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DWC SV2 Institutional Services Public Use Data File (PUDF) Data Dictionary

Updated March 5, 2010

Claimant Confidentiality | Excluded Records | Data Dictionary | File Structure | Header File Layout | Detail File Layout | Citation | Disclaimer

Introduction

The Texas Department of Insurance, Division of Workers' Compensation ( DWC), maintains a statewide database of medical services billing information. An extract of this database, the Public Use Data File ( PUDF), is available to the public for a reasonable fee established by the commissioner under Texas Labor Code §413.007 and §413.007(c).

Claimant Confidentiality

In providing the Public Use Data File ( PUDF), the identities of injured employees and beneficiaries may not be disclosed as required under Texas Labor Code §402.082, §402.083, and §413.007. Information remains confidential when released as under Texas Labor Code §402.086 Transfer of Confidentiality. In order to comply with these confidentiality requirements, certain data elements contained in the source medical billing/payment data base were either encrypted or removed from the PUDF. Some variables are unpopulated because they are optional or conditional, and were not populated when the carrier reported the data to DWC.

Excluded Records

The PUDF excludes the following records:

  1. Records that failed to pass EDI reporting edits and were rejected;
  2. Records replaced, updated or deleted through subsequent submissions and bill sequencing; and
  3. Records that were determined to be duplicates of other records by DWC.

Data Dictionary

Definitions

The following information is provided in the data dictionary:

Column Definition
DN# IAIABC data element number
Name Name of the variable
Start Beginning position number of the variable
Length Length of the variable
Description Variable description including coding scheme and valid codes

File Structure

The DWC SV2 Institutional Services PUDF contains billing information for hospital and facility services, excluding ambulatory surgical centers (ASC). It consists of a header and detail file for each reporting period. Each file is in a fixed width format. The header file contains billing level information and the detail file contains itemized service level information. The "Bill ID" is a unique identification number contained in both the header and detail files. It is used as the primary key linking the bill level and service level information. The detail file contains one or more lines of service level information.

Header File Layout

The header file contains information about the EDI submission, carriers, employers, employees, and bill level information.

Header Variables
DN# Name Start Length Description
Bill ID 1 41 Bill ID uniquely identifies a bill and links line items to the bill.
523 Billing Provider Unique Bill Identification Number 42 38 A unique number assigned by the billing provider to a specific bill within a batch of bills.
500 Unique Bill ID Number 80 30 Assigned by and unique to the Insurer. This number should never be reused except when sending bill submission type "01" for cancellations or "05" for replacing a bill. Acknowledgements will refer to this number when a bill is accepted or rejected.
Bill Type 110 3 SV1 = Professional Service,
SV2 = Institutional (Hospital) Service
SV3 = Dental Service
SV4 = Drug (Pharmacy) Service
615 Reporting Period Start Date 113 8 The start date during which the information sent was processed. Format: CCYYMMDD
615 Reporting Period End Date 121 8 The end date during which the information sent was processed. Format: CCYYMMDD
6 Insurer FEIN 129 9 Encrypted
The federal identification number of the carrier or self-insured assuming responsibility for workers' compensation claims.
616 Insurer Postal Code 138 5 The zip code of the carrier or self-insured's specific business site.
187 Claim Administrator FEIN 143 9 Encrypted
The federal identification number of the entity licensed or allowed to adjust a bill.
188 Claim Administrator Name 152 35 The name of the entity licensed or allowed to adjust a bill.
14 Claim Administrator Postal Code 187 5 The mailing zip code of the claim administrator's processing facility.
353 Transaction Set Purpose Code 192 2 Identifies the purpose of the transaction set.
16 Employer FEIN 194 10 Encrypted
The federal identification number of the employer where the employee was employed at the time of the injury.
21 Employer Physical City 204 30 The city name of the facility where the injured worker was employed at the time of the injury.
22 Employer Physical State Code 234 2 The two-character state code of the facility where the injured worker was employed at the time of the injury.
23 Employer Physical Postal Code 236 5 The zip code of the facility where the injured worker was employed at the time of the injury.
164 Employer Physical Country Code 241 3 A three-character code indicating the country where the injured worker was employed at the time of the injury.
48 Employee Mailing City 244 30 The city name of the injured worker's mailing address.
49 Employee Mailing State Code 274 2 The two-character state code of the injured worker's mailing address.
50 Employee Mailing Postal Code 276 5 The zip code of the injured worker's mailing address.
50 Employee Mailing Postal Code 276 5 The zip code of the injured worker's mailing address.
155 Employee Mailing Country Code 281 3 A three-character code indicating the country of the injured worker's mailing address.
52 Employee Date of Birth 284 6 The year and month the injured worker was born. Format: CCYYMM
53 Employee Gender Code 290 1 Indicates the sex of the injured worker:
M=Male
F=Female U=Unknown
54 Employee Marital Status Code 291 1 Indicates the marital status of the injured worker:
I=Single
K=Unknown
M=Married
S=Separated
U=Widowed
15 Claim Administrator Claim Number 292 30 Encrypted
A number assigned by the insurance carrier or TPA to identify a specific claim.
31 Employee Date of Injury 322 6 The year and month the accident occurred. Format: CCYYMM
Filler 328 2
501 Total Charge Per Bill 330 15 The cumulative dollar amount of all line items on the bill.
502 Billing Type Code 345 2 Identifies the kind of billing:
DM = Durable Medical
MO = Mail Order Drug RX = Pharmacy or Drug
555 Place of Service Bill Code 347 2 Identifies the place of service at the bill level.
503 Billing Format Code 349 2 Indicates whether the data is from a UB92 or CMS1500.
A = Institutional (UB 92)
B = Professional (CMS 1500)
Note: If the bill is not a UB92 or CMS 1500, uses 'B' as the default.
506 Provider Signature On File Indicator 351 1 Indicates if the signature of the provider is on file.
Y=Yes
N=No
526 Release of Information Code 352 1 Identifies whether the release of information related to a claim is authorized or not.
A = Appropriate release of information on file at health care service provider or at a URA.
I = Informed consent to release medical information for conditions or diagnosis regulated by Federal Statues.
M = The provider has a limited or restricted ability to release data related to a claim.
N = No, provider is not allowed to release data.
O = On file at payor or at plan sponsor.
Y = Yes, provider has signed statement permitting release of medical billing data related to the claim.
507 Provider Agreement Code 353 1 Identifies the kind of provider agreement applicable to a bill:
H=Network
N=No Agreement
P=Participant Agreement
Y=PPO Agreement
504 Facility Code 354 2 Identifies the kind of facility where treatment was rendered.
505 Bill Frequency Type Code 356 1 Indicates the claim billing status:
0 = Non Payment/Zero Payment
1 = Admit through Discharge Claim
2 = Interim - First Claim
3 = Interim - Continuing Claim
4 = Interim - Last Claim
5 = Late Charges(s) Only Claim
6 = Adjustment of Prior Claim
7 = Replacement of Prior Claim
8 = Void/Cancel of Prior Claim
513 Admission Date 357 8 The calendar date the claimant was admitted to the facility. Format: CCYYMMDD
622 Admission Hour 365 8 The hour the claimant was admitted to the facility. Format: HH:MM:SS
514 Discharge Date 373 8 The calendar date the claimant was discharged from the facility. Format: CCYYMMDD
623 Discharge Hour 381 8 The hour the claimant was discharged from the facility. Format: HH:MM:SS
577 Admission Type Code 389 1 Identifies the kind of admission:
1 = Emergency
2 = Urgent
3 = Elective
9 = Information not available
518 Diagnosis Related Group Code 390 3 Classification of a hospital stay in terms of what was wrong and what was done for the patient. The DRG frequently determines the amount of money that will be reimbursed, independently of the charges that the hospital may have incurred.
Filler 393 1
508 Bill Submission Reason Code 394 2 Identifies the bill submission/re-submission type:
00 = Original
01 = Cancellation (removed during bill sequencing)
05 = Replacement
511 Date Insurer Received Bill 396 8 The calendar date the insurer received the bill from the provider. Format: CCYYMMDD
509 Service Bill From Date 404 8 The starting date in which services were performed. Format: CCYYMMDD
509 Service Bill To Date 412 8 The ending date in which services were performed. Format: CCYYMMDD
510 Date of Bill 420 8 The provider's bill date. Format: CCYYMMDD
512 Date Insurer Paid Bill 428 8 The calendar date the insurer or financially responsible party paid the bill or received credit from the provider. Format: CCYYMMDD
515 Contract Type Code 436 2 Identifies the kind of contractual agreement for provider reimbursement:
01 = Diagnosis Related Group
02 = Per Diem
03 = Variable per diem
04 = Flat fee per service
05 = Capitate
06 = Percent
09 = Other
516 Total Amount Paid Per Bill 438 15 The dollar amount paid or credited for a submitted bill by payor after adjustments.
517 Patient Account Number 453 30 A unique number assigned by the provider to identify the patient/claimant.
266 Transaction Tracking Number 483 30 A number assigned by the sender (the organization that actually sent the data).
522 First ICD-9 CM Diagnosis Code 513 7 Identifies the diagnosis of the work related injury or illness.
522 Second ICD-9 CM Diagnosis Code 520 7 Identifies the diagnosis of the work related injury or illness.
522 Second ICD-9 CM Diagnosis Code 520 7 Identifies the diagnosis of the work related injury or illness.
522 Third ICD-9 CM Diagnosis Code 527 7 Identifies the diagnosis of the work related injury or illness.
522 Fourth ICD- 9 CM Diagnosis Code 534 7 Identifies the diagnosis of the work related injury or illness.
522 Fifth ICD-9 CM Diagnosis Code 541 7 Identifies the diagnosis of the work related injury or illness.
521 Principal Diagnosis Code 548 7 Identifies the primary ICD9 code of the bill.
535 Admitting Diagnosis Code 555 7 Identifies the admitting ICD9 code of the bill.
525 ICD-9 CM Principal Procedure Code 562 6 Identifies the principal procedure rendered.
550 Principal Procedure Date 568 8 The calendar date the primary procedure was performed. Format: CCYYMMDD
736 First ICD-9 CM Procedure Code 576 6 Identifies a procedure rendered other than the principal procedure.
736 Second ICD-9 CM Procedure Code 582 6 Identifies a procedure rendered other than the principal procedure.
736 Third ICD-9 CM Procedure Code 588 6 Identifies a procedure rendered other than the principal procedure.
736 Fourth ICD-9 CM Procedure Code 594 6 Identifies a procedure rendered other than the principal procedure.
524 First Procedure Date 600 8 The calendar date the first procedure was performed. Format: CCYYMMDD
524 First Procedure Date 600 8 The calendar date the first procedure was performed. Format: CCYYMMDD
524 Second Procedure Date 608 8 The calendar date the second procedure was performed. Format: CCYYMMDD
524 Third Procedure Date 616 8 The calendar date the third procedure was performed. Format: CCYYMMDD
524 Fourth Procedure Date 624 8 The calendar date the fourth procedure was performed. Format: CCYYMMDD
Filler 632 1
678 Facility Name 633 35 The name of the facility where the medical services were rendered. Mandatory for SV1 bills.
679 Facility FEIN 668 9 Encrypted
The federal identification number of the facility where the medical services were rendered.
684 Facility Primary Address 677 50 The first line in the facility's address.
685 Facility Secondary Address 727 32 The second line in the facility's address.
686 Facility City 759 30 The city name of the facility's address.
687 Facility State Code 789 2 The two-character state code of the facility's address.
688 Facility Postal Code 791 5 The zip code of the facility's address.
689 Facility Country Code 796 3 A three-character code indicating the country of the facility's mailing address.
680 Facility State License Number 799 20 A unique number assigned to identify the facility.
681 Facility Medicare Number 819 10 A unique number assigned to the facility by the Medicare program.
682 Facility National Provider ID 829 20 The unique National Provider ID of the facility.
208 Managed Care Organization Identification 849 30 Encrypted
The jurisdiction assigned number that corresponds to and uniquely identifies the managed care organization involved in the claim.
528 Billing Provider Last Name or Group 879 35 The surname of the person or full name of an organization receiving payment. It is assumed to be the rendering provider for all services unless a specific rendering provider is identified at the bill or service line levels. If the billing provider is a non-person, a specific individual rendering bill provider may be required by a jurisdiction.
529 Billing Provider First Name 914 25 The given name of the billing provider.
530 Billing Provider Middle Name Initial 939 25 The middle name or initial of the billing provider.
531 Billing Provider Last Name Suffix 964 10 The legally recognized last name suffix of the billing provider which is used on legal documents. Examples: Jr., Sr., II, III
629 Billing Provider FEIN 974 9 Encrypted
The federal tax identification number of the billing provider.
534 Billing Provider Gate Keeper Indicator 983 3 Indicates that the billing provider is the treating doctor. If present, must = 'GP' (Gateway Provider).
537 Billing Provider Primary Specialty Code 986 10 Indicates the primary specialty of the billing provider.
538 Billing Provider Primary Address 996 50 The first line in the billing provider's address.
539 Billing Provider Secondary Address 1046 32 The second line of the billing provider's address.
540 Billing Provider City 1078 30 The city name of the billing provider's address.
541 Billing Provider State Code 1108 2 The two-character state code of the billing provider's address.
542 Billing Provider Postal Code 1110 5 The zip code of the billing provider's address.
569 Billing Provider Country Code 1115 3 A three-character code indicating the country of the billing provider's mailing address.
630 Billing Provider State License Number 1118 20 The billing provider's license type, license number and jurisdiction code.
632 Billing Provider Medicare Number 1138 10 The specific number issued to the billing provider by the Medicare program.
581 Treatment Authorization Number 1148 1 A number assigned by the carrier to identify pre-authorized or pre-certified treatment plans.
Y = reported,
N = not reported.
634 Billing Provider National Provider ID 1149 20 The unique National Provider ID of the billing provider.
638 Rendering Bill Provider Last Name or Group 1169 35 The surname of the individual provider actually rendering care. If not present, the billing provider is assumed to be the rendering provider for all services on this bill. If the billing provider was not an individual, a jurisdiction may require a rendering bill provider to be specified.
639 Rendering Bill Provider First Name 1204 25 The given name of the rendering bill provider.
640 Rendering Bill Provider Middle Name Initial 1229 25 The middle name or initial of the rendering bill provider.
641 Rending Bill Provider Last Name Suffix 1254 10 The legally recognized last name suffix of the rendering bill provider which is used on legal documents. Examples: Jr., Sr., II, III
642 Rendering Bill Provider FEIN 1264 9 Encrypted
The federal tax identification number of the rendering bill provider.
534 Rendering Bill Provider Gate Keeper Indicator 1273 3 Indicates that the rendering bill provider is the treating doctor. If present, must = 'GP' (Gateway Provider).
651 Rendering Bill Provider Primary Specialty Code 1276 10 Indicates the primary medical specialty of the rendering bill provider.
652 Rendering Bill Provider Primary Address 1286 50 The first line of the rendering bill provider's address.
653 Rendering Bill Provider Secondary Address 1336 32 The second line of the rendering bill provider's address.
654 Rendering Bill Provider City 1368 30 The city name of the rendering bill provider's address.
655 Rendering Bill Provider State Code 1398 2 The two-character state code of the rendering bill provider's address.
656 Rendering Bill Provider Postal Code 1400 5 The zip code in the rendering bill provider's address.
657 Rendering Bill Provider Country Code 1405 3 A three-character code indicating the country of the rendering bill provider's mailing address.
643 Rendering Bill Provider State License Number 1408 20 The rendering bill provider's license type, license number and jurisdiction code.
647 Rendering Bill Provider National Provider ID 1428 20 The unique National Provider ID of the rendering bill provider.
690 Referring Provider Last Name or Group 1448 35 The surname of the provider referring claimant for care. Only used when needed to document that a bill results from care provided based on a referral from another provider.
691 Referring Provider First Name 1483 25 The given name of the referring provider.
692 Referring Provider Middle Name Initial 1508 25 The middle name or initial of the referring provider.
693 Referring Provider Last Name Suffix 1533 10 The legally recognized last name suffix of the referring provider which is used on legal documents. Examples: Jr., Sr., II, III
694 Referring Provider FEIN 1543 9 Encrypted
The federal tax identification number of the referring provider.
534 Referring Provider Gate Keeper Indicator 1552 3 Indicates that the referring provider is the treating doctor. If present, must = 'GP' (Gateway Provider).
695 Referring Provider State License Number 1555 20 The referring provider's license type, license number and jurisdiction code.
701 Referring Provider Specialty License Number 1575 30 The specific license number issued by a state to the referring provider that denotes specialty of the referring provider.
697 Referring Provider Medicare Number 1605 10 The specific number issued to the referring provider by the Medicare Program.
699 Referring Provider National Provider ID 1615 20 The unique National Provider ID of the referring provider.

Detail File Layout

The detail file contains line item information, and line item adjustments.

Detail Variables
DN# Name Start Length Details
Bill ID 1 41 Bill ID uniquely identifies a bill and links line items to the bill.
Line Number 42 6 The number of the line item on the bill.
714 HCPCS Line Procedure Billed Code 48 15 Identifies the treatment that was rendered and billed. HCPCS is the abbreviation for Health Care Financing Administration's Common Procedure Coding System. HCPCS codes include Level 1 CPT procedure codes.
717 First HCPCS Modifier Billed Code 63 2 The first two-character code identifying special circumstances related to the procedure billed.
717 Second HCPCS Modifier Billed Code 65 2 The second two-character code identifying special circumstances related to the procedure billed.
717 Third HCPCS Modifier Billed Code 67 2 The third two-character code identifying special circumstances related to the procedure billed.
717 Fourth HCPCS Modifier Billed Code 69 2 The fourth two-character code identifying special circumstances related to the procedure billed.
551 Procedure Description 71 60 Free form text describing the treatment rendered.
552 Total Charge Per Line 131 15 The service charge amount for the line item.
553 Days/Units Code 146 2 Indicates the time or units billed or paid.
DA = Days
MJ = Minutes
UN = Unit
554 Days/Units Billed 148 15 The number of services billed for the line item in days or units.
600 Place of Service Line Code 163 2 Identifies the place where the medical service was rendered. Examples:
21 = Inpatient Hospital
56 = Psychiatric Residential Treatment Center
72 = Rural Health Clinic
Filler 165 9
742 Provider Agreement Line Code 174 1 Indicates the type of provider agreement applicable to the line item.
H = Network
N = No Agreement
P = Participation Agreement
Y = PPO Agreement
559 Revenue Billed Code 175 10 Indicates the specific cost center billed. Examples:
117 = Private room and board oncology
201 = Intensive care surgical
515 = Clinic pediatric
560 Revenue Unit Rate 185 10 The rate per unit of associated revenue code for hospital accommodations.
605 Service Line From Date 195 8 The starting date that services were performed for the line item. Format: CCYYMMDD
605 Service Line To Date 203 8 The ending date that services were performed for the line item. Format: CCYYMMDD
741 Contract Line Type Code 211 2 A two-character code indicating the line item contractual arrangement for provider reimbursement.
01 = Diagnosis Related Group
02 = Per Diem
03 = Variable Per Diem
04 = Flat
05 = Capitate
06 = Percent
09 = Other
738 Treatment Line Authorization Number 213 1 Defaults to the Treatment Authorization Number (DN581 at the bill level) unless a data element is transmitted in this field.
Y = reported,
N = not reported.
574 Total Amount Paid Per Line 214 15 The total dollar amount paid or credited to the line item.
726 HCPCS Line Procedure Paid Code 229 15 Identifies the treatment that was rendered and paid.
727 First HCPCS Modifier Paid Code 244 2 The first two-character code identifying special circumstances related to the procedure paid.
727 Second HCPCS Modifier Paid Code 246 2 The second two-character code identifying special circumstances related to the procedure paid.
727 Third HCPCS Modifier Paid Code 248 2 The third two-character code identifying special circumstances related to the procedure paid.
727 Fourth HCPCS Modifier Paid Code 250 2 The fourth two-character code identifying special circumstances related to the procedure paid.
576 Revenue Paid Code 252 10 Indicates the specific cost center paid. Examples:
117 = Private room and board oncology
201 = Intensive care surgical
515 = Clinic pediatric
580 Days/Units Paid 262 10 The number of services paid for the line item in days or units.
Number of Service Adjustments 272 1 The number of service adjustments for the line item.
731 Service Adjustment Group Code 1 273 2 A code indicating the general category of the first adjustment made to the dollar amount paid or credited to the line item.
CO = Contractual Obligations
OA = Other Adjustments
PI = Payer initiated reductions
PR = Patient Responsibility
732 Service Adjustment Reason Code 1 275 5 A code indicating the detailed reason of the first adjustment made to the dollar amount paid or credited to the line item.
733 Service Adjustment Amount 1 280 15 The dollar amount of the first adjustment paid or credited to the line item.
734 Service Adjustment Units 1 295 15 The number of units applicable to the first adjustment to the line item.
731 Service Adjustment Group Code 2 310 2 A code indicating the general category of the second adjustment made to the dollar amount paid or credited to the line item.
732 Service Adjustment Reason Code 2 312 5 A code indicating the detailed reason of the second adjustment made to the dollar amount paid or credited to the line item.
733 Service Adjustment Amount 2 317 15 The dollar amount of the second adjustment paid or credited to the line item.
734 Service Adjustment Units 2 332 15 The number of units applicable to the second adjustment to the line item.
731 Service Adjustment Group Code 3 347 2 A code indicating the general category of the third adjustment made to the dollar amount paid or credited to the line item.
732 Service Adjustment Reason Code 3 349 5 A code indicating the detailed reason of the third adjustment made to the dollar amount paid or credited to the line item.
733 Service Adjustment Amount 3 354 15 The dollar amount of the third adjustment paid or credited to the line item.
734 Service Adjustment Units 3 369 15 The number of units applicable to the third adjustment to the line item.
731 Service Adjustment Group Code 4 384 2 A code indicating the general category of the fourth adjustment made to the dollar amount paid or credited to the line item.
732 Service Adjustment Reason Code 4 386 5 A code indicating the detailed reason of the fourth adjustment made to the dollar amount paid or credited to the line item.
733 Service Adjustment Amount 4 391 15 The dollar amount of the fourth adjustment paid or credited to the line item.
734 Service Adjustment Units 4 406 15 The number of units applicable to the fourth adjustment to the line item.
731 Service Adjustment Group Code 5 421 2 A code indicating the general category of the fifth adjustment made to the dollar amount paid or credited to the line item.
732 Service Adjustment Reason Code 5 423 5 A code indicating the detailed reason of the fifth adjustment made to the dollar amount paid or credited to the line item.
733 Service Adjustment Amount 5 428 15 The dollar amount of the fifth adjustment paid or credited to the line item.
734 Service Adjustment Units 5 443 15 The number of units applicable to the fifth adjustment to the line item.

Citation

Any reporting or analysis based on the data shall cite the source as the following:
DWC SV2 Institutional Services Public Use Data File ( PUDF). Texas Department of Insurance, Division of Workers' Compensation, Austin, TX.

Disclaimer

Please note that DWC is providing the PUDF as a public service, and users of this data are responsible for checking the accuracy, completeness, currency and/or suitability of all information themselves. DWC assumes no responsibility for any errors or for the use of the information provided. Additionally, DWC makes no representations, guarantees, or warranties as to the accuracy, completeness, currency, or suitability of this information. DWC expressly disclaims all implied warranties of merchantability and of fitness for a particular purpose. You expressly agree that your use of this data is at your own risk. Under no circumstances shall DWC be liable for any direct, indirect, incidental, special, punitive, or consequential damages that result in any way from your use of this site or from reliance on or use of information provided on this site or that result from deletion of files, delays in operation or transmission of data, or any failure of performance of the site. For purposes of this disclaimer, the term " DWC" includes the Texas Department of Insurance (TDI), the State of Texas, and their employees. For additional information, consult TDI's Web Site Disclaimer, which also applies to the DWC SV2 Institutional Services Public Use Data Files ( PUDF).

For more information, contact: Russ.Harper@tdi.texas.gov.



Last updated: 05/19/2017

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