog No. 071) for
the reported Procedure Code (Catalog No. 070). For Record Type 6, the End Date of
Service (Catalog No. 031) must fall within the modifiers' Begin/End Date range, as
shown on Attachment A of the Behavioral Health Services Classification Chart. For
Record Type S, the Coverage Begin Date (Catalog No. 013) and Coverage End Date
(Catalog No. 014) must be consistent with the modifiers’ Begin/End Date range, as
shown on Attachment A of the Behavioral Health Services Reporting Classification
Chart. Note: Procedure Code appears in the column labeled "HCPCS Code"
on Attachment A of the Behavioral Health Services Reporting Classification Chart.
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ENCOUNTER AND SUBCAPITATION DATA CATALOG DEFINITIONS
Picture 9(09)
Format RJ, zero-fill
Positions 004-012
Catalog No. 073
Data Name CAU Provider ID Number
Revised 1/1/05
Page 1 of 1
HEADER
Field Required
Field Optional
Field N/A
Type 6 Medical Services
Type 8 Inpatient
Subcapitation
DEFINITION: The CAU's OMHSAS assigned provider type 99 number.
SPECIAL INSTRUCTIONS:
Editing Criteria: Must be numeric. Must be the Provider ID Number associated with the
CAU on the OMHSAS list of valid Provider Type "99" numbers.
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ENCOUNTER AND SUBCAPITATION DATA CATALOG DEFINITIONS
Picture S9(05)
Format RJ, zero-fill
Positions 124-129
Catalog No. 074
Data Name Quantity
Revised 09/01/05
Page 1 of 1
Type 6 Medical Services
Type 8 Inpatient
Subcapitation
Field Required
X
X
Field Optional
Field N/A
X
DEFINITION: The number of units of service. The definition of a unit will vary
depending on the service received. For example, it could be a day of care, an office visit,
a tablet of medication, etc.
SPECIAL INSTRUCTIONS: Fractional units cannot be reported. Units should be
rounded up and if <1, ‘1’ should be reported.
Editing Criteria: Must be numeric. Must be equal to or greater than zero if Adjustment
Code (Catalog No. 003) equals "1" or "3". Must be less than or equal to zero if
Adjustment Code (Catalog No. 003) equals "0".
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ENCOUNTER AND SUBCAPITATION DATA CATALOG DEFINITIONS
Picture X(08)
Format CCYYMMDD
Positions 261-268 (Type 6)
814-821 (Type 8)
Revised 5/1/00
Page 1 of 1
Type 6 Medical Services
Type 8 Inpatient
Subcapitation
Catalog No. 076
Data Name Recipient Birth Date
Field Required
X
X
Field Optional
Field N/A
X
DEFINITION: The birth date of the recipient.
SPECIAL INSTRUCTIONS: Zero-fill if not applicable. This field is not applicable
when reporting aggregated services to unidentified consumers. If birth date is unknown,
estimate the century, year, and month; use "99" as the day (estimate CCYYMM; use "99"
as DD).
When reporting aggregate services provided to unidentified consumers, zero-fill.
Editing Criteria: Must be numeric. If zeros, Recipient Social Security Number (Catalog
No. 080) must equal "XX0000000" (where "XX" represents the MA Provider Type).
Must be less than or equal to File Header's Adjudication To Date (Catalog No. 002).
Month must be valid (01 through 12). If Day = 99, no further editing of the day portion
(DD) is required. If Day is not equal to 99, day must be valid for the input month, with
consideration given to leap years.
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ENCOUNTER AND SUBCAPITATION DATA CATALOG DEFINITIONS
Picture 9(10)
Format RJ, zero-fill
Positions 054-063 (encounter)
017-026 (subcapitation)
Revised 6/30/98
Page 1 of 2
Catalog No. 077
Data Name Recipient CIS Number
Field Required
Type 6 Medical Services
Type 8 Inpatient
Subcapitation
Field Optional
X
X
Field N/A
X
DEFINITION: The unique number assigned to the recipient by DPW. This number
should not change and is the same number that appears on the recipient's ACCESS card.
SPECIAL INSTRUCTIONS: For Record Types (Catalog No. 081) 6 and 8, zero-fill the
Recipient CIS Number if the individual receiving the service is not eligible for Medical
Assistance.
The right-most digit is a check digit. An incorrect check digit indicates an error in one or more of the previous 9 digits.
The Luhn Formula for computing Modulus 10
"Double-Add-Double" check digit is used. The calculation involves the following steps:
1.
2.
3.
Double the value of alternate digits beginning with the first right-hand digit (low order).
Add the individual digits comprising the products obtained in Step #1 to each of the unaffected digits in the
original number.
Subtract the total obtained in Step #2 from the next higher number ending in zero (this is the equivalent of
calculating the "tens complement" of the low order digit (unit digit) of the total. If the total obtained in Step #2 is a
number ending in zero (30, 40, etc.), the check digit is zero.
Example -- Recipient Number without check digit: 257461120
2
x2
4
5
7
x2
5 14
4
4
6
x2
12
1
1
1
x2
2
2
2
0
x2
0 STEP #1
4 + 5 + 1 + 4 + 4 + 1 + 2 + 1 + 2 + 2 + 0 + 26 STEP #2
30 – 26 = 4
STEP #3
The Recipient Number with the check digit is 2574611204
Editing Criteria: Must be numeric. Check digit must be valid. If not equal to zeros, must be found on the DPW
recipient eligibility file (DPW internal use only).
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ENCOUNTER AND SUBCAPITATION DATA CATALOG DEFINITIONS
Picture 9(09)
Format RJ
Positions 252-260 (Type 6)
805-813 (Type 8)
Revised 1/1/05
Page 1 of 1
Catalog No. 080
Data Name Recipient SS #
Field Required
X
X
Type 6 Medical Services
Type 8 Inpatient
Subcapitation
Field Optional
Field N/A
X
DEFINITION: The unique Social Security Number of the recipient.
Positions 1 through 3 must be:
greater than “000” and less than “666”
OR
greater than “666” and less than “734”
OR
greater than “749” and less than “773”
Positions 4 through 5 must be greater than “00”.
Positions 6 through 9 must be greater than “0000”.
SPECIAL INSTRUCTIONS:
NOTE: Corrections to the pseudo Social Security Number will be made through
Consumer Data. Please refer to the Consumer Data File “Unknowns, Data Errors and
Correction Instructions”. When reporting Aggregate Services Provided to Unidentified
Consumers, the Social Security Number is to be reported by entering the MA Provider
Type in positions 1-2 and zeros in positions 3-9.
Editing Criteria: This is a required field. If known, the number must match the number
assigned by the Social Security Administration (without hyphens). If unknown, a pseudo
Social Security Number must be created. The format for a pseudo Social Security
Number is “0999”in the four left-most positions, followed by a five digit identifier that is
unique within the CAU. The value "00000" as the final five digits is NOT considered
valid.
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ENCOUNTER AND SUBCAPITATION DATA CATALOG DEFINITIONS
Picture X(01)
Format
Positions 001-001
Catalog No. 081
Data Name Record Type
Revised 12/15/97
Page 1 of 2
Type 6 Medical Services
Type 8 Inpatient
Subcapitation
Field Required
X
X
X
Field Optional
Field N/A
DEFINITION: A single character code identifying the input type.
Acceptable values include:
0 Encounter File Header
6 Medical Services Encounter
8 Inpatient Encounter
9 Encounter File Trailer
H Subcapitation Financial Header
S Subcapitation Financial Detail
T Subcapitation Financial Trailer
SPECIAL INSTRUCTIONS:
Encounter Record Types 0 and 9:
Each encounter data file must contain Header and Trailer records, in addition to the
individual encounters.
Encounter Record Type 0 represents the File Header.
Encounter Record Type 9 represents the File Trailer.
Encounter Record Types 6 and 8.
The Department classifies Record Types 6 and 8 primarily by the type of provider
rendering the service.
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Record Type 6 Providers:
08- Clinic
Independent Medical/Surgical
Rural Health Clinic & Federally Qualified Health Center
Outpatient D&A
Outpatient Psychiatric
EPSDT Provider
11-Mental Health/Substance Abuse
Outpatient D&A
Family Based Rehab Service-MH
EPSDT Service Provider
Behavioral Health
09-CRNP
16-Nurse
17-Therapist
19-Psychologist
21-Case Manager
28-Laboratory
34-Program Exception
52-Community Residential Rehab
56-Residential Treatment Facility (Non-JCAHO Certified)
Record Type 8 Providers:
01-Inpatient Facility
General Hospital
Rehab Hospital, Rehab Unit, D&A Unit
Private Psych Hospital or Unit
Extended Acute Psych Care
RTF (JCAHO Certified) Unit
Editing Criteria: Input must be present (not equal to spaces) and equal to 0, 6, 8, 9, H, S
or T. If first record on file, value must equal 0 or H. If not first record on file, must equal
6, 8, S or T. If last record on file, value must equal 9 or T. If equal to 0, cannot be other
than the first record on the file. If not equal to 9, cannot be last record on the file.
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ENCOUNTER AND SUBCAPITATION DATA CATALOG DEFINITIONS
Picture X(04)
Format RJ, zero-fill
Positions See below
Catalog No. 082
Data Name Revenue Code
Revised 5/1/00
Page 1 of 1
Field Required
Type 6 Medical Services
Type 8 Inpatient
Subcapitation
Field Optional
Field N/A
X
X
X
DEFINITION: Codes to indicate the services provided during the service period.
Standard UB-92 codes must be used.
SPECIAL INSTRUCTIONS: Up to 22 Revenue Codes may be reported for each
encounter. The positions on the Encounter Record for the 22 Revenue Codes are: 384 387, 403 - 406, 422 - 425,441 - 444, 460 - 463, 479 - 482, 498 - 501, 517 - 520, 536 539, 555 - 558,574 - 577, 593 - 596, 612 - 615, 631 - 634, 650 - 653, 669 - 672, 688 691,707 - 710, 726 - 729, 745 - 748, 764 - 767, and 783 - 786.
Editing Criteria: If present (not spaces) and the Adjustment Code (Catalog No. 003)
equals "0", "1", or "3", the corresponding Revenue Code Charges (Catalog No. 083) must
not equal zero.
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ENCOUNTER AND SUBCAPITATION DATA CATALOG DEFINITIONS
Picture S9(7),V99
Format RJ, zero-fill
Positions See below
Catalog No. 083
Data Name Revenue Code Charges
Revised 1/1/03
Page 1 of 1
Field Required
Type 6 Medical Services
Type 8 Inpatient
Subcapitation
Field Optional
Field N/A
X
X
X
DEFINITION: The charges related to the corresponding Revenue Code (Catalog No.
082).
Up to 22 Revenue Codes and associated charges may be reported for each encounter. The
positions on the encounter record for the 22 Revenue Code Charges are: 393 - 402,
412 - 421, 431 - 440, 450 - 459, 469 - 478, 488 - 497, 507 - 516, 526 - 535, 545 - 554,
564 - 573, 583 - 572, 602 - 611, 621 - 630, 640 - 649, 659 - 668, 678 - 687, 697 - 706,
716 - 725, 735 - 744, 754 - 763, 773 - 782, and 792 - 801.
Any of the 22 fields that are not applicable should be zero-filled.
Editing Criteria: All 22 fields must be numeric. If not equal to zero, the corresponding
Revenue Code (Catalog No. 082) must not be spaces. (This is applicable for all
Adjustment Codes (Catalog No. 003). If equal to zero and the Adjustment Code (Catalog
No. 003) equals "0", "1" or "3", the corresponding Revenue Code (Catalog No. 082) must
equal spaces. Must be equal to or greater than zero if Adjustment Code (Catalog No.
003) equals "1" or "3". Must be less than or equal to zero if Adjustment Code (Catalog
No. 003) equals "0".
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ENCOUNTER AND SUBCAPITATION DATA CATALOG DEFINITIONS
Picture S9(04)
Format RJ, zero-fill
Positions See below
Catalog No. 084
Data Name Revenue Code Service Units
Revised 09/01/05
Page 1 of 2
Field Required
Type 6 Medical Services
Type 8 Inpatient
Subcapitation
Field Optional
Field N/A
X
X
X
DEFINITION: The service units related to the corresponding Revenue Code (Catalog
No. 082).
SPECIAL INSTRUCTIONS: Up to 22 Revenue Codes and associated service units may
be reported for each encounter. The positions on the encounter record for the 22 Revenue
Code Service units are: 388 - 392, 407 - 411, 426 - 430, 445 - 449, 464 - 468, 483 - 487,
502 - 506, 521 - 525, 540 - 544, 559 - 563, 578 - 582, 597 - 601, 616 - 620, 635 - 639,
654 - 658, 673 - 677, 692 - 696, 711 - 715, 730 - 734, 749 - 753, 768 - 772, and 787 791.
The following Revenue Codes require a Revenue Code Units value not equal to zero:
032X -- Radiology Diagnostic
035X -- CT Scan
042X -- Physical Therapy
043X -- Occupational Therapy
061X -- Magnetic Resonance Imaging
073X -- EKG/ECG - Electrocardiogram
074X -- EEG - Electroencephalogram
091X -- Psychiatric/Psychological Services - Nursing Care
094X -- Other Therapeutic Services
Note: the right-most position ("X") represents the subcategory.
Any of the 22 fields that are not applicable should be zero-filled.
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Editing Criteria: All 22 fields must be numeric. If not equal to zero, the corresponding
Revenue Code (Catalog No. 082) must not be spaces. This is applicable to an Adjustment
Codes (Catalog No. 003). If greater than zero and the Adjustment Code (Catalog No.
003) equals "1" or "3", the corresponding Revenue Code Charges (Catalog no. 083) must
be greater than zero. If less than zero and the Adjustment Code (Catalog No. 003) equals
"0", the corresponding Revenue Code Charges (Catalog no. 083) must be less than zero.
Must not be equal to zero if the corresponding Revenue Code (Catalog No. 082) is on the
list in the Definition above and the Adjustment Code (Catalog No. 003) equals "0", "1",
or "3". Must be equal to or greater than zero if Adjustment Code (Catalog No. 003)
equals "1" or "3". Must be less than or equal to zero if Adjustment Code (Catalog No.
003) equals "0".
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ENCOUNTER AND SUBCAPITATION DATA CATALOG DEFINITIONS
Picture X(05)
Format LJ, blank-fill
Positions 144-148 Type 8
148-152 Type 6
Revised 5/23/97
Page 1 of 1
Catalog No. 085
Data Name Secondary Diagnosis Code
Field Required
Type 6 Medical Services
Type 8 Inpatient
Subcapitation
Field Optional
X
X
Field N/A
X
DEFINITION: The ICD-9-CM secondary diagnosis code. Enter the full code, up to the
fifth digit, if applicable.
SPECIAL INSTRUCTIONS: Do not include a decimal point. Blank-fill if not
applicable.
Editing Criteria: If present (not spaces), must match the BHSRCC Attachment C.
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Consolidated Community Reporting
Performance Outcome Management System
Reporting Manual for Encounter & Subcapitation Data
ENCOUNTER AND SUBCAPITATION DATA CATALOG DEFINITIONS
Picture 9(08)
Format RJ, zero-fill
Positions 002-009
Catalog No. 090
Data Name Subcapitation Record Count
Revised
Page 1 of 1
Trailer
Field Required
Field Optional
Field N/A
Type 6 Medical Services
Type 8 Inpatient
Subcapitation
DEFINITION: Total number of subcapitation financial detail records (Record Type S)
included on the input file. When processing the input file, the Department's validation
software will maintain record counts. These counts will be compared with the CAU’s
input trailer record counts.
SPECIAL INSTRUCTIONS:
Editing Criteria: Must be numeric. Must equal the number of subcapitation financial
detail records (Record Type S) included on the input file.
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Performance Outcome Management System
Reporting Manual for Encounter & Subcapitation Data
ENCOUNTER AND SUBCAPITATION DATA CATALOG DEFINITIONS
Picture S9(07)V99
Format RJ, zero-fill
Positions 027-036
Catalog No. 091
Data Name Subcapitation Payment
Revised 1/1/03
Page 1 of 1
Field Required
Type 6 Medical Services
Type 8 Inpatient
Subcapitation
Field Optional
Field N/A
X
X
X
DEFINITION: The amount of the subcapitation payment for the period being reported
(Coverage Begin/Coverage End, Catalog No. 013 and 014). The amount reported should
be the total of DPW Reimbursement and County Match.
SPECIAL INSTRUCTIONS
Editing Criteria: Must be numeric.
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Performance Outcome Management System
Reporting Manual for Encounter & Subcapitation Data
ENCOUNTER AND SUBCAPITATION DATA CATALOG DEFINITIONS
Picture X(01)
Format
Positions 021-021
Catalog No. 092
Data Name Submission Indicator
Revised 5/1/00
Page 1 of 1
Header
Field Required
Field Optional
Field N/A
Type 6 Medical Services
Type 8 Inpatient
Subcapitation
DEFINITION: A code identifying the input file as an initial. Acceptable values include:
I for Initial Submission
CCR POMS Encounter and Subcapitation files are always submitted as initial
submissions. The Header Record should be coded as an "initial submission" whether the
file being submitted is one that was previously returned by OMHSAS because of errors in
the File Header (causing the ENTIRE file to be rejected by OMHSAS), or the file
contains corrected records that are being resubmitted because they had been rejected by
OMHSAS because of errors.
Editing Criteria: File submission must equal “I”.
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Performance Outcome Management System
Reporting Manual for Encounter & Subcapitation Data
ENCOUNTER AND SUBCAPITATION DATA CATALOG DEFINITIONS
Picture X(05)
Format LJ, blank fill
Positions 149-153
Catalog No. 093
Data Name Tertiary Diagnosis
Revised 12/15/97
Page 1 of 1
Field Required
Type 6 Medical Services
Type 8 Inpatient
Subcapitation
Field Optional
Field N/A
X
X
X
DEFINITION: The ICD-9-CM tertiary diagnosis code, if available. Enter the full code,
up to the fifth digit, if applicable.
SPECIAL INSTRUCTIONS: Do not include a decimal point. Blank fill if not
applicable.
Editing Criteria: If present (not spaces), must match the BHSRCC Attachment C.
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Performance Outcome Management System
Reporting Manual for Encounter & Subcapitation Data
ENCOUNTER AND SUBCAPITATION DATA CATALOG DEFINITIONS
Picture 9(01)
Format
Positions 117-117
Catalog No. 098
Data Name Type of Admission
Revised 12/17/96
Page 1 of 1
Field Required
Type 6 Medical Services
Type 8 Inpatient
Subcapitation
Field Optional
Field N/A
X
X
X
DEFINITION: Valid codes and their definitions are:
1 -- Emergency admission after the sudden onset or exacerbation of a behavioral
health condition manifesting itself by acute symptoms of sufficient severity such that
the absence of immediate behavioral health attention could reasonably be expected
to result in: serious bodily harm or injury to the patient or others; or serious physical
debilitation.
2 -- Urgent admission resulting from a severe condition which under reasonable
standards of medical practice would be diagnosed and treated within a twenty-four
(24) hour period and if left untreated, could rapidly become a crisis or emergency
situation.
3 -- Elective admissions refer to those patients designated as scheduled or routine
admissions. This group includes those cases where there is no urgency for
immediate or very early medical evaluation or treatment because the possibility of
serious consequences resulting from lack of attention is small.
SPECIAL INSTRUCTIONS:
Editing Criteria: Must equal "1", "2", or "3".
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Performance Outcome Management System
Reporting Manual for Encounter & Subcapitation Data
ENCOUNTER AND SUBCAPITATION DATA CATALOG DEFINITIONS
Picture 9(03)
Format RJ, zero-fill
Positions 802-804
Catalog No. 105
Data Name DRG Number
Revised 5/1/00
Page 1 of 1
Field Required
Type 6 Medical Services
Type 8 Inpatient
Subcapitation
Field Optional
Field N/A
X
X
X
DEFINITION: The Diagnosis Related Group (DRG) number for the hospital stay.
The DRG represents related groupings of diagnoses which require the use of similar
hospital resources. Five elements are considered in the determination of the appropriate
DRG. They are patient sex, age, procedure codes performed, diagnosis codes and the
patient’s status. Acute general care hospitals come under the DRG prospective payment
system as does a licensed detoxification unit.
Licensed Psychiatric units, Licensed Drug and Alcohol Detoxification and
Treatment/Rehabilitation Units within acute care hospitals do not come under the DRG
system. Private Psychiatric Hospitals, Residential Treatment Facilities and Extended
Acute Care Psychiatric Units are not in the DRG system.
SPECIAL INSTRUCTIONS: DRG Number applies to inpatient acute care General
Hospital stays only. If not applicable, field is to be zero-filled.
This field is not applicable when reporting aggregated services to unidentified consumers.
Editing Criteria: Must be numeric. If zeros, Recipient Social Security Number (Catalog
No. 080) must equal "XX0000000" (where "XX" represents the MA Provider Type).
If the provider type associated with the MA Provider Number on the DPW provider
database indicates General Hospital (value = 11), must match the DPW file of valid DRG
numbers; Attachment B of BHSRCC. If the input DRG Number is found on the DPW
file, the End Date of Service (Catalog No. 031) must fall within DPW's DRG record's
Begin/End Date range.
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Performance Outcome Management System
Reporting Manual for Encounter & Subcapitation Data
ENCOUNTER AND SUBCAPITATION DATA CATALOG DEFINITIONS
Picture X(01)
Format
Positions 251-251 (Type 6)
849-849 (Type 8)
Revised 1/1/05
Page 1 of 2
Type 6 Medical Services
Type 8 Inpatient
Subcapitation
Catalog No. 109
Data Name Capitation FFS Indicator
Field Required
X
X
Field Optional
Field N/A
X
DEFINITION: A code indicating the type of service/payment arrangement applicable to
the encounter.
SPECIAL INSTRUCTIONS: Acceptable values for CAU’s who opt to report expenditure
information at the detail service level (Option 1 in Appendix C) are:
F-- Fee for service payment arrangement
R-- Retainer agreement with a retainer fee
S-- Subcapitation agreement with a capitation fee
Z-- Reinvestment funds
1,2,3,4,5,6,7, or 8--Program Funded Services
9--Gross Adjustment payment arrangement for a fee-for-service provider (where
the provider delivers services after county based funds have been depleted)
A, B, D, E, G, H, I, J, K, L, M, N, P, Q, T, U, V, W, X, Y may also be used for reporting
Program Funded payment arrangements, if needed.
If the provider was paid on a fee-for-service basis for the encounter, use the value "F",
and complete the Amount Reimbursed (Catalog No. 006) field with the appropriate value.
For record type 8, the Revenue Code charges (Catalog No. 083) must also be entered.
If the encounter is a service covered by any other provider payment arrangement, use the
appropriate value and enter zero in Amount Reimbursed (Catalog No. 006).
Reporting of services funded by payment arrangements other than fee-for-service is
further described under “Option 1” in Appendix C for CAU’s who opt to report
expenditures information at the detail service level.
Acceptable values for CCR POMS counties who opt to report expenditure information
in an annual summary subcapitation file (Option 2 in Appendix C) are:
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Performance Outcome Management System
Reporting Manual for Encounter & Subcapitation Data
F-- Fee for Service payment arrangement
P-- Program funding
Z-- Reinvestment
Reporting of services is further described under “Option 2” in Appendix C for CAU’s
who opt to report expenditure information in an annual summary subcapitation file.
Editing Criteria: Must be a valid code for the CAU's chosen Reporting Option, as listed
above.
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Performance Outcome Management System
Reporting Manual for Encounter & Subcapitation Data
ENCOUNTER AND SUBCAPITATION DATA CATALOG DEFINITIONS
Picture 9(01)
Format RJ, zero-fill
Positions 296-296 Type 6
850-850 Type 8
Revised 9/1/05
Page 1 of 1
Catalog No. 111
Data Name Missing SS # Status
Field Required
Type 6 Medical Services
Type 8 Inpatient
Subcapitation
Field Optional
X
X
Field N/A
X
DEFINITION: A code to indicate the Social Security Number status of a recipient who
is registered under a pseudo Social Security Number.
SPECIAL INSTRUCTIONS: This field is applicable if the recipient is registered under a
pseudo Social Security Number ("0999" in positions 1 through 4 of Recipient Social
Security No., Catalog No. 080). This field is not applicable if the recipient is registered
under a valid Social Security Number or if services reported are Aggregate Services
Provided to Unidentified Consumers. SSN corrections are made by submitting a
Consumer Registry correction record which also updates all corresponding encounter
records.
Acceptable values include:
0 Not applicable
1 Recipient has no Social Security Number; SSN application initiated.
2 Unable to obtain valid Social Security Number; investigating further.
3 Unable to obtain valid Social Security Number; no further action planned.
Zero-fill if not applicable.
Editing Criteria: Field must equal "0", "1", "2", or "3"
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Performance Outcome Management System
Reporting Manual for Encounter & Subcapitation Data
ENCOUNTER AND SUBCAPITATION DATA CATALOG DEFINITIONS
Picture X(02)
Catalog No. 124
Format RJ, zero fill, blank if not
Data Name Recipient County of
present
Residence
Positions 074-075
Revised 1/1/03
Page 1 of 2
Field Required
Field Optional
Field N/A
Type 6 Medical Services
X
Type 8 Inpatient
X
Subcapitation
X
DEFINITION: A code to indicate the county which pays for the service.
01 = Adams
02 = Allegheny
03 = Armstrong
04 = Beaver
05 = Bedford
06 = Berks
07 = Blair
08 = Bradford
09 = Bucks
10 = Butler
11 = Cambria
12 = Cameron
13 = Carbon
14 = Centre
15 = Chester
16 = Clarion
17 = Clearfield
18 = Clinton
19 = Columbia
20 = Crawford
21 = Cumberland
22 = Dauphin
23 = Delaware
24 = Elk
25 = Erie
26 = Fayette
27 = Forest
28 = Franklin
29 = Fulton
30 = Greene
31 = Huntington
32 = Indiana
33 = Jefferson
34 = Juniata
35 = Lackawanna
36 = Lancaster
37 = Lawrence
38 = Lebanon
39 = Lehigh
40 = Luzerne
41 = Lycoming
42 = McKean
43 = Mercer
44 = Mifflin
45 = Monroe
46 = Montgomery
47 = Montour
48 = Northampton
49 = Northumberland
50 = Perry
51 = Philadelphia
52 = Pike
53 = Potter
54 = Schuylkill
55 = Snyder
56 = Somerset
57 = Sullivan
58 = Susquehanna
59 = Tioga
60 = Union
61 = Venango
62 = Warren
63 = Washington
64 = Wayne
65 = Westmoreland
66 = Wyoming
67 = York
98=Out of State
99=Unknown
SPECIAL INSTRUCTIONS: Zero-fill if reporting aggregated services for unidentified
consumers.
Editing Criteria: If used, must be numeric. The two digit numeric county code for this
recipient county of residence must correspond to the two digit alpha CAU code (catalog
no. 037) for all CAU’s, both joinder and non joinder. Example:
County of Residence=08, CAU code must be BN
County of Residence=57, CAU code must be BN
County of Residence=22, CAU code must be DA.
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Performance Outcome Management System
Reporting Manual for Encounter & Subcapitation Data
ENCOUNTER AND SUBCAPITATION DATA CATALOG DEFINITIONS
Picture 9(04)
Format RJ, zero fill
Positions 85-88 Encounter
13-16 Subcapitation
Revised 1/1/05
Page 1 of 1
Type 6 Medical Services
Type 8 Inpatient
Subcapitation
Catalog No. 125
Data Name Provider Service Location
Field Required
X
X
X
Field Optional
Field N/A
DEFINITION: Four digit service location of provider. For provider type 99 services, it
is not required that the service location match the CAU numeric ID. Any CAU can
utilize any provider 99 /service location combination found on the PT 99 database as long
as the provider is registered for that specialty/procedure code/modifier combination.
SPECIAL INSTRUCTIONS: Required.
Editing Criteria: This field is required. The number must be a valid provider number
found on the DPW provider file (PRV414) or if a non-MA provider, must be found on
the OMHSAS Provider 99 database. This element in combination with provider service
location (catalog 125) must be associated with a behavioral health provider type:
01 (Inpatient Facility)
08 (Clinic)
09 (Certified Registered
Nurse Practitioner)
11 (Mental Health/Substance Abuse)
16 (Nurse)
17 (Therapist)
19 (Psychologist)
21 (Case Manager)
28 (Laboratory)
31 (Physician)
34 (Program Exception)
52 (Community
Residential Rehab)
56 (Residential Treatment
Facility)
99-CCR POMS ONLY
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Performance Outcome Management System
Reporting Manual for Encounter & Subcapitation Data
ENCOUNTER AND SUBCAPITATION DATA CATALOG DEFINITIONS
Picture 9(03)
Format RJ, zero fill
Positions 89-91
Catalog No. 126
Data Name Provider Specialty Code
Revised 3/1/07
Page 1 of 1
Type 6 Medical Services
Type 8 Inpatient
Subcapitation
Field Required
X
X
X
Field Optional
Field N/A
DEFINITION: For MA Providers enrolled in PROMISe, refer to the “PROMISe PT
Crosswalk.CCRPoms.2.28.05.xls” (found in additional documentation/crosswalks).
Provider specialty codes are also available on the PRV414 file.
For services being reported under OMHSAS “Provider Type 99”, the following
specialties exist:
099-Emergency
110-Psychiatric Outpatient
111-Community Mental Health
112-Outpatient Practitioner- MH
119-MH-OMHSAS
123-Psychiatric Rehabilitation
215-MH Case Management-Administrative
267-Non Emergency
456-CRR Adult
515-Pre-Vocational-2390
519-Family Support Services
525-Community Integration
551-Community Transition Services
560-Residential Treatment Facility (Non-JCAHO Certified)
SPECIAL INSTRUCTIONS: Required.
Editing Criteria: Must be a valid specialty for the reported provider type, as set forth in
the definition.
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Reporting Manual for Encounter & Subcapitation Data
Revision Dates for Encounter and Subcapitation Data Elements
Current as of 2/1/07 - Page 1 of 2
Catalog No.
Catalog No. 001
Catalog No. 002
Catalog No. 003
Catalog No. 004
Catalog No. 005
Catalog No. 006
Catalog No. 007
Catalog No. 008
Catalog No. 009
Catalog No. 010
Catalog No. 011
Catalog No. 012
Catalog No. 013
Catalog No. 014
Catalog No. 015
Catalog No. 016
Catalog No. 017
Catalog No. 018
Catalog No. 019
Catalog No. 020
Catalog No. 021
Catalog No. 022
Catalog No. 023
Catalog No. 024
Catalog No. 025
Last Revised
Revised 09/01/05
Revised 09/01/05
Revised 04/01/01
Revised 09/01/05
Revised 05/23/97
Revised 09/01/05
Revised 10/05/01
Revised 01/24/03
Revised 09/01/05
Deleted 01/01/05
Deleted 01/01/05
Revised 1/23/07
Revised 09/01/05
Revised 09/01/05
Deleted 01/01/05
Deleted 01/01/05
Deleted 01/01/05
Deleted 01/01/05
Deleted 01/01/05
Deleted 01/01/05
Deleted 09/01/05
Deleted 01/01/05
Deleted 01/01/05
Deleted 01/01/05
Original not revised
Catalog No.
Catalog No. 065
Catalog No. 066
Catalog No. 067
Catalog No. 068
Catalog No. 069
Catalog No. 070
Catalog No. 071
Catalog No. 072
Catalog No. 073
Catalog No. 074
Catalog No. 075
Catalog No. 076
Catalog No. 077
Catalog No. 078
Catalog No. 079
Catalog No. 080
Catalog No. 081
Catalog No. 082
Catalog No. 083
Catalog No. 084
Catalog No. 085
Catalog No. 086
Catalog No. 087
Catalog No. 088
Catalog No. 089
Catalog No. 026
Catalog No. 027
Catalog No. 028
Catalog No. 029
Catalog No. 030
Catalog No. 031
Catalog No. 032
Catalog No. 033
Catalog No. 034
Catalog No. 035
Catalog No. 036
Catalog No. 037
Catalog No. 038
Catalog No. 039
Catalog No. 040
Catalog No. 041
Catalog No. 042
Catalog No. 043
Deleted 01/01/05
Deleted 01/01/05
Deleted 01/01/05
Original not revised
Original not revised
Revised 09/01/05
Revised 05/23/97
Revised 09/01/05
Revised 12/15/97
Deleted 01/01/05
Deleted 01/01/05
Revised 09/01/05
Deleted 01/01/05
Deleted 01/01/05
Deleted 01/01/05
Deleted 01/01/05
Deleted 01/01/05
Deleted 01/01/05
Catalog No. 090
Catalog No. 091
Catalog No. 092
Catalog No. 093
Catalog No. 094
Catalog No. 095
Catalog No. 096
Catalog No. 097
Catalog No. 098
Catalog No. 099
Catalog No. 100
Catalog No. 101
Catalog No. 102
Catalog No. 103
Catalog No. 104
Catalog No. 105
Catalog No. 106
Catalog No. 107
Last Revised
Deleted 01/01/05
Deleted 01/01/05
Revised 04/08/02
Deleted 01/01/05
Deleted 01/01/05
Revised 01/01/05
Revised 02/01/05
Revised 02/01/05
Revised 01/01/05
Revised 09/01/05
Deleted 01/01/05
Revised 05/01/00
Revised 06/30/98
Deleted 01/01/03
Deleted 01/01/03
Revised 01/01/05
Revised 12/15/97
Revised 05/01/00
Revised 01/01/03
Revised 09/01/05
Revised 05/23/97
Deleted 02/01/05
Deleted 02/01/05
Deleted 01/01/05
Deleted prior to
01/01/05
Original not revised
Revised 01/01/03
Revised 05/01/00
Revised 12/15/97
Deleted 01/01/05
Deleted 01/01/05
Deleted 01/01/05
Deleted 01/01/05
Revised 12/17/96
Deleted 01/01/05
Deleted 02/01/05
Deleted 01/01/05
Deleted 01/01/05
Deleted 01/01/05
Deleted 01/01/05
Revised 05/01/00
Deleted 01/01/05
Deleted prior to
01/01/05
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Performance Outcome Management System
Reporting Manual for Encounter & Subcapitation Data
Catalog No. 044
Deleted 01/01/05
Catalog No. 108
Catalog No. 045
Catalog No. 046
Catalog No. 047
Catalog No. 048
Catalog No. 049
Catalog No. 050
Catalog No. 051
Catalog No. 052
Catalog No. 053
Catalog No. 054
Catalog No. 055
Catalog No. 056
Catalog No. 057
Catalog No. 058
Catalog No. 059
Catalog No. 060
Deleted 01/01/05
Deleted 01/01/05
Deleted 01/01/05
Deleted 01/01/05
Deleted 01/01/05
Revised 03/04/05
Deleted 01/01/05
Deleted 01/01/05
Deleted 01/01/05
Deleted 01/01/05
Deleted 01/01/05
Deleted 01/01/05
Deleted 01/01/05
Deleted 01/01/05
Deleted 01/01/05
Deleted 01/01/05
Catalog No. 109
Catalog No. 110
Catalog No. 111
Catalog No. 112
Catalog No. 113
Catalog No. 114
Catalog No. 115
Catalog No. 116
Catalog No. 117
Catalog No. 118
Catalog No. 119
Catalog No. 120
Catalog No. 121
Catalog No. 122
Catalog No. 123
Catalog No. 124
Catalog No. 061
Catalog No. 062
Catalog No. 063
Deleted 01/01/05
Revised 05/01/00
Revised 01/24/03
Catalog No. 125
Catalog No. 126
Catalog No. 127
Catalog No. 064
Revised 02/01/05
Catalog No. 128
Deleted prior to
01/01/05
Revised 01/01/03
Deleted 02/01/05
Revised 09/01/05
Deleted 01/01/05
Deleted 01/01/05
Deleted 01/01/05
Deleted 01/01/05
Deleted 01/01/05
Deleted 01/01/05
Deleted 01/01/05
Deleted 01/01/05
Deleted 01/01/05
Deleted 01/01/05
Deleted 01/01/05
Deleted 01/01/03
Revised 01/01/03
*Previously Catalog
No. 119
New 01/01/05
Revised 03/01/07
New 01/01/05
(Merged into 072
2/1/05)
New 01/01/05
(Merged into 072
2/1/05)
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Reporting Manual for Encounter & Subcapitation Data
Encounter Data and Subcapitation Financial Data Adjustment Overview
Encounter adjustments are described below but the same principle applies to subcapitation payment
records.
All encounters initially submitted to the Department are designated by an Adjustment Code (Catalog No.
003) value of "1". The Department will validate each encounter, and either accept the encounter, or return it
to the plan for correction. All corrected encounters will be returned to the Department for "re-validation"
and eventual Department acceptance. Until an "initial" encounter passes all validation criteria, and is
accepted by the Department, the Adjustment Code value of "1" will continue to be used, despite the number
of times the correction cycle may occur. Once an encounter has been accepted by DPW, if any of the
information initially submitted changes, or was submitted incorrectly, an adjustment encounter should be
sent to the Department.
There are two types of encounter adjustments that may be used to alter encounters previously accepted by
DPW:
1. Cancel (ONLY) a DPW accepted encounter.
Cancel the incorrect encounter record by submitting an encounter adjustment and submit all fields
on the encounter adjustment exactly as they were submitted on the encounter record that is being canceled
EXCEPT for the following:
 Adjustment Code - Use the value "0" on the encounter adjustment.
 Claim Reference Number - Assign a new number; do NOT use the Claim Reference Number
previously assigned by the CAU to the encounter record that is being canceled.
 Adjustment CRN - Use the Claim Reference Number originally assigned by the CAU to the
encounter record that is being canceled.
 NOTE: For an adjustment to an adjustment, use the Claim Reference Number assigned to the most
recent encounter record to be adjusted.
 All quantity and dollar amount data fields with non-zero values must have a negative sign. (Please
refer to previous chart for specific quantity and dollar amount data elements.)
 If the cancellation impacted the payment to the provider, use the date applicable to the cancellation,
not the date originally assigned to the record being adjusted. If the cancellation is submitted to
correct a non-payment related error and did not cancel the payment to the provider, use the
Payment/Adjudication Date as it appeared on the encounter record which is being canceled. This is
the methodology which is to be used when adjusting records in response to an OMHSAS secondlevel (Quality) edit notification.
2. Cancel AND replace a DPW accepted encounter.
Cancel the incorrect encounter record by submitting an encounter adjustment; replace the canceled
encounter with a new encounter (adjustment). The "cancel and replace" option is a two-step process that
requires the submission of two encounter adjustment records. The first will cancel, or negate, the original
DPW accepted encounter; the second will take the place of the canceled encounter.
A. Cancellation Record.-Submit all fields on the encounter adjustment exactly as they were
submitted on the encounter record that is being canceled, EXCEPT for the following:
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





Adjustment Code - Use the value "0" on the encounter adjustment.
Claim Reference Number - Assign a new number; do NOT use the Claim
Reference Number previously assigned by the CAU to the encounter record that is being canceled.
Adjustment CRN - Use the Claim Reference Number originally assigned by the CAU to the
encounter record that is being canceled. NOTE: For an adjustment to an adjustment, use the Claim
Reference Number assigned to the most recent encounter record to be adjusted.
All quantity and dollar amount data fields with non-zero values must have a negative sign. (Please
refer to previous chart for specific quantity and dollar amount data elements.)
Payment/Adjudication Date - If the cancellation impacted the payment to the provider, use a date
applicable to the cancellation; not the date originally assigned by the CAU to the record being
adjusted. Use the same date assigned to the replacement record. If the cancellation is submitted to
correct a non-payment related error and did not cancel the payment to the provider, use the
Payment/Adjudication Date as it appeared on the encounter record which is being cancelled.
B. Replacement Record-Submit corrected data in ALL fields, with the following EXCEPTIONS:




Adjustment Code - Use the value "3" on the encounter adjustment
Claim Reference Number - Assign a new number; do NOT use the Claim Reference Number
previously assigned by the CAU to the encounter record that is being replaced.
Adjustment CRN - Use the Claim Reference Number originally assigned by the CAU to the
encounter record that is being replaced. NOTE: For an adjustment to an adjustment, use the Claim
Reference Number assigned to the most recent encounter record to be adjusted.
Payment/Adjudication Date - If the replacement record impacts the payment to the provider, use the
date applicable to the adjustment; not the date originally assigned by the CAU to the
encounter/subcapitation record being adjusted. If the replacement is submitted to correct a nonpayment related error and does not impact the payment to the provider, use the
Payment/Adjudication Date as it appeared on the encounter record which is being corrected. This is
the methodology to be used when adjusting records in response to an OMHSAS second-level
(Quality) edit notification.
For each encounter record having an Adjustment Code value "3", there must be a corresponding
encounter record with an Adjustment Code value "0". Each record (value "3" and value "0") will have
a DIFFERENT Claim Reference Number, but will share a COMMON Adjustment CRN.
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Encounter Data Import Errors
Err Code
1.1
1.2
1.3
1.5
2.1
2.2
2.3
2.4
2.6
3.1
4.1
4.2
5.1
5.2
5.4
5.6
6.1
6.2
6.3
6.4
6.5
7.3
7.5
7.6
9.1
9.2
25.8
25.9
29.8
29.9
30.8
30.9
31.3
31.5
31.7
32.1
32.2
33.1
33.2
34.1
Error Message
Adjudication From Date is greater than the system processing date
Adjudication From Date is either blank, not numeric, not a valid calendar date, or is prior to
07/01/1999
Adjudication From Date is greater than the File Creation Date
Adjudication From Date is not the first day of a quarter (01/01, 04/01, 07/01, 10/01)
Adjudication To Date is greater than the system processing date
Adjudication To Date is less than Adjudication From Date
Adjudication To Date is either blank, not numeric, not a valid calendar date, or is prior to
09/30/1999
Adjudication To Date is greater than the File Creation Date
Adjudication To Date is not the last day of a quarter (03/31, 06/30, 09/30, 12/31)
Adjustment Code is not between 0 and 3
Adjustment CRN is blank, but Adjustment Code indicates it should be present
Adjustment CRN is present, but Adjustment Code indicates it should be blank
Admission Date is blank but Record Type indicates it should be present
Admission Date is either blank, not numeric, or not a valid calendar date
Admission Date is greater than header record File Creation Date
Admission date must be less than or equal to End Date of Service
Amount Reimbursed is blank, not numeric, or not a signed number
Amount Reimbursed is less than 0, but Adjustment Code indicates it should be 0 or greater
Amount Reimbursed is greater than 0, but Adjustment Code indicates it should be 0 or less
Amount reimbursed must be zero for program funded arrangement
Amount reimbursed cannot be zeroes on inpatient records (RT=8) for plans reporting
expenditure information under Option 2
Begin Date of Service is greater than header record Adjudication To Date
Begin Date of Service is greater or equal to the current date
Begin Date of Service is either blank, not numeric, not a valid calendar date, or is prior to
07/01/2004.
Claim Reference Number is blank
Claim Reference Number is not alphanumeric, contains blanks, or is invalid
WARNING - Inpatient Count from trailer record is not numeric
WARNING - Inpatient Count from trailer record does not match the total Inpatient records
processed
WARNING - Medical Count from trailer record is not numeric
WARNING - Medical Count from trailer record does the total Medical Record processed
WARNING- Total Count from trailer record is not numeric
WARNING - Total Count from trailer record does not match the total record processed
End Date of Service is less than Begin Date of Service
End Date of Service is greater than header record Adjudication To Date
End Date of Service is greater than the system processing date
Fifth Diagnosis Code is invalid or not on the list of approved diagnosis codes
If fifth diagnosis code is submitted then primary, secondary, third and fourth diagnosis codes
must be present.
File Creation Date is blank, not numeric, is not a valid calendar date, or is prior to 07/01/1999
File Creation Date is greater than the system processing date
Fourth Diagnosis Code is invalid or not on the list of approved diagnosis codes
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Err Code
34.2
37.1
37.2
37.3
37.4
37.5
62.1
62.2
63.1
63.2
63.9
64.1
64.4
67.1
67.2
70.1
71.1
72.1
73.1
74.1
74.3
74.4
76.1
76.2
76.4
77.1
77.2
77.3
80.1
80.2
81.1
81.2
81.3
82.1
82.2
83.1
83.2
83.3
83.4
83.5
83.6
83.9
84.1
84.2
84.3
84.4
84.5
Error Message
If fourth diagnosis code is submitted then primary, secondary and third diagnosis codes must
be present.
CAU Code is blank or not on the list of valid CAU Codes
CAU Code in submission record does not match CAU Code on header record
CAU Code in header record does not match CAU Code in submission file name.
The joinder for this CAU Code was not active during the Adjudication Period
The joinder for this CAU Code was not active during the service period
Patient Discharge Status is invalid
Patient Discharge Status must be 00 for aggregate records (SSN = xx0000000)
Payment/Adjudication Date is blank, not numeric, is not a valid calendar date, or is prior to
start of reporting (07/01/1999 for pre-PROMISe data, 07/01/2004 for PROMISe data)
Payment/Adjudication Date is greater than header record Adjudication To Date
WARNING-Payment/Adjudication Date should be zeroes when reporting expenditure
information on annual Subcapitation record
Place of Service is invalid
Place of Service must be “21” for Inpatient record (Record Type = “8”)
Primary Diagnosis Code is invalid or not on the list of approved diagnosis codes
Primary Diagnosis Code must be blank for aggregate records (SSN = xx0000000)
Procedure Code is blank or not on the list of approved procedure codes
Procedure Code Modifiers not valid for this Procedure Code
Procedure Code Information Modifier(s) not valid for this Procedure Code
CAU Provider ID Number is blank, not numeric, or not on the OMHSAS list of approved
CAU codes
Quantity is blank, not numeric, or not a signed number
Quantity is less than 0, but Adjustment Code indicates it should be 0 or greater
Quantity is greater than 0, but Adjustment Code indicates it should be 0 or less
Recipient Birth Date is blank, not numeric, or is an invalid calendar date
Recipient Birth Date is greater than header record Adjudication To Date
Recipient Birth Date must be zero-filled for aggregate records (SSN = xx0000000)
Recipient CIS Number is not numeric
Recipient CIS Number check digit is not valid
Recipient CIS Number must be zero-filled for aggregate records (SSN = xx0000000)
Recipient Social Security Number is not numeric or is invalid
Provider Type in Social Security Number does not match Provider Type of record
Record Type is not present, or is not 0, 6, 7, 8, or 9
Record Type of first record in file is not 0
Record Type for a record after the first record is not 6, 7, 8, or 9
Revenue Code is not numeric or not a valid Revenue Code
There are no Revenue Codes for this record
Revenue Code Charges is blank, not numeric, or not a signed number
Revenue Code Charges is not 0, but corresponding Revenue Code is blank
Revenue Code Charges is 0, but corresponding Revenue Code is present
Revenue Code Charges is less than 0, but Adjustment Code indicates it should be 0 or greater
Revenue Code Charges is greater than 0, but Adjustment Code indicates it should be 0 or less
There are no Revenue Code Charges for this record
WARNING-Revenue Code Charges should be zeroes when reporting expenditure information
on annual Subcapitation record; they will be set to zeroes
Revenue Code Units is blank, not numeric, or is not a signed number
Revenue Code Units is not 0, but corresponding Revenue Code is blank
Revenue Code Units is 0, but Revenue Code indicates it should be 0
Revenue Code Units is less than 0, but Adjustment Code indicates it should be 0 or greater
Revenue Code Units is greater than 0, but Adjustment Code indicates it should be 0 or less
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Err Code
84.6
85.1
85.2
92.1
93.1
93.2
98.1
105.1
105.2
109.1
109.2
126.1
126.2
126.3
126.4
301.1
Error Message
There are no Revenue Code Units for this record
Secondary Diagnosis Code is not on the list of approved diagnosis codes
Secondary diagnosis code must be blank for aggregate services records
Submission Indicator is not I
Third diagnosis code is invalid or not on the list of approved diagnosis codes
If third diagnosis code is submitted then primary and secondary codes must be present.
Type of Admission must be 1, 2, or 3
DRG Number is not numeric or not on the list of approved diagnostic related group values
DRG Number must be zero-filled for aggregate records (SSN = xx0000000)
Capitation FFS Indicator blank or invalid
Capitation FFS Indicator must be F, P, or Z when reporting expenditure information on annual
subcapitation record
Missing Social Security Number Status must be 0, 1, 2, or 3
Missing Social Security Number Indicator is 1, 2, or 3 even though this record has a valid
Social Security Number
Missing Social Security Number Indicator is 0 even though the Social Security Number for
this record is invalid
Missing SSN Indicator must be 0 for aggregate records (SSN = xx0000000)
Recipient County of Residence code is not valid
CAU Id associated with Recipient County of Residence does not match the CAU ID for this
record
WARNING - Recipient County of Residence was not submitted
Provider Service Location is blank, not numeric, or invalid; Provider Type could not be
determined
Provider Service Location not valid with this Provider Number; provider type could not be
determined.
Provider was not active at this location during period of service; provider type could not be
determined.
Provider Specialty Code is blank, not numeric, or invalid.
Provider Specialty Code not valid with this Provider Number and Service Location
Provider was not active in this specialty during period of service
Provider Specialty Code is not valid for this Type 99 Provider
No record with this CRN is available for deletion
301.3
302.1
304.1
No record with this CRN is available for replacement
A record with this Claim Reference Number has been found in the system
In-plan service group code could not be determined
320.9
321.9
WARNING - No match found for this SSN in CRF. Submit POMS data if applicable
WARNING - CRF is present, but recipient case is not open at time of service. Correct POMS
401.1
401.2
This record is rejected. It contains either too many or too few characters
This record is rejected. It contains characters other than A-Z, 0-9, +, -, space, carriage return,
and line feed
This submission contains no Encounter detail records
111.1
111.2
111.3
111.4
124.1
124.2
124.9
125.1
125.2
125.3
402.1
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Subcapitation Data Import Errors
Err Code
1.0
2.0
3.0
4.0
4.2
5.0
6.0
10.0
10.1
10.2
10.3
11.0
12.0
12.1
12.3
14.0
15.0
15.1
15.2
15.3
16.0
16.1
16.2
17.0
19.0
19.1
20.0
20.1
20.2
20.3
21.0
22.0
30.0
50.0
50.1
50.2
80.0
84.0
84.1
Error Message
Invalid "Record Type" in Header Record. Submission rejected.
Invalid or missing "CAU Code" in Header Record. Submission rejected.
Invalid or missing "Provider MA ID Number" in Header Record. Submission rejected.
Invalid or missing "File Creation Date" in Header Record. Submission rejected.
"File Creation Date" > today's date. Submission rejected.
Warning! Invalid or missing "Submission Indicator" in Header Record. Submission rejected.
Incorrect Record Length. Submission rejected.
Invalid or missing "Record Type" in Subcapitation record. Record rejected.
Record out of sequence in "Record Type". Record rejected.
Number of records with invalid "Record Type" exceeds 3. Submission rejected.
Blank line in file. Record rejected.
Invalid or missing "CAU Code" in Subcapitation record. Record rejected.
Invalid or missing "Provider ID Number" in Subcapitation record. Record rejected.
Invalid or missing "Provider Specialty Code in Subcapitation Record. Record rejected.
Invalid or missing "Provider Service Location" in Subcapitation file. Record rejected.
Invalid or missing "Subcapitation Payment" in Subcapitation record. Record rejected.
Invalid or missing "Coverage Begin Date" in Subcapitation record. Record rejected.
"Coverage Begin Date" less than Program Start Date. Record rejected.
Coverage Begin Date greater than coverage end date. Record rejected.
Coverage Begin Date must be start of fiscal year when Category of Provider = 'C'. Record
rejected.
Invalid or missing "Coverage End Date" in Subcapitation record. Record rejected.
Coverage End Date greater than file creation date. Record rejected.
Coverage End Date must be end of fiscal year when Category of Provider = 'C'. Record
rejected.
Invalid or missing "Category of Provider" in Subcapitation record. Record rejected.
Invalid or missing "Payment/Adjudication Date" in Subcapitation record. Record rejected.
"Payment/Adjudication Date" greater than "File Creation Date". Record rejected.
Procedure code is blank and option = 2. Record rejected.
Procedure code is 0 and option = 2. Record rejected.
Procedure code submitted is not on the list of approved procedure codes. Record rejected.
Invalid Procedure Code for this Provider/Service Location/Specialty. Record rejected.
Procedure Code Modifiers not valid for this Procedure Code. Record rejected.
Invalid or missing "Adjustment Code" in Subcapitation record. Record rejected.
Duplicate record. Record rejected.
Target record for Adjustment code "0" not found in database. Record rejected.
Target record for Adjustment code "2" not found in database. Record rejected.
Target record for Adjustment code “3” not found in database. Record rejected.
Invalid "Record Type" in last record ("T" expected). Submission rejected.
Warning| Invalid or missing "Number of Subcapitation Records" in Trailer Record.
Warning| "Number of Subcapitation Records" in Trailer Record does not match file.
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Section 4Appendix A- Priority Groups
Adult Target Populations:



Population 1- This population is defined in MH Bulletin OMH-94-04 as the “Adult Priority Group”.
Population 2- This population includes persons (age 18+ or 22+ if in Special Education) who meet
the federal definition of serious mental illness (as described in MH Bulletin OMH-94-04), but do
not meet all of the criteria for the adult target population #1.
Population 3- This population includes persons (age 18+ or 22+ if in Special Education) who are
statutorily eligible for publicly-funded mental health services, but do not meet the federal
definitions of serious mental illness.
Child and Adolescent Target Populations:
Group 1- Persons who meet all four criteria below:
 Age: Birth to less than 18 (or age 18 to less than 22 and enrolled in special education service).
 Currently or at any time during the past year have had a DSM diagnosis (excluding those sole
diagnosis is mental retardation or psychoactive substance use disorder or a “V” code) that resulted
in functional impairment which substantially interferes with or limits the child’s role of functioning
in family, school, or community activities.
 Receive services from Mental Health and one or more of the following:
o Mental Retardation
o Children and Youth
o Special Education
o Drug and Alcohol
o Juvenile Justice
o Health (the child has a chronic health condition requiring treatment)
 Identified as needing mental health services by a local interagency team, e.g., CASSP Committee,
Cordero Workgroup.
In addition to the above definition of Child and Adolescent Target Group 1, any child or adolescent (birth
to less than 18; or age 18 to less than 22 and enrolled in a special education service) who met the standards
for involuntary treatment within the 12 months preceding the assessment (as defined in Chapter 5100
Regulations – Mental Health Procedures) is automatically assigned to this high priority consumer group.
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Group 2Children and adolescents are at-risk of developing a serious emotional disturbance when they exhibit
substantial (50% or less of expected age level) delays in psycho-social development. Some children
between birth and three years of age are already in serious difficulty emotionally and are impaired in their
daily functioning and relationships. Though the ability to accurately diagnose mental and emotional
disorders in young children is limited, some diagnostic categories such as failure to thrive, pervasive
development disorders, autism and disorders of attachment are indicative of risk. In other instances, mental
and emotional disturbances are readily observable in infants and toddlers. The fearfulness and hypervigilance typical of the abused infant, for example, looks very much like the symptoms of post traumatic
stress or panic disorders of adulthood. Given the difficulty in diagnosing risk in young children and the
lack of firm evidence linking environmental and physical conditions to risk of serious emotional
disturbance, the plan purposes to focus upon children and adolescents who have historically and
demonstrably been at-risk of developing a serious emotional disturbance. Therefore, priority is associated
with children at-risk of developing a serious emotional disturbance by virtue of the fact that:
A. Their parent(s) has a severe mental illness
B. They have been physically or sexually abused
C. They are drug dependent
D. They are homeless
E. They have been referred to the Student Assistance Programs
Group 3Children and Adolescents who currently or at any time during the past year have had a DSM diagnosis
(excluding those whose sole diagnosis is mental retardation, psychoactive substance use disorder of a “V”
code) that resulted in functional impairment which substantially interferes with or limits the child’s role or
functioning in family, school or community activities and who do not met criteria for child and adolescent
target groups 1 or 2.
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Appendix B- MH Bulletin OMH-94-04
Appendix B
MENTAL HEALTH BULLETIN
COMMONWEALTH OF PENNSYLVANIA
DATE OF ISSUE
March 4, 1994
DEPARTMENT OF PUBLIC WELFARE
EFFECTIVE DATE
Immediately
SUBJECT
Serious Mental Illness: Adult Priority Group
NUMBER
OMH-94-04
BY
Ford S. Thompson, Jr
Deputy Secretary for Mental Health
SCOPE:
County Mental Health/Mental Retardation Programs
State Mental Health Planning Council
PURPOSE:
To establish the Adult Priority Group for planning and service development for adults with serious mental
illness.
BACKGROUND:
On May 20, 1993, the Center for Mental Health Services (CMHS) published its definition of serious mental illness in
the Federal Register:
Pursuant to Section 1912 (c) of the Public Health Services Act, as amended by Public Law 102-321, “adults with
serious mental illness” are persons age 18 and over, who currently or at any time during the past year, have had a
diagnosable mental, behavioral, or emotional disorder of sufficient duration to meet diagnostic criteria specified within
DSM-III-R that has resulted in functional impairment which substantially interferes with or limits one or more major life
activities.
These disorders include any mental disorders (including those of biological etiology) listed in DSM-III-R or their ICD9-CM equivalent (and subsequent revisions), with the exception of DSM-III-R, “V” codes, substance use disorders,
and developmental disorders, which are excluded unless they co-occur with other diagnosable serious mental illness.
All of these disorders have episodic, recurrent, or persistent features; however, they vary in terms of severity or
disabling effects.
Functional impairment is defined as difficulties that substantially interfere with or limit role functioning in one or more
major life activities including basic daily living skills (e.g., eating, bathing, dressing); instrumental living skills (e.g.,
maintaining a household, managing money, getting around the community, taking prescribed medication); and
functioning in social, family, and vocational/educational contexts. Adults who would have met functional impairment
criteria during the referenced year without benefit of treatment or other support services are considered to have
serious mental illnesses.
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This definition, required by the ADAMHA reorganization Act of 1992, is to be used by states in planning and providing
services under the CMHS Block Grant Program. States are permitted to establish priorities within the scope of this
definition. Accordingly, the Office of Mental Health has identified, within the federal definition, an Adult Priority Group
which will be used for the development of the State Mental Health Plan and the county needs based plans.
COMMENTS AND QUESTIONS REGARDING THIS BULLETIN SHOULD BE DIRECTED TO:
Office of Mental Health, Bureau of Adult Services: (717) 787-1948.
DISCUSSION:
Prior to the 1992 ADAMHA Reorganization Act, federal planning legislation permitted the states to develop their own
definitions of “serious mental illness.” Pennsylvania’s definition was developed in 1989, and included a combination
of diagnostic, service utilization and level of functioning criteria. The definition was used to establish the priority
group for state and county planning and service development, as well as to establish eligibility for Intensive Case
Management (ICM) Services.
In accordance with the federally delegated authority to establish priorities within the broad definition published by
CMHS, as well as to address a variety of limitations identified with our 1989 definition, the Office of Mental Health is
redefining Pennsylvania’s Adult Priority Group. This new definition does not change statutory and/or regulatory
requirements related to involuntary commitment or eligibility for mental health services, including ICM.
Major changes to the Adult Priority Group include: a requirement that the diagnosis criterion be met in all cases; an
expansion of the qualifying diagnoses to include borderline personality disorder and psychotic disorder NOS; an
expansion of the treatment history criteria to include mental health services provided in correctional settings as well
as those delivered by non-mental health professionals; a revision to the qualifying Global Assessment of Functioning
score, reducing it from 60 (indicating moderate) to 50 (indicating severe); and the incorporation of coexisting
diagnoses such as psychoactive substance use disorders as a qualifying criterion.
Persons who meet the Adult Priority Group definition are to be given top priority in state and county planning and
service development. Secondary priority is given to the group of persons who meet the CMHS definition but are not
included in the Adult Priority Group. The secondary group has priority over persons who are statutorily eligible for
publicly-funded mental health services, but do not meet the federal definition of serious mental illness.
ADULT PRIORITY GROUP
In order to be in the Adult Priority Group, a person: must meet the federal definition of serious mental illness; must be
age 18+, (or age 22+ if in special Education); must have a diagnosis of schizophrenia, major mood disorder,
psychotic disorder NOS or borderline personality disorder (DSM-III-R diagnostic codes 295.xx, 296.xx, 298.9x or
301.83); and must meet at least one of the following criteria: A. (Treatment History), B. (Functioning Level) or C.
(Coexisting Condition or Circumstance).
A. Treatment History
1. Current residence in or discharge from a state mental hospital within the past two years; or
2. Two admissions to community or correctional inpatient psychiatric units or crisis residential services totaling
20 or more days within the past two years; or
3. Five or more face-to-face contacts with walk-in or mobile crisis or emergency services within the past two
years; or
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4. One or more years of continuous attendance in a community mental health or prison psychiatric service (at
least one unit of service per quarter) within the past two years service (at least one unit of service per
quarter) within the past two years; or
5. History of sporadic course of treatment as evidenced by at least three missed appointments within the past
six months, inability or unwillingness to maintain medication regimen or involuntary commitment to outpatient
services; or
6. One or more years of treatment for mental illness provided by a primary care physician or other non-mental
health agency clinician, (e.g., Area Agency on Aging) within the past two years.
B. Functioning Level
Global Assessment of Functioning Scale (DSM-III-R, pages 12 and 20) rating of 50 or below.
C. Coexisting Condition or Circumstance:
1. Coexisting diagnosis:
a) Psychoactive Substance Use Disorder; or
b) Mental Retardation; or
c) HIV/AIDS; or
d) Sensory, Developmental and/or Physical Disability; or
2. Homelessness *; or
3. Release from criminal detention. **
In addition to the above definitions of the Adult Priority Group, any adult who met the standards for involuntary
treatment (as defined in Chapter 5100 Regulations – Mental Health Procedures) within the 12 months preceding the
assessment, is automatically assigned to this high priority consumer group.
* Homeless persons are those who are sleeping in shelters or in places not meant for human habitation, such as
cars, parks, sidewalks or abandoned buildings.
** Applicable categories of release from criminal detention are jail diversion; expiration of sentence or parole;
probation or Accelerated Rehabilitation Decision (ARD).
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Appendix C- Expenditure Reporting Options
Effective with fiscal year 2001/2002, the county mental health programs have two options for submitting
CCR POMS expenditure information.
Option 1 requires that all fee-for-service expenditure information be reported on the detail encounter
record (Record Type 6 or 8). The first option also provides for the reporting of program funded
expenditures and expenditures from other alternative payment arrangements by submitting detail encounter
data on the appropriate record type without payment information, then the county submits subcapitation
financial records with the expenditures monthly/quarterly/annually Subcapitation Financial Report
(Record Type S).
Option 2 requires the County to submit all detail encounter data without expenditure information,
regardless of the provider payment arrangement. Then the county submits subcapitation financial records
with expenditure information for all provider payment arrangements in an annual Subcapitation Financial
Report (Record Type S).
County programs must select either Option 1 or Option 2.
CCR POMS expenditure data is reported on two types of records, encounters and subcapitation financial
records.
Encounter data is the individual data that records a behavioral health service received by a consumer from
a provider. This data will account for each visit or service that an individual receives from county funded
programs. Depending upon the option selected by the county, the amount paid to the provider for that
service may or may not be included in the encounter record. There are currently two basic encounter
records, Record Type 6 includes all services performed in an outpatient setting, and Record Type 8
includes all services received in an inpatient hospital setting.
Many counties enter into arrangements with providers to provide specific service or services to an unknown
number of consumers for a specified timeframe and an agreed upon amount, regardless of the number of
consumers who access the service. There are several types of provider payment arrangements that fall into
this category, including retainer agreements, subcapitation agreements, reinvestment arrangements, and
program funded arrangements. Of these, the most common is the program funded arrangement.
**Subcapitation financial data consists of financial information submitted to supplement the information
on the encounter data. Depending upon the option selected by a county program, the data reported on the
subcapitation financial Record Type S will differ. For example, the subcapitation financial data may
include the monthly or quarterly amount reimbursed to a provider for the provision of program funded
services, or it may provide the annual reimbursement to a provider for a specific procedure. This record
will also be used to submit gross adjustment payments to a particular payment arrangement of a provider or
to report cost settlement payment adjustments to a provider as a whole.
**Known as Alternative Payment Arrangement (APA) financial data in HealthChoices
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OPTION 1
ENCOUNTER DATA
The county must submit one encounter record for each consumer for each service received.
For encounter records based on a fee-for-service arrangement, all fields should be completed as
appropriate. The Capitation/Fee-for-Service indicator (109) should be F. The Amount Reimbursed (006)
field should contain the amount paid to the provider for the service to the consumer. The Payment
Adjudication Date (063) is also required. For Record Type 8 (inpatient encounters), the county should
indicate the total of all Revenue Code Charges (083).
For encounter records based on program funded arrangements, reinvestment arrangements, retainer
agreements, and subcapitation agreements, all required fields must be submitted. The Amount Reimbursed
(006) field will contain zeros. For Record Type 8 (inpatient encounters), all Revenue Code Charges (083)
should be zero. The Capitation/Fee-for-Service Indicator (109) field will conform to specifications
described in the data definition and be consistent with the values reported in the Category of Provider (008)
of the subcapitation financial records that are submitted to report the periodic payments to the providers for
these services.
**SUBCAPITATION FINANCIAL DATA
For each payment arrangement other than fee-for-service, one subcapitation financial detail record (Record
Type S) must be submitted. This file can be monthly, quarterly or annually. The MA Provider number for
the provider with whom the county has the arrangement must be entered. The amount paid to the provider
for the services provided for the time period must also be entered. For instance, the provider received
$3000.00 for the period of January 1, 2004, through March 31, 2004, or for the period February 1, 2004
through February 29, 2004. The Category of Provider (008) field should contain the number or character
assigned to the arrangement between the provider and the county for which the record is being submitted
consistent with the value entered in the Capitation Fee-for-Service Indicator (109) on the encounter record.
For example, if the county has one program funded service arrangement with a provider, the number 1 is
entered in the Category of Provider (008) field. If the county has multiple program funded service
arrangements with a provider, they are numbered consecutively and the appropriate number of the
arrangement should be entered in the field. If the county has a retainer agreement with a provider, the letter
R is entered in the Category of Provider (008) field and in the Capitation Fee-for-Service Indicator (109) of
the encounter records detailing the services provided under this retainer agreement.
For each payment arrangement other than fee-for-service, OMHSAS will calculate the amount reimbursed
to be applied to encounter records by linking the encounter data records with the appropriate subcapitation
financial records. The link is established by the values found on both records for CAU Code (037), MA
Provider Number (050), and Provider Service Location (125), by comparing the End Date of Service (031)
of the encounter to the Coverage Begin Date (013) and Coverage End Date (014) of the subcapitation
financial record, and by matching the values in the Capitation Fee-for-service Indicator (109) of the
encounter record and the Category of Provider (008) of the subcapitation financial record.
**Known as Alternative Payment Arrangement (APA) financial data in HealthChoices
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ROUTINE PAYMENT ADJUSTMENTS
To adjust a monthly or quarterly payment arrangement to a provider, submit a cancellation record and a
payment record with the correct information. The details on the appropriate codes and information can be
found at Adjustment Code 003 in the data dictionary.
GROSS ADJUSTMENTS
If the county program at year end adjusts the amount paid to a provider under a specific payment
arrangement with a lump sum payment to cover a short-fall, the county should report the payment as a
gross adjustment:
 If the gross adjusted payment was for any payment arrangement other than fee-for-service, the
Coverage Begin Date (Catalog No. 013) should be the first day of the FY and the Coverage End
Date (Catalog No. 014) should be the last day of the FY. Enter the Category of Provider (Catalog
No. 008) value which corresponds to that program funding arrangement.
 If the gross adjustment payment was for a fee-for-service provider (where the county ran out of
funds toward the end of the fiscal year to pay the provider but the provider continued to deliver
services), the Coverage Begin Date (Catalog No. 013) should be the first date the funds were
depleted for the provider and the Coverage End Date (Catalog No. 014) should be the end date of
the fiscal year. The Category of Provider (Catalog No. 008) is to be entered as ‘9’. One Encounter
Record should be submitted for each service delivered by the provider after county based funds
have been depleted. Complete all required fields, entering zeros in the Amount Reimbursed
(Catalog No. 006) field and a ‘9’ in the Capitation Fee-for-service Indicator (Catalog No. 109). For
Record Type 8 (inpatient encounters), all Revenue Code Charges (Catalog N. 083) should be zero.
COST SETTLEMENT
If the county program at year-end adjusts the total amount paid to a provider by a lump sum payment, the
county should report the payment as a Cost Settlement.
The Coverage Begin Date (Catalog No. 013) is to be reported as the first day of the fiscal year and the
Coverage End Date (Catalog No. 014) as the last day of the fiscal year. The Category of Provider (Catalog
No. 008) is to be entered as ‘C’. The Subcapitation Payment reported will be applied to all encounters
reported for the provider, regardless of payment arrangement.
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OPTION 2
ENCOUNTER DATA
The county must submit one encounter record for each consumer for each service received.
Using the catalog definitions as a guide, all fields that are necessary to reflect the service provided must be
entered. For record type 6, the following fields are to be zero-filled: Amount Reimbursed (006), Revenue
Code Charges (083), and Payment Adjudication Date (063).
The Capitation Fee-for-service Indicator (109) field will conform to specifications described in the data
definition and will describe the payment arrangement with the provider of the service. The value entered in
that field must correspond to the value entered in Category of Provider (008) of the financial subcapitation
record that is submitted to report the annual payment made under the payment arrangement with the
provider of these services. For record type 8, the amount reimbursed should reflect the amount paid to the
provider. No corresponding Subcapitation record is necessary for record type 8.
**SUBCAPITATION FINANCIAL DATA
The subcapitation record is used to report the annual amount reimbursed on a fiscal year basis to each
provider by payment arrangement and by procedure. If the county program reimburses a provider for the
same procedure for program funded, fee-for-service, and reinvestment services, separate subcapitation
financial records are to be submitted to report the annual program funded, FFS and reinvestment amount
reimbursed.
The county program must submit one Subcapitation Financial Detail record (Record Type S) per fiscal year
for each Provider, Provider Service Location, Procedure Code, Procedure Code Pricing Modifier /
Procedure Code Information Modifier combination, and Type of funding (Program Funded, Fee-for-service
or Reinvestment) arrangement. The record must include the following detail:
Field Name
Record Type
CAU Code (037)
MA Provider Number (050)
Provider Service Location (125)
Subcapitation Payment (091)
Special Instructions
Constant S
County Program Identifier
Enrolled MA Provider Number
Service Location of Provider
Annual amount reimbursed to provider by procedure code/modifier
combination
Coverage Begin Date (013)
Begin date of fiscal year
Coverage End Date (014)
End date of fiscal year
Category of Provider (008)
Must equal F (fee-for-service), P (program funded), or Z reinvestment).
Payment Adjudication Date (063)
Date total provider payment determined
Adjustment Code (003)
Must equal 0, 1, or 3
Procedure Code (070)
Assigned Procedure Code
Procedure Code Pricing Modifier (071)
If applicable
Procedure Code Information Modifier (072) Up to three, if applicable
**Known as Alternative Payment Arrangement (APA) financial data in HealthChoices
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Option 2 continued:
The county has the option of reporting services paid with HealthChoices reinvestment funds through either
CCR POMS or HealthChoices
OMHSAS will calculate the amount reimbursed to be applied to encounter records by linking the encounter
data records with the appropriate subcapitation financial records. The link is established by the values
found on both records for CAU Code (037), MA Provider Number (050), Provider Service Location (125),
and Procedure Code (070), by comparing the End Date of Service (031) of the encounter to the Coverage
Begin Date (013) and Coverage End Date (014) of the subcapitation financial record, and by matching the
values in the Capitation Fee-for-service Indicator (109) of the encounter record and the Category of
Provider (008) of the subcapitation financial record.
PAYMENT ADJUSTMENTS
The financial subcapitation record may also be used to report an adjustment to a previously submitted
financial subcapitation record due to inaccurate reporting. To adjust an annual payment to a provider,
submit a cancellation record and a payment record with the correct information. The details on the
appropriate codes and information can be found at Adjustment Code (003) in the data dictionary.
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OPTION 1 EXAMPLES
The following examples show the values for the important fields that would enable OMHSAS to link the
appropriate encounter records with the subcapitation financial record for different non-fee-for-service
payment arrangements under Option 1.
Program Funded Arrangement
First arrangement with provider 123456789
Encounter Records
CAU
Code
BU
BU
BU
BU
MA Prov Prov Serv End Date Amount
Number Location of Service Reimb
123456789
123456789
123456789
123456789
0001 20040806
0001 20040729
0001 20040909
0001 20040812
Quantity
0
0
0
0
Pymnt Adj Capitation
Date
FFS Ind
4 00000000
12 00000000
15 00000000
3 00000000
1
1
1
1
Subcapitation Financial Record
CAU
Code
BU
Prov
Coverage Coverage Subcapitation Pymnt
Cat of
Serv
Beg Date End Date Payment
Adj Date Provider
Location
123456789
0001 20040701 20040930
47520 20041001
1
MA Prov
Number
Second arrangement with provider 123456789
Encounter Records
CAU
Code
BU
BU
BU
BU
MA Prov Prov Serv End Date Amount
Pymnt Adj Capitation
Quantity
Number Location of Service Reimb
Date
FFS Ind
123456789
0001 20040706
0
7 00000000
2
123456789
0001 20040729
0
4 00000000
2
123456789
0001 20040809
0
1 00000000
2
123456789
0001 20040812
0
16 00000000
2
Subcapitation Financial Record
CAU
Code
BU
Prov
Coverage Coverage Subcapitation Pymnt Adj Cat of
Serv
Beg Date End Date Payment
Date
Provider
Location
123456789
0001 20040701 20040930
16010 20041001
2
MA Prov
Number
Retainer Agreement
Encounter Records
CAU
Code
CE
CE
CE
MA Prov Prov Serv End Date Amount
Number Location of Service Reimb
123123123
123123123
123123123
0065 20041009
0065 20041029
0065 20041209
Quantity
0
0
0
Pymnt Adj Capitation
Date
FFS Ind
46 00000000
80 00000000
26 00000000
R
R
R
Subcapitation Financial Record
CAU
Code
MA Prov
Number
Prov
Coverage Coverage Subcapitation Pymnt Adj Cat of
Serv
Beg Date End Date Payment
Date
Provider
Location
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CE
123123123
0065 20041001 20041231
56810 20050111
R
Option 1 Examples Continued:
Gross Adjustment – Fee-for-service
Encounter Records
CAU
Code
CE
CE
CE
CE
MA Prov Prov Serv End Date Amount
Pymnt Adj Capitation
Quantity
Number Location of Service Reimb
Date
FFS Ind
987654321
0005 20050609
0
16 00000000
9
987654321
0005 20050619
0
7 00000000
9
987654321
0005 20050517
0
9 00000000
9
987654321
0005 20050515
0
11 00000000
9
Subcapitation Financial Record
CAU
Code
CE
Prov
Coverage Coverage Subcapitation Pymnt
Cat of
Serv
Beg Date End Date Payment
Adj Date Provider
Location
987654321
0005 20050515 20050630
3819 20050701
9
MA Prov
Number
Cost Settlement
Encounter Records
CAU
Code
LE
LE
LE
LE
LE
LE
LE
LE
MA Prov Prov Serv End Date Amount
Number Location of Service Reimb
043214321
043214321
043214321
043214321
043214321
043214321
043214321
043214321
0001 20041009
0001 20041029
0001 20041209
0001 20040806
0001 20040729
0001 20040909
0001 20040812
0001 20050524
Quantity
0
0
0
0
0
0
0
0
Pymnt Adj Capitation
Date
FFS Ind
46 00000000
80 00000000
26 00000000
4 00000000
12 00000000
15 00000000
3 00000000
30 00000000
R
R
R
1
1
1
1
1
Subcapitation Financial Record
CAU
Code
LE
Prov
Coverage Coverage Subcapitation Pymnt
Cat of
Serv
Beg Date End Date Payment
Adj Date Provider
Location
043214321
0001 20040701 20050630
3819 20050712
C
MA Prov
Number
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OPTION 2 EXAMPLES
The following examples show the values for the important fields that would enable OMHSAS to link the
appropriate encounter records with the subcapitation financial record for different payment arrangements
under Option 2.
Program Funded Arrangement
Encounter Records
CAU
Code
BU
BU
BU
BU
BU
BU
BU
BU
MA Prov Prov Serv Procedure Pricing
Number Location
Code
Modifier
U7
123456789
0001
H0036
U7
123456789
0001
H0036
U7
123456789
0001
H0036
U7
123456789
0001
H0036
U7
123456789
0001
H0036
U7
123456789
0001
H0036
U7
123456789
0001
H0036
U7
123456789
0001
H0036
Information End Date Amount
Pymnt Adj Capitation
Quantity
Modifier of Service Reimb
Date
FFS Ind
U2UA
20040806
0
4 00000000
P
U2UA
20050502
0
12 00000000
P
U2UA
20040909
0
15 00000000
P
U2UA
20041212
0
3 00000000
P
U2UA
20050206
0
4 00000000
P
U2UA
20050629
0
18 00000000
P
U2UA
20040909
0
23 00000000
P
U2UA
20040812
0
2 00000000
P
Subcapitation Financial Record
CAU
Code
BU
Prov
Procedure Pricing Information Coverage Coverage Subcapitation Pymnt Adj Cat of
Serv
Code
Modifier Modifier Beg Date End Date Payment
Date
Provider
Location
U7
U2UA
123456789
0001
H0036
20040701 20050630
117520 20041001
P
MA Prov
Number
Fee-for-service
Encounter Records
CAU
Code
DE
DE
DE
DE
DE
DE
DE
DE
MA Prov Prov Serv Procedure Pricing Information End Date Amount
Pymnt Adj Capitation
Quantity
Number Location
Code
Modifier Modifier of Service Reimb
Date
FFS Ind
U8
032323232
0014
T1016
20040706
0
8 00000000
F
U8
032323232
0014
T1016
20050602
0
17 00000000
F
U8
032323232
0014
T1016
20040709
0
45 00000000
F
U8
032323232
0014
T1016
20041212
0
22 00000000
F
U8
032323232
0014
T1016
20050206
0
40 00000000
F
U8
032323232
0014
T1016
20050129
0
18 00000000
F
U8
032323232
0014
T1016
20041109
0
23 00000000
F
U8
032323232
0014
T1016
20040812
0
3 00000000
F
Subcapitation Financial Record
CAU MA Prov Prov Serv Procedure Pricing Pricing Coverage Coverage Subcapitation Pymnt Adj Cat of
Code Number Location
Code
Modifier Modifier Beg Date End Date Payment
Date
Provider
U8
DE
032323232
0014
T1016
20040701 20050630
67250 20041001
F
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Appendix D- CCR POMS Submission Process



1.
2.
3.
Consumer Data
Encounter Data
Subcapitation Financial Data
Log onto the eGovernment Secure Data Exchange website at https://www.humanservices.state.pa.us\egovernment
Enter User Id and Password at the prompts
Upload files according to the following name conventions:
(If you elected to have your exchange configured to use the .zip extension, use .zip instead of .txt)
i.
ii.
iii.
Consumer Data
Encounter Data
Subcapitation Financial Data
cXXYYQs#.txt
eXXYYQs#.txt
sXXYYQs#.txt
(For Subcapitation annual reporting, Q=2)
Where XX = CAU Code
YY = Year (calendar year)
Q = Quarter (integer from 1 through 4 - based on calendar year)
# = Submission number
4.
5.
Exit the session by clicking on the X in the upper right corner of the web page.
Processing Results:
Consumer Data, Encounter Data, and Subcapitation Financial Data processing each produces two result files, an
Import Log and a Rejected Records file. “eGovernment” automatically returns these files to your designated
server.
File names:
Import Log
Rejected Records
i.
ii.
iii.
Consumer Data
Encounter Data
Subcapitation Financial Data
cXXYYQr#.txt
eXXYYQr#.txt
sXXYYQr#.txt
cXXYYQx#.txt
eXXYYQx#.txt
sXXYYQx#.txt
Where XX = CAU Code
YY = Year (calendar year)
Q = Quarter (integer from 1 through 4 - based on calendar year)
# = Submission number
Import Log
i.
Consumer Data Import Log is a listing of the error messages by error code and Social Security Number.
ii.
Encounter Data Import Log is a listing of the error messages by error code and Claim Reference Number.
iii. Subcapitation Financial Data Import Log is a listing of the error messages by error code, MA Provider
Number, Provider Service Location, Category of Provider, and other data elements depending on Reporting
Option.
Rejected records file
The Rejected Records file contains rejected records with the error codes appended.
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Appendix E- Historical Documents In Re: Summary Expenditure Collection
(Substitution of Summary Collection of Encounter and Expenditure Information for CAU’s who could not
successfully submit detail information).
October 18, 2002
Dear County Mental Health Administrator:
This letter is a follow-up to the CCR POMS management reports initiative that was discussed during the
Needs Assessment regional seminars held in September 2002. OMHSAS is committed to working with the
counties to provide consistent CCR POMS reporting and feel that the most effective approach is to focus
our efforts on collecting complete and accurate CCR POMS data as we move forward into Fiscal Year
2002/2003. Therefore, the CCR POMS reporting requirements have been modified as follows:
 County programs are not required to submit or to correct CCR POMS Consumer Data, Encounter
Data and Subcapitation Data files for Fiscal Years 1999/2000, 2000/2001, and 2001/2002.
 Summary information for FY 2001/2002 must be reported unless the county program has
confidence in the accuracy of the data they have submitted.
 County programs are required to submit Consumer Data, Encounter Data and Subcapitation Data
for Fiscal Year 2002/2003, with the July-September quarterly files due on November 30, 2002.
If your county has submitted complete and accurate CCR POMS Consumer Data, Encounter Data and
Subcapitation Data for Fiscal Year 2001/2002, the attached EXCEL spreadsheet is not required. OMHSAS
will produce the summary information based on the files already submitted by your county.
However, if your county has not submitted complete and accurate data, then the attached CCR POMS
Summary Reporting spreadsheet is required and should be e-mailed to Susan Harmon
(sharmon@state.pa.us) by November 30, 2002. The data must be entered on this template. The summary
file is to be named xxFY0102.xls where xx is your CAU-Code. Also attached is a list of the county contact
e-mail addresses that will be notified regarding the processing status of the CCR Summary Reporting file.
If you would prefer that this information be sent to a different e-mail address, please let me know.
We appreciate your cooperation and are looking forward to working with our contractors, Computer Aid
Inc., to develop a mutually beneficial CCR POMS reporting system. If you have questions regarding the
modified reporting requirements described above or if you will not be submitting Summary Data for FY
2001/2002 and would like OMHSAS to prepare your Summary information, please contact me at
dmckee@state.pa.us. Thank you.
Sincerely,
Douglas McKee
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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF PUBLIC WELFARE
OFFICE OF MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES
BUREAU OF OPERATIONS AND QUALITY MANAGEMENT
P.O. BOX 2675
HARRISBURG, PENNSYLVANIA 17105-2675
MICHAEL JEFFREY, DIRECTOR
EMAIL: MJEFFREY@STATE.PA.US
TELEPHONE: (717) 772-6650
FAX: (717) 772-6737
March 17, 2004
Dear MH Administrator:
This letter is regarding the Consolidated Community Reporting Performance Outcome
Management System (CCR POMS). As you know, we had focused a great deal of attention and
effort in this system and developed a web-based reporting system to display the data you sent to
us for your use. Unfortunately, there are still a number of counties who have not submitted the
required data.
I cannot stress to you how important it is for the Office of Mental Health and Substance
Abuse Services (OMHSAS) to know who you are serving, what services you are providing and
what those services are costing. We continually get questions from the Secretary, Governor’s
Budget Office, the Legislative Office, and Centers for Medicare and Medicaid Services, etc. and
must have accurate, complete data readily at hand. Additionally, the data should be important to
you for your planning purposes.
Therefore, the FY 2002/2003 CCR POMS encounter data and subcapitation data is due to
OMHSAS by April 30, 2004. If you are not able to send in the detailed client specific encounter
data, you must send in aggregate data in a spreadsheet format (as most of you did for FY
2001/2002). If you plan to send in a spreadsheet, please notify Candace Orr at corr@state.pa.us
by March 31, 2004, and you will be sent a spreadsheet to complete. Directions for submission
will be sent with the spreadsheet. If you do not know if you are in compliance, please contact
Candace, and she can provide you with detailed information as to which files have/have not been
accepted.
If you cannot meet that deadline, you should send a detailed explanation of why you cannot and
what you have done and continue to do to correct the problems.
For FY 2003/2004, there are several options available to you. They are as follows:
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1) Submit client specific encounter data as is currently required;
2) Submit the spreadsheet data at the end of the year; and
3) Submit client specific encounter data in the Health Insurance Portability and
Accountability Act (HIPAA) compliant 837 format.
If you should choose option 3, you must also submit in the spreadsheet format since OMHSAS
cannot process the 837 at this time.
For 2002/2003 and 2003/2004, there are no changes to the Consumer Data requirement.
If you have any questions, please contact me or Candace.
Sincerely,
Michael Jeffrey
cc:
Ms. Erney
Ms. Zelch
Ms. Foltz
Mr. McKee
Ms. Orr
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December 30, 2004
This is to advise you that the option to submit CCR POMS encounter data in an aggregate
spreadsheet is available again for FY 03/04 data. Attached is the spreadsheet to be completed for
CCR POMS data for FY 03/04 should you choose this option. It should be completed and e-mailed
to Susan Harmon (sharmon@state.pa.us) by February 15, 2005. The data must be entered on this
template. The summary file is to be named xxFY0304.xls where xx is your CAU-Code. You
should also advise Ms. Harmon of the email address of the person that you wish to be notified
regarding the processing status of the CCR Summary Reporting file. If you have questions
regarding this spreadsheet, please contact Doug McKee at domckee@state.pa.us.
December 13, 2005
This message is to advise you that the option to submit CCR POMS encounter data in an aggregate
spreadsheet is available again for FY 04/05 data. The preferred method for CCR POMS expenditure
reporting is by detail consumer specific encounter submissions and we encourage you to submit detail
encounter for FY 04/05 if possible. Also, if your county is able to at least submit detail encounters for all
Administrative Case Management for the year, we encourage you to do so. If you exercise this aggregate
spreadsheet option and do not submit detail for ACM, you may be asked to provide further follow up
documentation on those consumers served.
If your county/CAU wishes to use this method for finalizing fiscal year 04/05 CCR POMS expenditure
reporting, you must contact Rose Finkenbinder (Rofinkenbi@state.pa.us) and request the template and
instructions for submitting it. Each county must advise Rose by 12/30/05 whether they wish to submit
detail encounter/financial records or if they wish to use this spreadsheet option.
OMHSAS conducted regional CCR POMS technical assistance training sessions and county staff and
vendors who were in attendance heard the message delivered that OMHSAS is committed to receiving
complete data. It is our hope that each county will move forward in FY 05/06 with the timely and complete
submission of detail encounter/financial records. This fallback method of aggregate reporting will not be
available again.
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February 7, 2007
This message is to advise you that the option to submit CCR POMS encounter data in the aggregate
spreadsheet format is available again for FY 05/06 data. The preferred method for CCR POMS
expenditure reporting is by detail consumer specific encounter submissions and we encourage you to
submit detail encounter for FY 05/06 if possible. Financial incentives have been awarded to CAU’s who
submitted timely and accurate detail encounters.
If your county/CAU wishes to use this aggregate method for finalizing fiscal year FY05/06 CCR POMS
expenditure reporting, you must contact Lois Good (LGood@state.pa.us) and request the template and
instructions for submitting it. Each county (CAU) must advise Lois by 02/23/07 whether they wish to
submit detail encounter/financial records with accompanying subcapitation records if appropriate,
or if they wish to use this spreadsheet option. It is expected that CAU’s will finalize their expenditure
reporting for FY05/06 either by the spreadsheet or detail encounter/subcapitation not later than 3/30/07.
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PRV414- MA Provider File Layout
Header Record – one record per file
Field
Data Type
Length
Description
Header Indicator
Character
3
“HDR”
Header File ID
Character
9
File identifier.
Date
Numeric
8
The date the file was created. Formatted CCYYMMDD
because this is what is expected by the outside entity.
Provider Parent Records – one record per PROMISe Provider Number
Field
Data Type
Length
Description
Record Type Indicator
Character
1
“1”
PROMISe™ Provider
Number
Numeric
9
Provider ID number assigned by MPI
Service Location
Character
4
The service location of the provider.
PROMISe™ Begin Date
Numeric
8
The service location eligibility effective date, formatted
CCYYMMDD.
PROMISe™ End Date
Numeric
8
The service location eligibility end date, formatted
CCYYMMDD.
Provider Name
Character
50
The provider’s name
IRS or SSN
Numeric
9
The provider’s tax ID, either FEIN or SSN.
IRS/SSN Indicator
Character
1
Valid values are:
I = IRS Number,
S = Social Security Number
Medicare Number
Character
10
The provider’s Medicare Part B provider number.
Address – County*
Numeric
2
County code.
Address - Line 1*
Character
30
Provider address line one.
Address - Line 2*
Character
30
Provider address line two.
Address – City*
Character
18
Provider address city.
Address – State*
Character
2
Provider address state.
Address - Zip – Main*
Numeric
5
Provider address zip code prefix.
Address - Zip – Extension*
Numeric
4
Provider address zip code suffix.
Phone Number*
Numeric
10
Provider’s telephone number.
DEA Number
Character
9
Provider’s DEA number.
UPIN Number
Character
6
Provider’s UPIN number.
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Field
Data Type
MAMIS ID and Address
Code
Numeric
Length
10
Description
This is a compound field, composed of an 8-digit
MAMIS ID and 2-digit MAMIS Provider Address
Code.
bytes 1-8
Provider’s MAMIS ID. Zero-filled if
provider does not have an old MAMIS ID.
bytes 9-10
MAMIS Provider Address Code –
indicating the provider address where the service was
provided. Also zero-filled if no MAMIS ID is found.
EXAMPLE: A MAMIS ID of 12345678 with an address
code of 91 will be represented as follows: 1234567891
NOTE: At some point in the future, the two values in
this field will be replaced by the National Provider
Identifier (NPI), which will consist of a single 10-digit
identifier.
Provider Child Records – one or more records per PROMISe Provider Number
Field
Data Type
Length
Description
Record Type Indicator
Character
1
“2”
PROMISe™ Provider
Number
Numeric
9
Provider ID number assigned by MPI
Service Location
Character
4
The service location of the provider.
PROMISe™ Provider Type
Numeric
2
Provider Type code.
Specialty Code
Numeric
3
Provider specialty code.
PROMISe™ Specialty
Code Begin Date
Numeric
8
The provider’s PROMISe™ Specialty Code eligibility
effective date, formatted CCYYMMDD.
PROMISe™ Specialty
Code End Date
Numeric
8
The provider’s PROMISe™ Specialty code eligibility
end date, formatted CCYYMMDD.
License Number*
Character
10
The provider’s license number assigned to this service
location.
License End Date*
Will be very unreliable data
Numeric
8
The license end date, formatted CCYYMMDD.
Practice Type*
Numeric
1
The provider’s type of practice. This is a DPW user
defined table.
Medical Degree*
Character
3
Provider’s medical degree code. As per the Professional
Licensing Board.
Status Code*
Numeric
1
Indicates the provider’s status. This is a DPW user
defined table.
Trailer Record – one record per file
Field
Trailer Indicator
Data Type
Character
Length
3
Description
“TRL”
Record Count-Type 1
Records
Numeric
9
Excludes header and trailer record, zero filled, right
justified.
Record Count-Type 2
Records
Numeric
9
Excludes header and trailer record, zero filled, right
justified.
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Reporting Manual for Consumer, Encounter & Subcapitation Data
Reporting of Services Provided to Unidentified Consumers
It is anticipated that residential and inpatient services will not be provided to
unidentified consumers. To report services which are provided to unidentified
consumers, the required fields to be reported are:





Primary Diagnosis Code (Catalog #067) should be blank filled
Recipient Birth Date (Catalog #076) should be zero-filled
Patient Discharge Status (Catalog #062) should be zero-filled
DRG Number (Catalog #105) should be zero-filled
Missing SS # Status (Catalog #111) should be zero-filled
These records are identified by an entry of ‘XX0000000’ (XX=Provider Type) in
the Social Security Number Field (Catalog #080).
Reporting of Services in the Aggregate which were provided to
Unidentified Consumers
Services provided to unidentified consumers may be reported on a quarterly or a
monthly basis, with the first day of the reporting quarter or month entered in
“Begin Date of Service” (Catalog #007) and the last day of the reporting quarter
or month entered in “End Date of Service” (Catalog #031). It is anticipated that
residential and inpatient services will not be provided to unidentified consumers.
The encounter data record is to be completed based on the reporting
requirements for either Fee-for-Service or Program Funding, whichever is
appropriate.
The data elements which must be identical in order to aggregate services
provided to unidentified consumers are:
 MA Provider Number (Catalog #050)
 Provider Service Location (Catalog #125)
 Procedure Code (Catalog #070) and Procedure Code Modifier (Catalog
#071 Combination
 Place of Service (Catalog #064)
The recipient’s social security number (Catalog #080) is to be reported by
entering the Provider Type (see editing criteria in Catalog #050) in the positions
1-2 and zeros in positions 3-9.
The total number of units delivered by the provider to unidentified consumers for
the specific service is to be reported in Quantity (Catalog #074).
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Performance Outcome Management System
Reporting Manual for Consumer, Encounter & Subcapitation Data
Reporting of Services Provided to a Consumer over a Quarterly or Monthly Period
(If a continuous service)
Service categories which can be reported on a quarterly or monthly basis on the
Encounter Record Type 6 include (but are not limited to):






Outpatient
Partial Hospitalization
Social Rehabilitation
CRR
Any supported living
Vocational Rehabilitation/Employment
Data elements which must be identical in order to report on a quarterly or
monthly basis are:






Recipient CIS Number (Catalog #077)
Social Security Number (Catalog #080)
MA Provider Number (Catalog #050)
Provider Service Location (Catalog #125)
Procedure Code (Catalog #070) and Procedure Code Modifier (Catalog
#071) Combination
Place of Service (Catalog #064)
If reporting monthly, enter the day the service started in the first month and enter
the first day of month for subsequent reporting months in the “Begin Date of
Service” (Catalog #007). If reporting quarterly, enter the day the service started
in the first month.
Enter the actual end date of service or the last day of quarter/month if the service
is continuing into the next quarter/month in the “End Date of Service” (Catalog
#031).
Enter the Primary Diagnosis Code (Catalog #067) and the Secondary Diagnosis
if available (Catalog #085) as of the end of the reporting quarter/month.
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Performance Outcome Management System
Reporting Manual for Consumer, Encounter & Subcapitation Data
Glossary of Terms
ASCII - American Standard Code for Information Interchange - the authority who establishes the
printable character set standard adhered to by most commercial computer equipment designs
(including the IBM compatible Personal Computer). IBM standardized for the PC additional nonprintable machine codes that are contained in the IBM ASCII control character table, as well as
codes for foreign language and graphics characters that are contained in the IBM extended ASCII
character set.
BHMCO - Behavioral Health Managed Care Organization. An entity directly operated by county
government or licensed by the Commonwealth as a risk assuming Health Maintenance
Organization or Preferred Provider Organization, which manages the purchase and provision of
behavioral health services under the HealthChoices initiative.
CCYYMMDD- CC=First two digits of year expressed in format CCYY, YY=Last two digits of
year expressed in format CCYY, MM=Month of year in numeric format, DD=Day of month in
numeric format.
CHIPP - Community Hospital Integration Project
Consumer - A person registered to receive any behavioral health services.
E-Gov-DPW’s standardized methodology for secure data exchange made accessible via the
Internet using a standard web browser client or HTTPS Server-to-Server with Digital
Certificate to expedite data exchange and meet federal security requirements.
Encounter Data - Reports of procedures or services performed during, or as a result of contacts
between a recipient and a provider or subcontractor who renders a service.
HealthChoices - The name of Pennsylvania's 1915(b) waiver program to provide mandatory
managed health care to Medical Assistance recipients.
HMO - Health Maintenance Organization. A public or private entity organized under state law
that is a federally qualified HMO; or meets the Medicaid state plan definition of an HMO.
Picture- A picture character-string consists of certain combinations of characters in the COBOL
character set, used as symbols.
Plan of Care - A continuous period of coordinated treatment and support services within the
CAU. The Plan of Care must document the commencement, course, continuity, and end of
support services in such a way as to permit effective review of care and demonstrate care
coordination.
Program Funded Services- Arrangements with providers to provide specific service or services
to an unknown number of consumers for a specified timeframe and an agreed upon amount,
regardless of the number of consumers who access the service.
PROMISe™- (Provider Reimbursement and Operations Management Information System) is the
new HIPAA-compliant claims processing and management information system implemented by
the Pennsylvania Department of Public Welfare (DPW) in March 2004.
Record Type 6- The type of record used by the CAU to report medical services encounters.
Record Type 8-The type of record used by the CAU to report inpatient encounters.
Record Type S- Subcapitation- Financial information submitted to supplement the information
on the encounter data. In HealthChoices, subcapitation data is called Alternative Payment
Arrangement financial data.
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