{"text_format":"1","workbook":"xlsx","n_sheets":21,"sheets":["Legal Approval Form","Filters","DC","MC","ME","PC","PR","PV","BP","CHIA Internal-Checklist","MHEE","GEO","MEID","Document Versions","APCD Header Def","Hide Internal Use Notes","Data Fulfillment","UVR Filename Lkup","Hide Look up tables","MHEE - Verify Columns","Diagnosis Columns"],"not_rendered":{"charts":0,"images":3,"macros":1,"external_links":0,"defined_names":19,"comments":0,"pivot_tables":0},"unopened":[],"bounds":{"document_bytes":16777216,"sheet_cells":100000,"rows_first":2000,"rows_last":500,"rows_between":2000,"halvings":0,"cell_chars":16384,"cell_head_chars":4096},"cells_cut":0,"cells_raw":0,"read":"whole","date_system":"1900"}

{"sheet":"Legal Approval Form","index":0,"n_rows":79,"n_cols":11,"rows_kept":79,"cut":false,"hidden":false,"merged":[[36,0,36,2],[1,4,1,5],[0,4,0,5],[0,1,0,2],[7,1,7,2],[2,1,2,2],[4,0,4,2],[5,1,5,2],[6,1,6,2],[1,1,1,2],[3,9,3,10],[4,9,4,10],[6,9,6,10],[5,9,5,10],[2,9,2,10],[7,6,8,10],[7,4,9,4],[35,0,35,2],[8,1,8,2],[7,5,9,5]]}
["APCD Release ID:","Standardized APCD CY2024",null,"CY2024"]
["Data Release Type:",{"$f":"B32","v":"L1 - Deidentified Only"},null,"Hidden Column - Form use logic Instructions","Table 1: Universal Release Levels and CHIA naming.  "]
["Most recent available years:","2020, 2021, 2022, 2023, 2024",null,null,"UVR Release Level ID","UVR Level Description","Data Release Type","Release Level File Suffix","Release Suffix Description","Release Type Description"]
["Application ID#:  (assigned by CHIA)","#000","Template version: 5.7.3 xlsm","IT Enters - after unprotect",1,"Deidentified Only","L1 - General Release","DE","Deidentified","Deidentified Only"]
["Instructions: Legal approving authority - please fill out each item in the blue shaded section below:",null,null,"User can edit Blue shaded only",2,"Identifiable","L2 - Identifiers unmitigated","ID","Identifiable","Includes Protected Health Information"]
["Requesting Entity / Applicant Name:"," ",null,"Must enter something",3,"Special Request","L3 - Patient Identifiable","SR","Special Request","Direct Patient Identifiers (or special request)"]
["Requesting Entity Project Name:"," ",null,"Must enter something",4,"Internal (NR)","L4 - Internal Use","NR","No Release","Internal use - Audit, Deprecated, other"]
["Legal Contact Name:"," ",null,"Must enter something","List of Selected Views","All Possible Views","Required Files for this release:"]
["Date approved:",null,null,"Must enter something"]
[null,false,null,null,null,null,"CY2020","CY2021","CY2022","CY2023","CY2024"]
["Select Years approved:",false,null,null,{"$f":"IF(($B$16=\"Y\")*AND($B$33=\"N\"),'UVR Filename Lkup'!A2,\" \")","v":" "},"Dental DE-Identifed",{"$f":"IF(AND($B$10=TRUE,$B$16=\"Y\",$B$33=\"N\"),'UVR Filename Lkup'!E2,\" \")","v":" "},{"$f":"IF(AND($B$11=TRUE,$B$16=\"Y\",$B$33=\"N\"),'UVR Filename Lkup'!F2,\" \")","v":" "},{"$f":"IF(AND($B$12=TRUE,$B$16=\"Y\",$B$33=\"N\"),'UVR Filename Lkup'!G2,\" \")","v":" "},{"$f":"IF(AND($B$13=TRUE,$B$16=\"Y\",$B$33=\"N\"),'UVR Filename Lkup'!H2,\" \")","v":" "},{"$f":"IF(AND($B$14=TRUE,$B$16=\"Y\",$B$33=\"N\"),'UVR Filename Lkup'!I2,\" \")","v":" "}]
[null,false,null,null,{"$f":"IF(($B$16=\"Y\")*AND($B$33=\"Y\"),'UVR Filename Lkup'!A3,\" \")","v":" "},"Dental Identifiable",{"$f":"IF(AND($B$10=TRUE, $B$16=\"Y\", $B$33=\"Y\"),'UVR Filename Lkup'!E3,\" \")","v":" "},{"$f":"IF(AND($B$11=TRUE,$B$16=\"Y\",$B$33=\"Y\"),'UVR Filename Lkup'!F3,\" \")","v":" "},{"$f":"IF(AND($B$12=TRUE,$B$16=\"Y\",$B$33=\"Y\"),'UVR Filename Lkup'!G3,\" \")","v":" "},{"$f":"IF(AND($B$13=TRUE,$B$16=\"Y\",$B$33=\"Y\"),'UVR Filename Lkup'!H3,\" \")","v":" "},{"$f":"IF(AND($B$14=TRUE,$B$16=\"Y\",$B$33=\"Y\"),'UVR Filename Lkup'!I3,\" \")","v":" "}]
[null,false,null,null,{"$f":"IF(AND($B$16=\"Y\", $B$33=\"N\", $B$25=\"Y\"), 'UVR Filename Lkup'!A4, \" \")","v":" "},"Dental MH DE-Identified",{"$f":"IF(AND($B$10=TRUE, $B$16=\"Y\", $B$33=\"N\", $B$25=\"Y\"), 'UVR Filename Lkup'!E4, \" \")","v":" "},{"$f":"IF(AND($B$11=TRUE, $B$16=\"Y\", $B$33=\"N\", $B$25=\"Y\"), 'UVR Filename Lkup'!F4, \" \")","v":" "},{"$f":"IF(AND($B$12=TRUE, $B$16=\"Y\", $B$33=\"N\", $B$25=\"Y\"), 'UVR Filename Lkup'!G4, \" \")","v":" "},{"$f":"IF(AND($B$13=TRUE, $B$16=\"Y\", $B$33=\"N\", $B$25=\"Y\"), 'UVR Filename Lkup'!H4, \" \")","v":" "},{"$f":"IF(AND($B$14=TRUE, $B$16=\"Y\", $B$33=\"N\", $B$25=\"Y\"), 'UVR Filename Lkup'!I4, \" \")","v":" "}]
[null,false,null,null,{"$f":"IF(AND($B$16=\"Y\", $B$33=\"Y\", $B$25=\"Y\"), 'UVR Filename Lkup'!A5, \" \")","v":" "},"Dental MH Identifiable",{"$f":"IF(AND($B$10=TRUE, $B$16=\"Y\", $B$33=\"Y\", $B$25=\"Y\"), 'UVR Filename Lkup'!E5, \" \")","v":" "},{"$f":"IF(AND($B$11=TRUE, $B$16=\"Y\", $B$33=\"Y\", $B$25=\"Y\"), 'UVR Filename Lkup'!F5, \" \")","v":" "},{"$f":"IF(AND($B$12=TRUE, $B$16=\"Y\", $B$33=\"Y\", $B$25=\"Y\"), 'UVR Filename Lkup'!G5, \" \")","v":" "},{"$f":"IF(AND($B$13=TRUE, $B$16=\"Y\", $B$33=\"Y\", $B$25=\"Y\"), 'UVR Filename Lkup'!H5, \" \")","v":" "},{"$f":"IF(AND($B$14=TRUE, $B$16=\"Y\", $B$33=\"Y\", $B$25=\"Y\"), 'UVR Filename Lkup'!I5, \" \")","v":" "}]
["File Types Approved:",null,null,"Must enter something",{"$f":"IF(($B$17=\"Y\")*AND($B$33=\"N\"),'UVR Filename Lkup'!A6,\" \")","v":" "},"Medical Claims DE-Identifed",{"$f":"IF(AND($B$10=TRUE, $B$17=\"Y\", $B$33=\"N\"),'UVR Filename Lkup'!E6,\" \")","v":" "},{"$f":"IF(AND($B$11=TRUE, $B$17=\"Y\", $B$33=\"N\"),'UVR Filename Lkup'!F6,\" \")","v":" "},{"$f":"IF(AND($B$12=TRUE, $B$17=\"Y\", $B$33=\"N\"),'UVR Filename Lkup'!G6,\" \")","v":" "},{"$f":"IF(AND($B$13=TRUE, $B$17=\"Y\", $B$33=\"N\"),'UVR Filename Lkup'!H6,\" \")","v":" "},{"$f":"IF(AND($B$14=TRUE, $B$17=\"Y\", $B$33=\"N\"),'UVR Filename Lkup'!I6,\" \")","v":" "}]
["Dental Claims","N","select Y/N",null,{"$f":"IF(($B$17=\"Y\")*AND($B$33=\"Y\"),'UVR Filename Lkup'!A7,\" \")","v":" "},"Medical Claims Identifiable",{"$f":"IF(AND($B$10=TRUE, $B$17=\"Y\", $B$33=\"Y\"),'UVR Filename Lkup'!E7,\" \")","v":" "},{"$f":"IF(AND($B$11=TRUE, $B$17=\"Y\", $B$33=\"Y\"),'UVR Filename Lkup'!F7,\" \")","v":" "},{"$f":"IF(AND($B$12=TRUE, $B$17=\"Y\", $B$33=\"Y\"),'UVR Filename Lkup'!G7,\" \")","v":" "},{"$f":"IF(AND($B$13=TRUE, $B$17=\"Y\", $B$33=\"Y\"),'UVR Filename Lkup'!H7,\" \")","v":" "},{"$f":"IF(AND($B$14=TRUE, $B$17=\"Y\", $B$33=\"Y\"),'UVR Filename Lkup'!I7,\" \")","v":" "}]
["Medical Claims","N","\"",null,{"$f":"IF(AND($B$17=\"Y\", $B$33=\"N\", $B$25=\"Y\"), 'UVR Filename Lkup'!A8, \" \")","v":" "},"Medical Claims MH DE-Identified",{"$f":"IF(AND($B$10=TRUE, $B$17=\"Y\", $B$33=\"N\", $B$25=\"Y\"), 'UVR Filename Lkup'!E8, \" \")","v":" "},{"$f":"IF(AND($B$11=TRUE, $B$17=\"Y\", $B$33=\"N\", $B$25=\"Y\"), 'UVR Filename Lkup'!F8, \" \")","v":" "},{"$f":"IF(AND($B$12=TRUE, $B$17=\"Y\", $B$33=\"N\", $B$25=\"Y\"), 'UVR Filename Lkup'!G8, \" \")","v":" "},{"$f":"IF(AND($B$13=TRUE, $B$17=\"Y\", $B$33=\"N\", $B$25=\"Y\"), 'UVR Filename Lkup'!H8, \" \")","v":" "},{"$f":"IF(AND($B$14=TRUE, $B$17=\"Y\", $B$33=\"N\", $B$25=\"Y\"), 'UVR Filename Lkup'!I8, \" \")","v":" "}]
["Member Eligibility","N","\"","Y, N or blank only",{"$f":"IF(AND($B$17=\"Y\", $B$33=\"Y\", $B$25=\"Y\"), 'UVR Filename Lkup'!A9, \" \")","v":" "},"Medical Claims MH Identifiable",{"$f":"IF(AND($B$10=TRUE, $B$17=\"Y\", $B$33=\"Y\", $B$25=\"Y\"), 'UVR Filename Lkup'!E9, \" \")","v":" "},{"$f":"IF(AND($B$11=TRUE, $B$17=\"Y\", $B$33=\"Y\", $B$25=\"Y\"), 'UVR Filename Lkup'!F9, \" \")","v":" "},{"$f":"IF(AND($B$12=TRUE, $B$17=\"Y\", $B$33=\"Y\", $B$25=\"Y\"), 'UVR Filename Lkup'!G9, \" \")","v":" "},{"$f":"IF(AND($B$13=TRUE, $B$17=\"Y\", $B$33=\"Y\", $B$25=\"Y\"), 'UVR Filename Lkup'!H9, \" \")","v":" "},{"$f":"IF(AND($B$14=TRUE, $B$17=\"Y\", $B$33=\"Y\", $B$25=\"Y\"), 'UVR Filename Lkup'!I9, \" \")","v":" "}]
["Pharmacy Claims","N","\"","Y, N or blank only",{"$f":"IF(AND($B$17=\"Y\", $B$33=\"N\",$B$30=\"Y\"), 'UVR Filename Lkup'!A10, \" \")","v":" "},"MC Commercial SUD DE-Identified",{"$f":"IF(AND($B$10=TRUE, $B$17=\"Y\", $B$33=\"N\",$B$30=\"Y\"), 'UVR Filename Lkup'!E10, \" \")","v":" "},{"$f":"IF(AND($B$11=TRUE, $B$17=\"Y\", $B$33=\"N\",$B$30=\"Y\"), 'UVR Filename Lkup'!F10, \" \")","v":" "},{"$f":"IF(AND($B$12=TRUE, $B$17=\"Y\", $B$33=\"N\",$B$30=\"Y\"), 'UVR Filename Lkup'!G10, \" \")","v":" "},{"$f":"IF(AND($B$13=TRUE, $B$17=\"Y\", $B$33=\"N\",$B$30=\"Y\"), 'UVR Filename Lkup'!H10, \" \")","v":" "},{"$f":"IF(AND($B$14=TRUE, $B$17=\"Y\", $B$33=\"N\",$B$30=\"Y\"), 'UVR Filename Lkup'!I10, \" \")","v":" "}]
["Product File","N","\"","Y, N or blank only",{"$f":"IF(AND($B$17=\"Y\", $B$33=\"Y\",$B$30=\"Y\"), 'UVR Filename Lkup'!A11, \" \")","v":" "},"MC Commercial SUD Identifiable",{"$f":"IF(AND($B$10=TRUE, $B$17=\"Y\", $B$33=\"Y\",$B$30=\"Y\"), 'UVR Filename Lkup'!E11, \" \")","v":" "},{"$f":"IF(AND($B$11=TRUE, $B$17=\"Y\", $B$33=\"Y\",$B$30=\"Y\"), 'UVR Filename Lkup'!F11, \" \")","v":" "},{"$f":"IF(AND($B$12=TRUE, $B$17=\"Y\", $B$33=\"Y\",$B$30=\"Y\"), 'UVR Filename Lkup'!G11, \" \")","v":" "},{"$f":"IF(AND($B$13=TRUE, $B$17=\"Y\", $B$33=\"Y\",$B$30=\"Y\"), 'UVR Filename Lkup'!H11, \" \")","v":" "},{"$f":"IF(AND($B$14=TRUE, $B$17=\"Y\", $B$33=\"Y\",$B$30=\"Y\"), 'UVR Filename Lkup'!I11, \" \")","v":" "}]
["Provider File","N","\"","Y, N or blank only",{"$f":"IF(AND($B$17=\"Y\", $B$33=\"N\", $B$25=\"Y\",$B$30=\"Y\"), 'UVR Filename Lkup'!A12, \" \")","v":" "},"MC MassHealth SUD DE-Identified",{"$f":"IF(AND($B$10=TRUE, $B$17=\"Y\", $B$33=\"N\", $B$25=\"Y\",$B$30=\"Y\"), 'UVR Filename Lkup'!E12, \" \")","v":" "},{"$f":"IF(AND($B$11=TRUE, $B$17=\"Y\", $B$33=\"N\", $B$25=\"Y\",$B$30=\"Y\"), 'UVR Filename Lkup'!F12, \" \")","v":" "},{"$f":"IF(AND($B$12=TRUE, $B$17=\"Y\", $B$33=\"N\", $B$25=\"Y\",$B$30=\"Y\"), 'UVR Filename Lkup'!G12, \" \")","v":" "},{"$f":"IF(AND($B$13=TRUE, $B$17=\"Y\", $B$33=\"N\", $B$25=\"Y\",$B$30=\"Y\"), 'UVR Filename Lkup'!H12, \" \")","v":" "},{"$f":"IF(AND($B$14=TRUE, $B$17=\"Y\", $B$33=\"N\", $B$25=\"Y\",$B$30=\"Y\"), 'UVR Filename Lkup'!I12, \" \")","v":" "}]
["Benefit Plan Control Totals","N","\"","Y, N or blank only",{"$f":"IF(AND($B$17=\"Y\", $B$33=\"Y\", $B$25=\"Y\",$B$30=\"Y\"), 'UVR Filename Lkup'!A13, \" \")","v":" "},"MC MassHealth SUD Identifiable",{"$f":"IF(AND($B$10=TRUE, $B$17=\"Y\", $B$33=\"Y\", $B$25=\"Y\",$B$30=\"Y\"), 'UVR Filename Lkup'!E13, \" \")","v":" "},{"$f":"IF(AND($B$11=TRUE, $B$17=\"Y\", $B$33=\"Y\", $B$25=\"Y\",$B$30=\"Y\"), 'UVR Filename Lkup'!F13, \" \")","v":" "},{"$f":"IF(AND($B$12=TRUE, $B$17=\"Y\", $B$33=\"Y\", $B$25=\"Y\",$B$30=\"Y\"), 'UVR Filename Lkup'!G13, \" \")","v":" "},{"$f":"IF(AND($B$13=TRUE, $B$17=\"Y\", $B$33=\"Y\", $B$25=\"Y\",$B$30=\"Y\"), 'UVR Filename Lkup'!H13, \" \")","v":" "},{"$f":"IF(AND($B$14=TRUE, $B$17=\"Y\", $B$33=\"Y\", $B$25=\"Y\",$B$30=\"Y\"), 'UVR Filename Lkup'!I13, \" \")","v":" "}]
[null,null,null,"Y, N or blank only",{"$f":"IF(($B$18=\"Y\")*AND($B$33=\"N\"),'UVR Filename Lkup'!A14,\" \")","v":" "},"Member Eligibility DE-Identified",{"$f":"IF(AND($B$10=TRUE, $B$18=\"Y\", $B$33=\"N\"),'UVR Filename Lkup'!E14,\" \")","v":" "},{"$f":"IF(AND($B$11=TRUE, $B$18=\"Y\", $B$33=\"N\"),'UVR Filename Lkup'!F14,\" \")","v":" "},{"$f":"IF(AND($B$12=TRUE, $B$18=\"Y\", $B$33=\"N\"),'UVR Filename Lkup'!G14,\" \")","v":" "},{"$f":"IF(AND($B$13=TRUE, $B$18=\"Y\", $B$33=\"N\"),'UVR Filename Lkup'!H14,\" \")","v":" "},{"$f":"IF(AND($B$14=TRUE, $B$18=\"Y\", $B$33=\"N\"),'UVR Filename Lkup'!I14,\" \")","v":" "}]
["MassHealth data approvals:",null,null,"Y, N or blank only",{"$f":"IF(($B$18=\"Y\")*AND($B$33=\"Y\"),'UVR Filename Lkup'!A15,\" \")","v":" "},"Member Eligibility Identifiable",{"$f":"IF(AND($B$10=TRUE, $B$18=\"Y\", $B$33=\"Y\"),'UVR Filename Lkup'!E15,\" \")","v":" "},{"$f":"IF(AND($B$11=TRUE, $B$18=\"Y\", $B$33=\"Y\"),'UVR Filename Lkup'!F15,\" \")","v":" "},{"$f":"IF(AND($B$12=TRUE, $B$18=\"Y\", $B$33=\"Y\"),'UVR Filename Lkup'!G15,\" \")","v":" "},{"$f":"IF(AND($B$13=TRUE, $B$18=\"Y\", $B$33=\"Y\"),'UVR Filename Lkup'!H15,\" \")","v":" "},{"$f":"IF(AND($B$14=TRUE, $B$18=\"Y\", $B$33=\"Y\"),'UVR Filename Lkup'!I15,\" \")","v":" "}]
["Include MassHealth Data","N","select Y/N",null,{"$f":"IF(AND($B$18=\"Y\", $B$33=\"N\", $B$25=\"Y\"), 'UVR Filename Lkup'!A16, \" \")","v":" "},"Member Eligibility MH DE-Identified",{"$f":"IF(AND($B$10=TRUE, $B$18=\"Y\", $B$33=\"N\", $B$25=\"Y\"), 'UVR Filename Lkup'!E16, \" \")","v":" "},{"$f":"IF(AND($B$11=TRUE, $B$18=\"Y\", $B$33=\"N\", $B$25=\"Y\"), 'UVR Filename Lkup'!F16, \" \")","v":" "},{"$f":"IF(AND($B$12=TRUE, $B$18=\"Y\", $B$33=\"N\", $B$25=\"Y\"), 'UVR Filename Lkup'!G16, \" \")","v":" "},{"$f":"IF(AND($B$13=TRUE, $B$18=\"Y\", $B$33=\"N\", $B$25=\"Y\"), 'UVR Filename Lkup'!H16, \" \")","v":" "},{"$f":"IF(AND($B$14=TRUE, $B$18=\"Y\", $B$33=\"N\", $B$25=\"Y\"), 'UVR Filename Lkup'!I16, \" \")","v":" "}]
["MassHealth Enhanced Eligibility","N","\"",null,{"$f":"IF(AND($B$18=\"Y\", $B$33=\"Y\", $B$25=\"Y\"), 'UVR Filename Lkup'!A17, \" \")","v":" "},"Member Eligibility MH Identifiable",{"$f":"IF(AND($B$10=TRUE, $B$18=\"Y\", $B$33=\"Y\", $B$25=\"Y\"), 'UVR Filename Lkup'!E17, \" \")","v":" "},{"$f":"IF(AND($B$11=TRUE, $B$18=\"Y\", $B$33=\"Y\", $B$25=\"Y\"), 'UVR Filename Lkup'!F17, \" \")","v":" "},{"$f":"IF(AND($B$12=TRUE, $B$18=\"Y\", $B$33=\"Y\", $B$25=\"Y\"), 'UVR Filename Lkup'!G17, \" \")","v":" "},{"$f":"IF(AND($B$13=TRUE, $B$18=\"Y\", $B$33=\"Y\", $B$25=\"Y\"), 'UVR Filename Lkup'!H17, \" \")","v":" "},{"$f":"IF(AND($B$14=TRUE, $B$18=\"Y\", $B$33=\"Y\", $B$25=\"Y\"), 'UVR Filename Lkup'!I17, \" \")","v":" "}]
[null,null,null,"Y/N only - Default value \"N\"",{"$f":"IF(($B$19=\"Y\")*AND($B$33=\"N\"),'UVR Filename Lkup'!A18,\" \")","v":" "},"Pharmacy DE-Identified",{"$f":"IF(AND($B$10=TRUE, $B$19=\"Y\", $B$33=\"N\"),'UVR Filename Lkup'!E18,\" \")","v":" "},{"$f":"IF(AND($B$11=TRUE, $B$19=\"Y\", $B$33=\"N\"),'UVR Filename Lkup'!F18,\" \")","v":" "},{"$f":"IF(AND($B$12=TRUE, $B$19=\"Y\", $B$33=\"N\"),'UVR Filename Lkup'!G18,\" \")","v":" "},{"$f":"IF(AND($B$13=TRUE, $B$19=\"Y\", $B$33=\"N\"),'UVR Filename Lkup'!H18,\" \")","v":" "},{"$f":"IF(AND($B$14=TRUE, $B$19=\"Y\", $B$33=\"N\"),'UVR Filename Lkup'!I18,\" \")","v":" "}]
["Requesting Entity Type:","Internal or CHIA Contractor",{"$f":"IF(B28=\"\",'Hide Look up tables'!$C$4,\" \")","v":" "},"Y/N only - Default value \"N\"",{"$f":"IF(($B$19=\"Y\")*AND($B$33=\"Y\"),'UVR Filename Lkup'!A19,\" \")","v":" "},"Pharmacy Identifiable",{"$f":"IF(AND($B$10=TRUE, $B$19=\"Y\", $B$33=\"Y\"),'UVR Filename Lkup'!E19,\" \")","v":" "},{"$f":"IF(AND($B$11=TRUE, $B$19=\"Y\", $B$33=\"Y\"),'UVR Filename Lkup'!F19,\" \")","v":" "},{"$f":"IF(AND($B$12=TRUE, $B$19=\"Y\", $B$33=\"Y\"),'UVR Filename Lkup'!G19,\" \")","v":" "},{"$f":"IF(AND($B$13=TRUE, $B$19=\"Y\", $B$33=\"Y\"),'UVR Filename Lkup'!H19,\" \")","v":" "},{"$f":"IF(AND($B$14=TRUE, $B$19=\"Y\", $B$33=\"Y\"),'UVR Filename Lkup'!I19,\" \")","v":" "}]
[null,null,null,null,{"$f":"IF(AND($B$19=\"Y\", $B$33=\"N\", $B$25=\"Y\"), 'UVR Filename Lkup'!A20, \" \")","v":" "},"Pharmacy MH DE-Identified",{"$f":"IF(AND($B$10=TRUE, $B$19=\"Y\", $B$33=\"N\", $B$25=\"Y\"), 'UVR Filename Lkup'!E20, \" \")","v":" "},{"$f":"IF(AND($B$11=TRUE, $B$19=\"Y\", $B$33=\"N\", $B$25=\"Y\"), 'UVR Filename Lkup'!F20, \" \")","v":" "},{"$f":"IF(AND($B$12=TRUE, $B$19=\"Y\", $B$33=\"N\", $B$25=\"Y\"), 'UVR Filename Lkup'!G20, \" \")","v":" "},{"$f":"IF(AND($B$13=TRUE, $B$19=\"Y\", $B$33=\"N\", $B$25=\"Y\"), 'UVR Filename Lkup'!H20, \" \")","v":" "},{"$f":"IF(AND($B$14=TRUE, $B$19=\"Y\", $B$33=\"N\", $B$25=\"Y\"), 'UVR Filename Lkup'!I20, \" \")","v":" "}]
["Include Substance Abuse Claims:","N","select Y/N","Required - Data Validation via Drop down",{"$f":"IF(AND($B$19=\"Y\", $B$33=\"Y\", $B$25=\"Y\"), 'UVR Filename Lkup'!A21, \" \")","v":" "},"Pharmacy MH Identifiable",{"$f":"IF(AND($B$10=TRUE, $B$19=\"Y\", $B$33=\"Y\", $B$25=\"Y\"), 'UVR Filename Lkup'!E21, \" \")","v":" "},{"$f":"IF(AND($B$11=TRUE, $B$19=\"Y\", $B$33=\"Y\", $B$25=\"Y\"), 'UVR Filename Lkup'!F21, \" \")","v":" "},{"$f":"IF(AND($B$12=TRUE, $B$19=\"Y\", $B$33=\"Y\", $B$25=\"Y\"), 'UVR Filename Lkup'!G21, \" \")","v":" "},{"$f":"IF(AND($B$13=TRUE, $B$19=\"Y\", $B$33=\"Y\", $B$25=\"Y\"), 'UVR Filename Lkup'!H21, \" \")","v":" "},{"$f":"IF(AND($B$14=TRUE, $B$19=\"Y\", $B$33=\"Y\", $B$25=\"Y\"), 'UVR Filename Lkup'!I21, \" \")","v":" "}]
[null,{"$f":"IF(($B$28=\"Other\")*AND($B$32=\"Y\"),'Hide Look up tables'!$C$6,\" \")","v":" "},{"$f":"IF(B28=\"Other\",'Hide Look up tables'!$C$3,\" \")","v":" "},null,{"$f":"IF(($B$20=\"Y\")*AND($B$33=\"N\"),'UVR Filename Lkup'!A22,\" \")","v":" "},"Product DE-Identiied",{"$f":"IF(AND($B$10=TRUE, $B$20=\"Y\", $B$33=\"N\"),'UVR Filename Lkup'!E22,\" \")","v":" "},{"$f":"IF(AND($B$11=TRUE, $B$20=\"Y\", $B$33=\"N\"),'UVR Filename Lkup'!F22,\" \")","v":" "},{"$f":"IF(AND($B$12=TRUE, $B$20=\"Y\", $B$33=\"N\"),'UVR Filename Lkup'!G22,\" \")","v":" "},{"$f":"IF(AND($B$13=TRUE, $B$20=\"Y\", $B$33=\"N\"),'UVR Filename Lkup'!H22,\" \")","v":" "},{"$f":"IF(AND($B$14=TRUE, $B$20=\"Y\", $B$33=\"N\"),'UVR Filename Lkup'!I22,\" \")","v":" "}]
["Select Data Type Requested:","L1 - Deidentified Only",{"$f":"IF(AND($B$33=\"Y\", $B$30=\"Y\"),'Hide Look up tables'!$C$2,\" \")","v":" "},"Y/N only - Default value \"N\"",{"$f":"IF(($B$20=\"Y\")*AND($B$33=\"Y\"),'UVR Filename Lkup'!A23,\" \")","v":" "},"Product Identifiable",{"$f":"IF(AND($B$10=TRUE, $B$20=\"Y\", $B$33=\"Y\"),'UVR Filename Lkup'!E23,\" \")","v":" "},{"$f":"IF(AND($B$11=TRUE, $B$20=\"Y\", $B$33=\"Y\"),'UVR Filename Lkup'!F23,\" \")","v":" "},{"$f":"IF(AND($B$12=TRUE, $B$20=\"Y\", $B$33=\"Y\"),'UVR Filename Lkup'!G23,\" \")","v":" "},{"$f":"IF(AND($B$13=TRUE, $B$20=\"Y\", $B$33=\"Y\"),'UVR Filename Lkup'!H23,\" \")","v":" "},{"$f":"IF(AND($B$14=TRUE, $B$20=\"Y\", $B$33=\"Y\"),'UVR Filename Lkup'!I23,\" \")","v":" "}]
["Selection includes Identifiable Data:",{"$f":"IF($B$32=\"L1 - Deidentified Only\",\"N\",\"Y\")","v":"N"},"Hidden - office Use only",null,{"$f":"IF(AND($B$20=\"Y\", $B$33=\"N\", $B$25=\"Y\"), 'UVR Filename Lkup'!A24, \" \")","v":" "},"Product MH DE-Identified",{"$f":"IF(AND($B$10=TRUE, $B$20=\"Y\", $B$33=\"N\", $B$25=\"Y\"), 'UVR Filename Lkup'!E24, \" \")","v":" "},{"$f":"IF(AND($B$11=TRUE, $B$20=\"Y\", $B$33=\"N\", $B$25=\"Y\"), 'UVR Filename Lkup'!F24, \" \")","v":" "},{"$f":"IF(AND($B$12=TRUE, $B$20=\"Y\", $B$33=\"N\", $B$25=\"Y\"), 'UVR Filename Lkup'!G24, \" \")","v":" "},{"$f":"IF(AND($B$13=TRUE, $B$20=\"Y\", $B$33=\"N\", $B$25=\"Y\"), 'UVR Filename Lkup'!H24, \" \")","v":" "},{"$f":"IF(AND($B$14=TRUE, $B$20=\"Y\", $B$33=\"N\", $B$25=\"Y\"), 'UVR Filename Lkup'!I24, \" \")","v":" "}]
["Other restrictions - filters:","N","If yes, include details on Filters tab","Y/N only - Default value \"N\"",{"$f":"IF(AND($B$20=\"Y\", $B$33=\"Y\", $B$25=\"Y\"), 'UVR Filename Lkup'!A25, \" \")","v":" "},"Product MH Identifiable",{"$f":"IF(AND($B$10=TRUE, $B$20=\"Y\", $B$33=\"Y\", $B$25=\"Y\"), 'UVR Filename Lkup'!E25, \" \")","v":" "},{"$f":"IF(AND($B$11=TRUE, $B$20=\"Y\", $B$33=\"Y\", $B$25=\"Y\"), 'UVR Filename Lkup'!F25, \" \")","v":" "},{"$f":"IF(AND($B$12=TRUE, $B$20=\"Y\", $B$33=\"Y\", $B$25=\"Y\"), 'UVR Filename Lkup'!G25, \" \")","v":" "},{"$f":"IF(AND($B$13=TRUE, $B$20=\"Y\", $B$33=\"Y\", $B$25=\"Y\"), 'UVR Filename Lkup'!H25, \" \")","v":" "},{"$f":"IF(AND($B$14=TRUE, $B$20=\"Y\", $B$33=\"Y\", $B$25=\"Y\"), 'UVR Filename Lkup'!I25, \" \")","v":" "}]
[null,null,null,null,{"$f":"IF(($B$21=\"Y\")*AND($B$33=\"N\"),'UVR Filename Lkup'!A26,\" \")","v":" "},"Provider DE-Identified",{"$f":"IF(AND($B$10=TRUE, $B$21=\"Y\", $B$33=\"N\"),'UVR Filename Lkup'!E26,\" \")","v":" "},{"$f":"IF(AND($B$11=TRUE, $B$21=\"Y\", $B$33=\"N\"),'UVR Filename Lkup'!F26,\" \")","v":" "},{"$f":"IF(AND($B$12=TRUE, $B$21=\"Y\", $B$33=\"N\"),'UVR Filename Lkup'!G26,\" \")","v":" "},{"$f":"IF(AND($B$13=TRUE, $B$21=\"Y\", $B$33=\"N\"),'UVR Filename Lkup'!H26,\" \")","v":" "},{"$f":"IF(AND($B$14=TRUE, $B$21=\"Y\", $B$33=\"N\"),'UVR Filename Lkup'!I26,\" \")","v":" "}]
["Note: All requests include Geographic and Member Link reference data (see GEO, MEID tabs).",null,null,"Y/N only - Default value \"N\"",{"$f":"IF(($B$21=\"Y\")*AND($B$33=\"Y\"),'UVR Filename Lkup'!A27,\" \")","v":" "},"Provider Identifiable",{"$f":"IF(AND($B$10=TRUE, $B$21=\"Y\", $B$33=\"Y\"),'UVR Filename Lkup'!E27,\" \")","v":" "},{"$f":"IF(AND($B$11=TRUE, $B$21=\"Y\", $B$33=\"Y\"),'UVR Filename Lkup'!F27,\" \")","v":" "},{"$f":"IF(AND($B$12=TRUE, $B$21=\"Y\", $B$33=\"Y\"),'UVR Filename Lkup'!G27,\" \")","v":" "},{"$f":"IF(AND($B$13=TRUE, $B$21=\"Y\", $B$33=\"Y\"),'UVR Filename Lkup'!H27,\" \")","v":" "},{"$f":"IF(AND($B$14=TRUE, $B$21=\"Y\", $B$33=\"Y\"),'UVR Filename Lkup'!I27,\" \")","v":" "}]
["*Identifiable data allowed only if not selecting Substance Abuse - except for Internal/CHIA Contractor",null,null,null,{"$f":"IF(AND($B$21=\"Y\", $B$33=\"N\", $B$25=\"Y\"), 'UVR Filename Lkup'!A28, \" \")","v":" "},"Provider MH DE-Identified",{"$f":"IF(AND($B$10=TRUE, $B$21=\"Y\", $B$33=\"N\", $B$25=\"Y\"), 'UVR Filename Lkup'!E28, \" \")","v":" "},{"$f":"IF(AND($B$11=TRUE, $B$21=\"Y\", $B$33=\"N\", $B$25=\"Y\"), 'UVR Filename Lkup'!F28, \" \")","v":" "},{"$f":"IF(AND($B$12=TRUE, $B$21=\"Y\", $B$33=\"N\", $B$25=\"Y\"), 'UVR Filename Lkup'!G28, \" \")","v":" "},{"$f":"IF(AND($B$13=TRUE, $B$21=\"Y\", $B$33=\"N\", $B$25=\"Y\"), 'UVR Filename Lkup'!H28, \" \")","v":" "},{"$f":"IF(AND($B$14=TRUE, $B$21=\"Y\", $B$33=\"N\", $B$25=\"Y\"), 'UVR Filename Lkup'!I28, \" \")","v":" "}]
[null,null,null,null,{"$f":"IF(AND($B$21=\"Y\", $B$33=\"Y\", $B$25=\"Y\"), 'UVR Filename Lkup'!A29, \" \")","v":" "},"Provider MH Identifiable",{"$f":"IF(AND($B$10=TRUE, $B$21=\"Y\", $B$33=\"Y\", $B$25=\"Y\"), 'UVR Filename Lkup'!E29, \" \")","v":" "},{"$f":"IF(AND($B$11=TRUE, $B$21=\"Y\", $B$33=\"Y\", $B$25=\"Y\"), 'UVR Filename Lkup'!F29, \" \")","v":" "},{"$f":"IF(AND($B$12=TRUE, $B$21=\"Y\", $B$33=\"Y\", $B$25=\"Y\"), 'UVR Filename Lkup'!G29, \" \")","v":" "},{"$f":"IF(AND($B$13=TRUE, $B$21=\"Y\", $B$33=\"Y\", $B$25=\"Y\"), 'UVR Filename Lkup'!H29, \" \")","v":" "},{"$f":"IF(AND($B$14=TRUE, $B$21=\"Y\", $B$33=\"Y\", $B$25=\"Y\"), 'UVR Filename Lkup'!I29, \" \")","v":" "}]
[null,null,null,null,{"$f":"IF(($B$22=\"Y\")*AND($B$33=\"N\"),'UVR Filename Lkup'!A30,\" \")","v":" "},"Benefit Plan DE-Identified",{"$f":"IF(AND($B$10=TRUE, $B$22=\"Y\", $B$33=\"N\"),'UVR Filename Lkup'!E30,\" \")","v":" "},{"$f":"IF(AND($B$11=TRUE, $B$22=\"Y\", $B$33=\"N\"),'UVR Filename Lkup'!F30,\" \")","v":" "},{"$f":"IF(AND($B$12=TRUE, $B$22=\"Y\", $B$33=\"N\"),'UVR Filename Lkup'!G30,\" \")","v":" "},{"$f":"IF(AND($B$13=TRUE, $B$22=\"Y\", $B$33=\"N\"),'UVR Filename Lkup'!H30,\" \")","v":" "},{"$f":"IF(AND($B$14=TRUE, $B$22=\"Y\", $B$33=\"N\"),'UVR Filename Lkup'!I30,\" \")","v":" "}]
[null,null,null,null,{"$f":"IF(($B$22=\"Y\")*AND($B$33=\"Y\"),'UVR Filename Lkup'!A31,\" \")","v":" "},"Benefit Plan Identifiable",{"$f":"IF(AND($B$10=TRUE, $B$22=\"Y\", $B$33=\"Y\"),'UVR Filename Lkup'!E31,\" \")","v":" "},{"$f":"IF(AND($B$11=TRUE, $B$22=\"Y\", $B$33=\"Y\"),'UVR Filename Lkup'!F31,\" \")","v":" "},{"$f":"IF(AND($B$12=TRUE, $B$22=\"Y\", $B$33=\"Y\"),'UVR Filename Lkup'!G31,\" \")","v":" "},{"$f":"IF(AND($B$13=TRUE, $B$22=\"Y\", $B$33=\"Y\"),'UVR Filename Lkup'!H31,\" \")","v":" "},{"$f":"IF(AND($B$14=TRUE, $B$22=\"Y\", $B$33=\"Y\"),'UVR Filename Lkup'!I31,\" \")","v":" "}]
[null,null,null,null,{"$f":"IF(AND($B$26=\"Y\", $B$33=\"N\", $B$25=\"Y\"), 'UVR Filename Lkup'!A32, \" \")","v":" "},"MH Enhanced Eligibility DE-identified",{"$f":"IF(AND($B$10=TRUE, $B$26=\"Y\", $B$33=\"N\", $B$25=\"Y\"), 'UVR Filename Lkup'!E32, \" \")","v":" "},{"$f":"IF(AND($B$11=TRUE, $B$26=\"Y\", $B$33=\"N\", $B$25=\"Y\"), 'UVR Filename Lkup'!F32, \" \")","v":" "},{"$f":"IF(AND($B$12=TRUE, $B$26=\"Y\", $B$33=\"N\", $B$25=\"Y\"), 'UVR Filename Lkup'!G32, \" \")","v":" "},{"$f":"IF(AND($B$13=TRUE, $B$26=\"Y\", $B$33=\"N\", $B$25=\"Y\"), 'UVR Filename Lkup'!H32, \" \")","v":" "},{"$f":"IF(AND($B$14=TRUE, $B$26=\"Y\", $B$33=\"N\", $B$25=\"Y\"), 'UVR Filename Lkup'!I32, \" \")","v":" "}]
[null,null,null,null,{"$f":"IF(AND($B$26=\"Y\", $B$33=\"Y\", $B$25=\"Y\"), 'UVR Filename Lkup'!A33, \" \")","v":" "},"MH Enhanced Eligibility Identifiable",{"$f":"IF(AND($B$10=TRUE, $B$26=\"Y\", $B$33=\"Y\", $B$25=\"Y\"), 'UVR Filename Lkup'!E33, \" \")","v":" "},{"$f":"IF(AND($B$11=TRUE, $B$26=\"Y\", $B$33=\"Y\", $B$25=\"Y\"), 'UVR Filename Lkup'!F33, \" \")","v":" "},{"$f":"IF(AND($B$12=TRUE, $B$26=\"Y\", $B$33=\"Y\", $B$25=\"Y\"), 'UVR Filename Lkup'!G33, \" \")","v":" "},{"$f":"IF(AND($B$13=TRUE, $B$26=\"Y\", $B$33=\"Y\", $B$25=\"Y\"), 'UVR Filename Lkup'!H33, \" \")","v":" "},{"$f":"IF(AND($B$14=TRUE, $B$26=\"Y\", $B$33=\"Y\", $B$25=\"Y\"), 'UVR Filename Lkup'!I33, \" \")","v":" "}]
[]
[]
[null,null,null,null,"Ref: Tab (UVR Filename Lkup)"]
[null,null,null,null,"Row #","Column A","Column E","Column F","Column G","Column H","Column I"]
[null,null,null,null,1,"UVR View Description ","2018","2019","2020","2021","2022"]
[null,null,null,null,{"$f":"E47 +1","v":2},"Dental DE-Identifed","apcd2018_DC_CM_DE","apcd2019_DC_CM_DE","apcd2020_DC_CM_DE","apcd2021_DC_CM_DE","apcd2022_DC_CM_DE"]
[null,null,null,null,{"$f":"E48 +1","v":3},"Dental Identifiable"]
[null,null,null,null,4,"Dental MH DE-Identified"]
[null,null,null,null,5,"Dental MH Identifiable"]
[null,null,null,null,6,"Medical Claims DE-Identifed"]
[null,null,null,null,7,"Medical Claims Identifiable"]
[null,null,null,null,8,"Medical Claims MH DE-Identified"]
[null,null,null,"Entity Drop down List:",9,"Medical Claims MH Identifiable"]
[null,null,null,null,10,"MC Commercial SUD DE-Identified"]
[null,null,null,null,11,"MC Commercial SUD Identifiable"]
[null,null,null,null,12,"MC MassHealth SUD DE-Identified"]
[null,null,null,null,13,"MC MassHealth SUD Identifiable"]
[null,null,null,null,14,"Member Eligibility DE-Identified"]
[null,null,null,null,15,"Member Eligibility Identifiable"]
[null,null,null,null,16,"Member Eligibility MH DE-Identified"]
[null,null,null,null,17,"Member Eligibility MH Identifiable"]
[null,null,null,null,18,"Pharmacy DE-Identified"]
[null,null,null,null,19,"Pharmacy Identifiable"]
[null,null,null,null,20,"Pharmacy MH DE-Identified"]
[null,null,null,null,21,"Pharmacy MH Identifiable"]
[null,null,null,null,22,"Product DE-Identiied"]
[null,null,null,null,23,"Product Identifiable"]
[null,null,null,null,24,"Product MH DE-Identified"]
[null,null,null,null,25,"Product MH Identifiable"]
[null,null,null,null,26,"Provider DE-Identified"]
[null,null,null,null,27,"Provider Identifiable"]
[null,null,null,null,28,"Provider MH DE-Identified"]
[null,null,null,null,29,"Provider MH Identifiable"]
[null,null,null,null,30,"Benefit Plan DE-Identified"]
[null,null,null,null,31,"Benefit Plan Identifiable"]
[null,null,null,null,32,"MH Enhanced Eligibility DE-identified"]
[null,null,null,null,33,"MH Enhanced Eligibility Identifiable"]

{"sheet":"Filters","index":1,"n_rows":18,"n_cols":2,"rows_kept":18,"cut":false,"hidden":false,"merged":[[3,0,3,1]]}
["Default","CHIA Default Filter Criteria applied to APCD Release"]
["CHIA","CHIA applies default exclusion of MassHealth* data from all APCD filing types, MC, ME, PC, DC, PV, and PR - However release is allowed with approval."]
["CHIA","CHIA applies a default exclusion of substance use disorder conditions. Release is allowed with approval - but inclusion of substance use conditions will place restrictions on the rest of the data to deidentified only (with possible exceptions for CHIA internal and it's Contractors). "]
["                               *MassHealth restriction includes MassHealth, Health Safety Net (HSN), and HMO Medicaid Commercial Products"]
["Additional","Additional filters may include age ranges, Dx codes, carriers etc.  Attach details if necessary."]
["Filter","Legal can specify here any additional filters to be applied to this Release."]
[1," "]
[{"$f":"A7 + 1","v":2}]
[3]
[4]
[5]
[6]
[7]
[8]
[9]
[10]
[11]
[12]

{"sheet":"DC","index":2,"n_rows":99,"n_cols":19,"rows_kept":99,"cut":false,"hidden":false,"merged":[]}
["Release Level","Data Element Source","Included   (this request)","Dental Claim (DC) - Data Element Name","CHIA Notes","Release View Source Table","Release Column Name","Data Type","Length","FLAG Carrier Specific TLKP","Notes","CHIA Code","Redaction","De-Identified Set","OnPoint Mitigation","Onpoint De-Identification Requirement - Amended"," 2025 UVR Release Comments ","Action"]
[1,"DC046",{"$f":"IF('Legal Approval Form'!$B$16=\"Y\",\"Yes\", \"No\")","v":"No"},"Allowed Amount",null,"TBL_CORE_DENTALCLAIM","ALLOWEDAMOUNTCLEANED","Numeric",18.2,null,"Cleaned",null,null,"Y","N","None"]
[1,"DC067",{"$f":"IF('Legal Approval Form'!$B$16=\"Y\",\"Yes\", \"No\")","v":"No"},"APCD ID Code","As Reported","TBL_CORE_DENTALCLAIM","APCDIDCODE","Char",1,null,null,null,null,"Y","N","None","OK per Amendment",null,"APCDID Domain values:"]
[1,"DC056",{"$f":"IF('Legal Approval Form'!$B$16=\"Y\",\"Yes\", \"No\")","v":"No"},"Carrier Specific Unique Member ID","Surrogate","TBL_CORE_DENTALCLAIM","CHIACARRIERSPECIFICUNIQUEMEMBERID","Integer",20,null,null,"CHIA",null,"Y","N","Release only hashed or surrogate version","mitigated by definition"]
[1,"DC057",{"$f":"IF('Legal Approval Form'!$B$16=\"Y\",\"Yes\", \"No\")","v":"No"},"Carrier Specific Unique Subscriber ID","Surrogate","TBL_CORE_DENTALCLAIM","CHIACARRIERSPECIFICUNIQUESUBSCRIBERID","Integer",20,null,null,"CHIA",null,"Y","N","Release only hashed or surrogate version","mitigated by definition"]
[1,"DC032",{"$f":"IF('Legal Approval Form'!$B$16=\"Y\",\"Yes\", \"No\")","v":"No"},"CDT Code",null,"TBL_CORE_DENTALCLAIM","CDTCODE","Char",5,null,null,null,null,"Y","N","None"]
[1,"DC037",{"$f":"IF('Legal Approval Form'!$B$16=\"Y\",\"Yes\", \"No\")","v":"No"},"Charge Amount",null,"TBL_CORE_DENTALCLAIM","CHARGEAMOUNTCLEANED","Numeric",18.2,null,"Cleaned",null,null,"Y","N","None"]
[1,"Derived",{"$f":"IF('Legal Approval Form'!$B$16=\"Y\",\"Yes\", \"No\")","v":"No"},"CHIA Incurred Full Date","New in CY2021 Release","TBL_CORE_DENTALCLAIM","INCURREDFULLDATE","Date",null,null,"Derived",null,null,"Y","N","None","Was new in Release CY2021 (R11)"]
[1,"Derived",{"$f":"IF('Legal Approval Form'!$B$16=\"Y\",\"Yes\", \"No\")","v":"No"},"CHIA Incurred Date (Year and Month Only)",null,"TBL_CORE_DENTALCLAIM","INCURREDYEARMONTH","Integer",6,null,"Derived",null,null,"Y","N","None","Year Month YYYYMM"]
[1,"DC068",{"$f":"IF('Legal Approval Form'!$B$16=\"Y\",\"Yes\", \"No\")","v":"No"},"Claim Line Paid Flag",null,"TBL_CORE_DENTALCLAIM","CLAIMLINEPAIDFLAG","Char",1,null,null,null,null,"Y","N","None"]
[1,"DC059",{"$f":"IF('Legal Approval Form'!$B$16=\"Y\",\"Yes\", \"No\")","v":"No"},"Claim Line Type",null,"TBL_CORE_DENTALCLAIM","CLAIMLINETYPECLEANED","Char",1,null,"Cleaned",null,null,"Y","N","None"]
[1,"DC031",{"$f":"IF('Legal Approval Form'!$B$16=\"Y\",\"Yes\", \"No\")","v":"No"},"Claim Status",null,"TBL_CORE_DENTALCLAIM","CLAIMSTATUSCLEANED","Char",2,null,"Cleaned",null,null,"Y","N","None"]
[1,"DC040",{"$f":"IF('Legal Approval Form'!$B$16=\"Y\",\"Yes\", \"No\")","v":"No"},"Coinsurance Amount",null,"TBL_CORE_DENTALCLAIM","COINSURANCEAMOUNT","Numeric",18.2,null,null,null,null,"Y","N","None"]
[1,"DC039",{"$f":"IF('Legal Approval Form'!$B$16=\"Y\",\"Yes\", \"No\")","v":"No"},"Copay Amount",null,"TBL_CORE_DENTALCLAIM","COPAYAMOUNTCLEANED","Numeric",18.2,null,"Cleaned",null,null,"Y","N","None"]
[1,"Derived",{"$f":"IF('Legal Approval Form'!$B$16=\"Y\",\"Yes\", \"No\")","v":"No"},"County of Service Provider",null,"TBL_SUPPLEMENT_DENTALCLAIM","SERVICEPROVIDERCOUNTY","Char",25,null,"Derived",null,null,"Y","N","None"]
[1,"DC035",{"$f":"IF('Legal Approval Form'!$B$16=\"Y\",\"Yes\", \"No\")","v":"No"},"Date of Service - From","YYYYMMDD","TBL_CORE_DENTALCLAIM","DATEOFSERVICEFROM","Integer",8,null,"YYYYMMDD",null,null,"Y","N","None"]
[1,"DC036",{"$f":"IF('Legal Approval Form'!$B$16=\"Y\",\"Yes\", \"No\")","v":"No"},"Date of Service - Thru","YYYYMMDD","TBL_CORE_DENTALCLAIM","DATEOFSERVICETHRU","Integer",8,null,"YYYYMMDD",null,null,"Y","N","None"]
[1,"DC017",{"$f":"IF('Legal Approval Form'!$B$16=\"Y\",\"Yes\", \"No\")","v":"No"},"Date Service Approved (AP Date)","YYYYMMDD","TBL_CORE_DENTALCLAIM","DATESERVICEAPPROVEDAPDATE","Integer",8,null,"YYYYMMDD",null,null,"Y","N","None"]
[1,"DC041",{"$f":"IF('Legal Approval Form'!$B$16=\"Y\",\"Yes\", \"No\")","v":"No"},"Deductible Amount",null,"TBL_CORE_DENTALCLAIM","DEDUCTIBLEAMOUNT","Numeric",18.2,null,null,null,null,"Y","N","None"]
[1,"DC025",{"$f":"IF('Legal Approval Form'!$B$16=\"Y\",\"Yes\", \"No\")","v":"No"},"Delegated Benefit Administrator Organization ID",null,"TBL_CORE_DENTALCLAIM","DELEGATEDBENEFITADMINISTRATORORGANIZATIONIDCLEANED","Integer",6,null,"Cleaned",null,null,"Y","N","None"]
[1,"DC064",{"$f":"IF('Legal Approval Form'!$B$16=\"Y\",\"Yes\", \"No\")","v":"No"},"Denial Reason",null,"TBL_CORE_DENTALCLAIM","DENIEDREASONCLEANED","Char",20,null,null,null,"Y","Y","N","None"]
[1,"DC063",{"$f":"IF('Legal Approval Form'!$B$16=\"Y\",\"Yes\", \"No\")","v":"No"},"Denied Flag",null,"TBL_CORE_DENTALCLAIM","DENIEDFLAG","Char",1,null,null,null,null,"Y","N","None"]
[1,"Derived",{"$f":"IF('Legal Approval Form'!$B$16=\"Y\",\"Yes\", \"No\")","v":"No"},"Dental Claim ID",null,"TBL_CORE_DENTALCLAIM","DENTALCLAIMID","Integer",7,null,"Derived",null,null,"Y","N","None"]
[1,"DC003",{"$f":"IF('Legal Approval Form'!$B$16=\"Y\",\"Yes\", \"No\")","v":"No"},"Dental Insurance Type Code/Product",null,"TBL_CORE_DENTALCLAIM","DENTALINSURANCETYPECODEPRODUCT","Char",2,null,null,null,null,"Y","N","None"]
[1,"DC048",{"$f":"IF('Legal Approval Form'!$B$16=\"Y\",\"Yes\", \"No\")","v":"No"},"Dental Quadrant",null,"TBL_CORE_DENTALCLAIM","DENTALQUADRANT","Char",2,null,null,null,null,"Y","N","None"]
[1,"DC061",{"$f":"IF(AND('Legal Approval Form'!$B$16=\"Y\",'Legal Approval Form'!$B$33=\"N\"),\"Yes\",\"No\")","v":"No"},"Diagnosis Code","some dx code suppression","TBL_CORE_DENTALCLAIM","DIAGNOSISDE","Char",7,null,null,null,null,"Y","Y","CHIA will map codes as prescribed. See Section 6.2.3 of the assessment.","Checked CY2022 Release for both ICD10 and ICD9 qualifying codes - No qualifying codes found in CY2022 data! ","Create column: DIAGNOSISDE        See specs: UVR - Deidentify Diagnosis Codes.docx   "]
[1,"DC030",{"$f":"IF('Legal Approval Form'!$B$16=\"Y\",\"Yes\", \"No\")","v":"No"},"Facility Type - Professional",null,"TBL_CORE_DENTALCLAIM","FACILITYTYPEPROFESSIONAL","Char",2,null,null,null,null,"Y","N","None"]
[1,"DC060",{"$f":"IF('Legal Approval Form'!$B$16=\"Y\",\"Yes\", \"No\")","v":"No"},"Former Claim Number","Surrogate","TBL_CORE_DENTALCLAIM","CHIAFORMERCLAIMNUMBER","Integer",20,null,null,"CHIA",null,"Y","N","None"]
[1,"DC062",{"$f":"IF('Legal Approval Form'!$B$16=\"Y\",\"Yes\", \"No\")","v":"No"},"ICD Indicator",null,"TBL_CORE_DENTALCLAIM","ICDINDICATOR","Char",1,null,null,null,null,"Y","N","None"]
[1,"DC011",{"$f":"IF('Legal Approval Form'!$B$16=\"Y\",\"Yes\", \"No\")","v":"No"},"Individual Relationship Code",null,"TBL_CORE_DENTALCLAIM","INDIVIDUALRELATIONSHIPCODE","Char",2,null,null,null,null,"Y","N","None"]
[1,"DC005",{"$f":"IF('Legal Approval Form'!$B$16=\"Y\",\"Yes\", \"No\")","v":"No"},"Line Counter",null,"TBL_CORE_DENTALCLAIM","LINECOUNTER","Integer",4,null,null,null,null,"Y","N","None"]
[1,"Derived",{"$f":"IF('Legal Approval Form'!$B$16=\"Y\",\"Yes\", \"No\")","v":"No"},"Linking OrgID Member Eligibility",null,"TBL_CORE_DENTALCLAIM","LINKORGIDME","Integer",6,null,null,null,null,"Y","N","None"]
[1,"Derived",{"$f":"IF('Legal Approval Form'!$B$16=\"Y\",\"Yes\", \"No\")","v":"No"},"Linking OrgID Product",null,"TBL_CORE_DENTALCLAIM","LINKORGIDPR","Integer",6,null,null,null,null,"Y","N","None"]
[1,"Derived",{"$f":"IF('Legal Approval Form'!$B$16=\"Y\",\"Yes\", \"No\")","v":"No"},"Linking OrgID Provider",null,"TBL_CORE_DENTALCLAIM","LINKORGIDPV","Integer",6,null,null,null,null,"Y","N","None"]
[1,"Derived",{"$f":"IF('Legal Approval Form'!$B$16=\"Y\",\"Yes\", \"No\")","v":"No"},"Medicaid/HSN Indicator",null,"TBL_SUPPLEMENT_DENTALCLAIM","MEDICAIDHSNINDICATOR","Logical",1,null,"1,0",null,null,"Y","N","None"]
[1,"Derived",{"$f":"IF(AND('Legal Approval Form'!$B$16=\"Y\",'Legal Approval Form'!$B$33=\"N\"),\"Yes\",\"No\")","v":"No"},"Member Age At Service","Age >89<=115 set to '90', Invalid age set to null","TBL_CORE_DENTALCLAIM","MEMBERAGEATSERVICEINYEARSDE","Integer",3,null,"Derived",null,null,"Y","Y","If age 90 or older, CHIA will suppress or recode to denote 'over 89' ","We will set the 'Over 89' group to '90' (same as OCDW). ","Create New column: MEMBERAGEATSERVICEINYEARSDE               Case when MEMBERAGEATSERVICEINYEARSREDACTED > \"89\"    Set MEMBERAGEATSERVICEINYEARSDE = \"90\" (char 2) ,   Else  Set MEMBERAGEATSERVICEINYEARSDE = MEMBERAGEATSERVICEINYEARSREDACTED"]
[1,"DC013",{"$f":"IF(AND('Legal Approval Form'!$B$16=\"Y\",'Legal Approval Form'!$B$33=\"N\"),\"Yes\",\"No\")","v":"No"},"Member Birth Month (Month Only)",null,"TBL_CORE_DENTALCLAIM","MEMBERBIRTHMONTHDE","Char",2,null,null,null,null,"Y","Y","If age 90 or older, CHIA will suppress or recode to denote 'over 89' ","Scott confirmed redaction required when age > 89. Create new column, using '99' as default redaction value here. ","Create New column: MEMBERBIRTHMONTHDE              Case when  MEMBERAGEATSERVICEINYEARSREDACTED > \"89\"      Set MEMBERBIRTHMONTHDE = \"99\" (char 2)   ,ELSE Set MEMBERBIRTHMONTHDE = MEMBERBIRTHOFBIRTHMONTH "]
[1,"DC013",{"$f":"IF(AND('Legal Approval Form'!$B$16=\"Y\",'Legal Approval Form'!$B$33=\"N\"),\"Yes\",\"No\")","v":"No"},"Member Birth (Year Only)","Redacted when age > 89","TBL_CORE_DENTALCLAIM","memberdateofbirthyearcleaned","Char",4,null,"Cleaned",null,null,"Y","Y","If age 90 or older, CHIA will suppress or recode to denote 'over 89' ","When age older than 89, CHIA sets value to \"999\". Confirmed in data.","No action needed"]
[1,"DC012",{"$f":"IF(AND('Legal Approval Form'!$B$16=\"Y\",'Legal Approval Form'!$B$33=\"N\"),\"Yes\",\"No\")","v":"No"},"Member Gender",null,"TBL_CORE_DENTALCLAIM","MEMBERGENDERDE","Char",1,null,"Cleaned",null,null,"Y","Y","Male, Female, Unkown only","M, F, U only","See \"UVR - Deidentify Gender.docx\""]
[]
[1,"DC020",{"$f":"IF('Legal Approval Form'!$B$16=\"Y\",\"Yes\", \"No\")","v":"No"},"National Service Provider ID",null,"TBL_CORE_DENTALCLAIM","NATIONALSERVICEPROVIDERIDCLEANED","Char",10,null,"Cleaned",null,null,"Y","N","None","This is NPI"]
[1,"DC038",{"$f":"IF('Legal Approval Form'!$B$16=\"Y\",\"Yes\", \"No\")","v":"No"},"Paid Amount",null,"TBL_CORE_DENTALCLAIM","PAIDAMOUNTCLEANED","Numeric",18.2,null,"Cleaned",null,null,"Y","N","None"]
[1,"DC045",{"$f":"IF('Legal Approval Form'!$B$16=\"Y\",\"Yes\", \"No\")","v":"No"},"Paid Date","YYYYMMDD","TBL_CORE_DENTALCLAIM","PAIDDATE","Integer",8,null,"YYYYMMDD",null,null,"Y","N","None"]
[1,"DC065",{"$f":"IF('Legal Approval Form'!$B$16=\"Y\",\"Yes\", \"No\")","v":"No"},"Payment Arrangement Type",null,"TBL_CORE_DENTALCLAIM","PAYMENTARRANGEMENTTYPE","Char",2,null,null,null,null,"Y","N","None"]
[1,"DC033",{"$f":"IF('Legal Approval Form'!$B$16=\"Y\",\"Yes\", \"No\")","v":"No"},"Procedure Modifier - 1",null,"TBL_CORE_DENTALCLAIM","PROCEDUREMODIFIER1","Char",2,null,null,null,null,"Y","N","None"]
[1,"DC034",{"$f":"IF('Legal Approval Form'!$B$16=\"Y\",\"Yes\", \"No\")","v":"No"},"Procedure Modifier - 2",null,"TBL_CORE_DENTALCLAIM","PROCEDUREMODIFIER2","Char",2,null,null,null,null,"Y","N","None"]
[1,"DC042",{"$f":"IF('Legal Approval Form'!$B$16=\"Y\",\"Yes\", \"No\")","v":"No"},"Product ID Number","Surrogate","TBL_CORE_DENTALCLAIM","PRODUCTIDNUMBER_LINKAGE_ID","Integer",20,null,null,"CHIA",null,"Y","N","None"]
[1,"DC027",{"$f":"IF('Legal Approval Form'!$B$16=\"Y\",\"Yes\", \"No\")","v":"No"},"Service Provider City Name",null,"TBL_SUPPLEMENT_DENTALCLAIM","SERVICEPROVIDERCITYNAMECLEANED","Char",30,null,"Derived",null,"Y","Y","N","None"]
[1,"DC021",{"$f":"IF('Legal Approval Form'!$B$16=\"Y\",\"Yes\", \"No\")","v":"No"},"Service Provider Entity Type Qualifier",null,"TBL_CORE_DENTALCLAIM","SERVICEPROVIDERENTITYTYPEQUALIFIER","Char",1,null,null,null,null,"Y","N","None"]
[1,"DC022",{"$f":"IF('Legal Approval Form'!$B$16=\"Y\",\"Yes\", \"No\")","v":"No"},"Service Provider First Name",null,"TBL_CORE_DENTALCLAIM","SERVICEPROVIDERFIRSTNAMECLEANED","Char",25,null,null,null,"Y","Y","N","None"]
[1,"DC024",{"$f":"IF('Legal Approval Form'!$B$16=\"Y\",\"Yes\", \"No\")","v":"No"},"Service Provider Last Name or Organization Name",null,"TBL_CORE_DENTALCLAIM","SERVICEPROVIDERLASTNAMEORORGANIZATIONNAMECLEANED","Char",60,null,null,null,"Y","Y","N","None"]
[1,"DC023",{"$f":"IF('Legal Approval Form'!$B$16=\"Y\",\"Yes\", \"No\")","v":"No"},"Service Provider Middle Name",null,"TBL_CORE_DENTALCLAIM","SERVICEPROVIDERMIDDLENAMECLEANED","Char",25,null,"Cleaned",null,"Y","Y","N","None"]
[1,"DC018",{"$f":"IF('Legal Approval Form'!$B$16=\"Y\",\"Yes\", \"No\")","v":"No"},"Service Provider Number","Surrogate","TBL_CORE_DENTALCLAIM","SERVICEPROVIDERNUMBER_LINKAGE_ID","Integer",20,null,null,"CHIA",null,"Y","N","None","NPI Linkage"]
[1,"DC026",{"$f":"IF('Legal Approval Form'!$B$16=\"Y\",\"Yes\", \"No\")","v":"No"},"Service Provider Specialty ","Standard and/or Carrier-Specific Values","TBL_CORE_DENTALCLAIM","SERVICEPROVIDERSPECIALTYCLEANED","Char",10,1,null,null,"Y","Y","N","None"]
[1,"DC028",{"$f":"IF('Legal Approval Form'!$B$16=\"Y\",\"Yes\", \"No\")","v":"No"},"Service Provider State",null,"TBL_SUPPLEMENT_DENTALCLAIM","SERVICEPROVIDERSTATE","Char",2,null,"Derived",null,null,"Y","N","None"]
[1,"DC029",{"$f":"IF('Legal Approval Form'!$B$16=\"Y\",\"Yes\", \"No\")","v":"No"},"Service Provider ZIP Code",null,"TBL_SUPPLEMENT_DENTALCLAIM","SERVICEPROVIDERZIPCODE_5","Char",5,null,"Derived",null,"Y","Y","N","None","Left([SERVICEPROVIDERZIPCODECLEANED],5) ","Renamed - Removed the LDS from column name. LDS is a deprecated term. "]
[1,"Derived",{"$f":"IF('Legal Approval Form'!$B$16=\"Y\",\"Yes\", \"No\")","v":"No"},"Submission Control ID",null,"TBL_CORE_DENTALCLAIM","SUBMISSIONCONTROLID","Integer",8,null,"Derived",null,null,"Y","N","None"]
[1,"HD005",{"$f":"IF('Legal Approval Form'!$B$16=\"Y\",\"Yes\", \"No\")","v":"No"},"Submission Year-Month","YYYYMM","TBL_CORE_DENTALCLAIM","SUBMISSIONYEARMONTH","Char",6,null,"Derived",null,null,"Y","N","None","Release column name corrected R12 - CJK"]
[1,"DC001",{"$f":"IF('Legal Approval Form'!$B$16=\"Y\",\"Yes\", \"No\")","v":"No"},"Submitter ","Submitting OrgID ","TBL_CORE_DENTALCLAIM","ORGID","Integer",6,null,null,null,null,"Y","N","None","No change - Defined as Char on SG but stored as Integer in all CHIA tables & views."]
[1,"DC047",{"$f":"IF('Legal Approval Form'!$B$16=\"Y\",\"Yes\", \"No\")","v":"No"},"Tooth Number/Letter",null,"TBL_CORE_DENTALCLAIM","TOOTHNUMBERLETTER","Char",2,null,null,null,"Y","Y","N","None"]
[1,"DC049",{"$f":"IF('Legal Approval Form'!$B$16=\"Y\",\"Yes\", \"No\")","v":"No"},"Tooth Surface",null,"TBL_CORE_DENTALCLAIM","TOOTHSURFACECLEANED","Char",5,null,null,null,"Y","Y","N","None"]
[1,"DC005A",{"$f":"IF('Legal Approval Form'!$B$16=\"Y\",\"Yes\", \"No\")","v":"No"},"Version Number",null,"TBL_CORE_DENTALCLAIM","VERSIONNUMBER","Integer",4,null,null,null,null,"Y","N","None"]
[1,"Derived",{"$f":"IF('Legal Approval Form'!$B$16=\"Y\",\"Yes\", \"No\")","v":"No"},"Highest Version Paid Flag","Recommended for all requestors default","TBL_CORE_DENTALCLAIM","VERSIONINDICATOR","Integer",1,null,"Derived",null,null,"Y","N","None","New in Release cy2023"]
[1,"DC004",{"$f":"IF('Legal Approval Form'!$B$16=\"Y\",\"Yes\", \"No\")","v":"No"},"Payer Claim Control Number","Surrogate","TBL_CORE_DENTALCLAIM","CHIAPAYERCLAIMCONTROLNUMBER","Integer",20,null,null,"CHIA",null,"N",null,"Not reviewed",null,"Moved to SR per Scott 7/1/2025"]
[]
["ID -  Dental Claim (DC) - Identifiable (L2) Elements"]
["Release Level","Data Element Source","Included   (this request)","Dental Claim (DC) - Data Element Name","CHIA Notes","Release View Source Table","Release Column Name","Data Type","Length","FLAG Carrier Specific TLKP","Notes","CHIA Code","Redaction","De-Identified Set","ONPoiNt MitigatioN","Onpoint De-Identification Requirement"," 2025 UVR Release Comments ","Action"]
[]
[2,"Derived",{"$f":"IF(AND('Legal Approval Form'!$B$16=\"Y\",'Legal Approval Form'!$B$33=\"Y\"),\"Yes\",\"No\")","v":"No"},"Member Age At Service","Not redacted for Age > 89","TBL_CORE_DENTALCLAIM","MEMBERAGEATSERVICEINYEARS","Integer",3,null,null,null,null,"N",null,"Not reviewed","These are the unredacted for age > 89. OK for identified release.","No action"]
[2,"DC013",{"$f":"IF(AND('Legal Approval Form'!$B$16=\"Y\",'Legal Approval Form'!$B$33=\"Y\"),\"Yes\",\"No\")","v":"No"},"Member Birth Month (Month Only)",null,"TBL_CORE_DENTALCLAIM","MEMBERDATEOFBIRTHMONTH","Char",2,null,null,null,null,"N",null,"see DE version","OK to release in Identified without transformation. ","No action"]
[2,"DC013",{"$f":"IF(AND('Legal Approval Form'!$B$16=\"Y\",'Legal Approval Form'!$B$33=\"Y\"),\"Yes\",\"No\")","v":"No"},"Member Date of Birth (Year and Month)","Not redacted for Age > 89","TBL_CORE_DENTALCLAIM","MEMBERDATEOFBIRTHYEARMONTH","Integer",6,null,"YYYYMM",null,null,"N",null,"Not reviewed","OK to release in Identified without transformation. Note that this column is Year & Month (YYYYMM). ","No action (possibly s.b. stored as encrypted)"]
[]
[2,"DC061",{"$f":"IF(AND('Legal Approval Form'!$B$16=\"Y\",'Legal Approval Form'!$B$33=\"Y\"),\"Yes\",\"No\")","v":"No"},"Diagnosis Code","no suppression","TBL_CORE_DENTALCLAIM","DIAGNOSISCLEANED","Char",7,null,null,null,null,"N",null,"see DE version (DIAGNOSISDE)",null,"No action needed"]
[2,"DC012",{"$f":"IF(AND('Legal Approval Form'!$B$16=\"Y\",'Legal Approval Form'!$B$33=\"Y\"),\"Yes\",\"No\")","v":"No"},"Member Gender",null,"TBL_CORE_DENTALCLAIM","MEMBERGENDERCLEANED","Char",1,null,"Cleaned",null,null,"N",null,"See : MEMBERGENDERDE  (M, F, U only)","Unredacted version OK for Gov","Include unredacted in Deidentified release"]
[]
["SR - Patient Identifiable, (L3) Special Release"]
["Release Level","Data Element Source","Included   (this request)","Data Element Name","CHIA Notes","Release View Source Table","Release Column Name","Data Type","Length","FLAG Carrier Specific TLKP","Notes","CHIA Code","Redaction","De-Identified Set","ONPoiNt MitigatioN","Onpoint De-Identification Requirement"," 2025 UVR Release Comments ","Action"]
[3,"DC015","SR Only","Member State or Province","No longer collected on Dental Claims at submission. Users should use field in Geography file which is sourced from Member Eligibility submissions. Field populated less than 1%","TBL_SUPPLEMENT_DENTALCLAIM","MEMBERSTATEORPROVINCELDS","Char",2,null,"Derived",null,null,"N",null,"CHIA will map codes as prescribed. States would be reported as CT, MA, ME, NH, NY, RI, VT, or Other (Transformed according to Section 6.2.2)","This mapping was already the case for the LDS release of memberstateorprovince, however this column is <1% populated. Recommend drop. ","Drop from Release begin Universal CY2022"]
[3,"DC015","SR Only","Member State or Province","No longer collected on Dental Claims at submission. Users should use field in Geography file which is sourced from Member Eligibility submissions. Field populated less than 1%","TBL_SUPPLEMENT_DENTALCLAIM","MEMBERSTATEORPROVINCE","Char",2,null,null,null,null,"N",null,null,"Does not exist in the current VW - but is no longer being populated in any case, so adds little value.","Moved to NR"]
[3,"Derived","SR Only","County of Member","Source field for derivation no longer collected on Dental Claims at submission. Users should use field in Geography file which is sourced from Member Eligibility submissions. Derivation is sparse","TBL_SUPPLEMENT_DENTALCLAIM","MEMBERCOUNTY","Char",25,null,"Derived",null,null,"N",null,"CHIA will update Member County to reflect assignment from mapped ZIP codes (Transformed according to Section 6.2.2)","County is derived from Zip, and Zip is no longer reported 99% of the time.  Recommend drop. ","Drop from Release begin Universal CY2022"]
[3,"DC016","SR Only","Member ZIP Code","No longer collected on Dental at submission. Users should use field in Geography file which is sourced from Member Eligibility submissions. Field populated less than 1%","TBL_SUPPLEMENT_DENTALCLAIM","MEMBERZIPCODECLEANED","Char",5,null,null,"Cleaned",null,"N",null,null,"Reported on less than 2% of claim lines. Recommend drop. ","Drop from Release begin Universal CY2022"]
[3,"DC009","SR Only","Member Suffix or Sequence Number",null,"TBL_CORE_DENTALCLAIM","MEMBERSUFFIXORSEQUENCENUMBER","Char",20,null,null,null,null,"N"]
[3,"DC008","SR Only","Plan Specific Contract Number",null,"TBL_CORE_DENTALCLAIM","PLANSPECIFICCONTRACTNUMBER","Char",30,null,null,"Encryp",null,"N"]
[3,"DC042","SR Only","Product ID Number","linkage-id used, but keep reported ","TBL_CORE_DENTALCLAIM","PRODUCTIDNUMBER","Char",30,null,null,null,null,"N"]
[3,"DC018","SR Only","Service Provider Number","linkage-id used, but keep reported ","TBL_CORE_DENTALCLAIM","SERVICEPROVIDERNUMBER","Char",30,null,null,null,null,"N"]
[3,"DC044","SR Only","Billing Provider Tax ID Number",null,"TBL_CORE_DENTALCLAIM","BILLINGPROVIDERTAXIDNUMBER","Char",9,null,null,"Encryp",null,"N",null,"Not reviewed","Moved to SR. May release as exceptions for an identifiable release. "]
[3,"DC019","SR Only","Service Provider Tax ID Number",null,"TBL_CORE_DENTALCLAIM","SERVICEPROVIDERTAXIDNUMBER","Char",9,null,null,null,null,"N",null,"Not reviewed","Moved to SR. May release as exceptions for an identifiable release. "]
[3,"DC056","SR Only","Carrier Specific Unique Member ID","Reported - decrypted","TBL_CORE_DENTALCLAIM","CARRIERSPECIFICUNIQUEMEMBERID","Char",50,null,null,"Encryp",null,"N",null,"Not reviewed","Moved to SR for UR - Rarely requested. We can decrypt and release as Identifiable if approved. "]
[3,"DC057","SR Only","Carrier Specific Unique Subscriber ID","Reported - decrypted","TBL_CORE_DENTALCLAIM","CARRIERSPECIFICUNIQUESUBSCRIBERID","Char",50,null,null,"Encryp",null,"N",null,"Not reviewed","Moved to SR for UR - Rarely requested. We can decrypt and release as Identifiable if approved. "]
[3,"DC060","SR Only","Former Claim Number",null,"TBL_CORE_DENTALCLAIM","FORMERCLAIMNUMBER","Char",35,null,null,"Encryp",null,"N",null,"Not reviewed","Note Lev 2 has surrogate version of Former Claim Number","Moved to SR per Scott 7/1/2025"]
[3,"DC004","SR Only","Payer Claim Control Number",null,"TBL_CORE_DENTALCLAIM","PAYERCLAIMCONTROLNUMBER","Char",35,null,null,"Encryp",null,"N",null,"Not reviewed","Note Lev 1 has surrogate version of Claim control ID's","Moved to SR per Scott 8/20/2025"]
[3,"DC006","SR Only","Insured Group or Policy Number",null,"TBL_CORE_DENTALCLAIM","INSUREDGROUPORPOLICYNUMBER","Char",30,null,null,"Encryp",null,"N",null,"Not reviewed",null,"Moved to SR per Scott 8/20/2025"]
["NR - No Release - Internal and/or Deprecated"]
["Release Level","Data Element Source","Included   (this request)","Data Element Name","CHIA Notes","Release View Source Table","Release Column Name","Data Type","Length","FLAG Carrier Specific TLKP","Notes","CHIA Code","Redaction","De-Identified Set","ONPoiNt MitigatioN","Onpoint De-Identification Requirement"," 2025 UVR Release Comments ","Action"]
[4,"Derived","NR","Create Date","timestamp","TBL_CORE_DENTALCLAIM","CREATEDATE","Date:Time",23,null,"timestamp",null,null,"N"]
[4,"Derived","NR","ETL Batch ID","same as SubmissionControlId","TBL_CORE_DENTALCLAIM","ETLBATCHID","Integer",6,null,null,null,null,"N"]
[4,"Derived","NR","Line Number",null,"TBL_CORE_DENTALCLAIM","LINENUMBER","Integer",9,null,null,null,null,"N"]
[4,"Derived","NR","CHIA Incurred Date (Year and Month Only)","Column to be depreated - see full date","TBL_CORE_DENTALCLAIM","INCURREDDATE","Integer",6,null,"Derived",null,null,"N",null,null,"See full date and YearMonth versions"]
[4,"Derived","NR","Member Link EID","Moved to MEID File","TBL_SUPPLEMENT_DENTALCLAIM","MEMBERLINKEID","Integer",10,null,"Derived",null,null,"Y","N",null,"MEMBERLINKEID is an alias for MEMBERMDMID, which is sourced from TBL_SUPPLEMENT_DENTALCLAIM","Moved to separate MEID Table"]

{"sheet":"MC","index":3,"n_rows":351,"n_cols":9,"rows_kept":351,"cut":false,"hidden":false,"merged":[]}
["Release Level","Data Element Source","Included   (this request)","Medical Claim (MC) Data Element Name","CHIA Notes","Release View Source Table","Release Column Name","Data Type","Length"]
[1,"MC126",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Accident Indicator",null,"TBL_CORE_MEDICALCLAIM","ACCIDENTINDICATOR","Integer",1]
[1,"MC018",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Admission Date","YYYYMMDD","TBL_CORE_MEDICALCLAIM","ADMISSIONDATE","Integer",8]
[1,"MC021",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"N\"),\"Yes\",\"No\")","v":"No"},"Admission Source",null,"TBL_CORE_MEDICALCLAIM","ADMISSIONSOURCEDE","Char",1]
[1,"MC020",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Admission Type",null,"TBL_CORE_MEDICALCLAIM","ADMISSIONTYPE","Char",1]
[1,"MC039",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"N\"),\"Yes\",\"No\")","v":"No"},"Admitting Diagnosis","some Dx code redaction","TBL_CORE_MEDICALCLAIM","ADMITTINGDIAGNOSISDE","Char",7]
[1,"MC098",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Allowed amount",null,"TBL_CORE_MEDICALCLAIM","ALLOWEDAMOUNTCLEANED","Numeric",18.2]
[1,"MC241",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"APCD ID Code",null,"TBL_CORE_MEDICALCLAIM","APCDIDCODE","Integer",1]
[1,"MC125",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Attending Provider",null,"TBL_CORE_MEDICALCLAIM","ATTENDINGPROVIDER_LINKAGE_ID","Integer",20]
[1,"MC133",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Bill Frequency Code",null,"TBL_CORE_MEDICALCLAIM","BILLFREQUENCYCODE","Char",1]
[1,"MC078",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Billing Provider Last Name or Organization Name",null,"TBL_CORE_MEDICALCLAIM","BILLINGPROVIDERLASTNAMEORORGANIZATIONNAMECLEANED","Char",60]
[1,"MC076",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Billing Provider Number",null,"TBL_CORE_MEDICALCLAIM","BILLINGPROVIDERNUMBER_LINKAGE_ID","Integer",20]
[1,"MC081",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Capitated Encounter Flag",null,"TBL_CORE_MEDICALCLAIM","CAPITATEDENCOUNTERFLAG","Char",1]
[1,"MC137",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Carrier Specific Unique Member ID","Surrogate key","TBL_CORE_MEDICALCLAIM","CHIACARRIERSPECIFICUNIQUEMEMBERID","Integer",20]
[1,"MC141",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Carrier Specific Unique Subscriber ID","Surrogate key","TBL_CORE_MEDICALCLAIM","CHIACARRIERSPECIFICUNIQUESUBSCRIBERID","Integer",20]
[1,"MC062",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Charge Amount",null,"TBL_CORE_MEDICALCLAIM","CHARGEAMOUNTCLEANED","Numeric",18.2]
[1,"Derived",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"CHIA Incurred Full Date ","Full date new CY2021","TBL_CORE_MEDICALCLAIM","INCURREDFULLDATE","Date"]
[1,"Derived",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"CHIA Incurred Date (Year Month only) ","YYYYMMDD","TBL_CORE_MEDICALCLAIM","INCURREDYEARMONTH","Date"]
[1,"MC244",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Claim Line Paid Flag",null,"TBL_CORE_MEDICALCLAIM","CLAIMLINEPAIDFLAG","Integer",1]
[1,"MC138",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Claim Line Type",null,"TBL_CORE_MEDICALCLAIM","CLAIMLINETYPE","Char",1]
[1,"MC110",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Claim Processed Date",null,"TBL_CORE_MEDICALCLAIM","CLAIMPROCESSEDDATE","Integer",8]
[1,"MC038",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Claim Status",null,"TBL_CORE_MEDICALCLAIM","CLAIMSTATUS","Char",2]
[1,"MC066",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Coinsurance Amount",null,"TBL_CORE_MEDICALCLAIM","COINSURANCEAMOUNT","Numeric",18.2]
[1,"MC091",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Coinsurance Days",null,"TBL_CORE_MEDICALCLAIM","COINSURANCEDAYS","Integer",4]
[1,"MC179",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"N\"),\"Yes\",\"No\")","v":"No"},"Condition Code - 1",null,"TBL_CORE_MEDICALCLAIM","CONDITIONCODE1DE","Char",2]
[1,"MC180",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"N\"),\"Yes\",\"No\")","v":"No"},"Condition Code - 2",null,"TBL_CORE_MEDICALCLAIM","CONDITIONCODE2DE","Char",2]
[1,"MC181",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"N\"),\"Yes\",\"No\")","v":"No"},"Condition Code - 3",null,"TBL_CORE_MEDICALCLAIM","CONDITIONCODE3DE","Char",2]
[1,"MC182",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"N\"),\"Yes\",\"No\")","v":"No"},"Condition Code - 4",null,"TBL_CORE_MEDICALCLAIM","CONDITIONCODE4DE","Char",2]
[1,"MC183",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"N\"),\"Yes\",\"No\")","v":"No"},"Condition Code - 5",null,"TBL_CORE_MEDICALCLAIM","CONDITIONCODE5DE","Char",2]
[1,"MC184",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"N\"),\"Yes\",\"No\")","v":"No"},"Condition Code - 6",null,"TBL_CORE_MEDICALCLAIM","CONDITIONCODE6DE","Char",2]
[1,"MC185",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"N\"),\"Yes\",\"No\")","v":"No"},"Condition Code - 7",null,"TBL_CORE_MEDICALCLAIM","CONDITIONCODE7DE","Char",2]
[1,"MC186",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"N\"),\"Yes\",\"No\")","v":"No"},"Condition Code - 8",null,"TBL_CORE_MEDICALCLAIM","CONDITIONCODE8DE","Char",2]
[1,"MC187",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"N\"),\"Yes\",\"No\")","v":"No"},"Condition Code - 9",null,"TBL_CORE_MEDICALCLAIM","CONDITIONCODE9DE","Char",2]
[1,"MC188",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"N\"),\"Yes\",\"No\")","v":"No"},"Condition Code - 10",null,"TBL_CORE_MEDICALCLAIM","CONDITIONCODE10DE","Char",2]
[1,"MC189",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"N\"),\"Yes\",\"No\")","v":"No"},"Condition Code - 11",null,"TBL_CORE_MEDICALCLAIM","CONDITIONCODE11DE","Char",2]
[1,"MC190",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"N\"),\"Yes\",\"No\")","v":"No"},"Condition Code - 12",null,"TBL_CORE_MEDICALCLAIM","CONDITIONCODE12DE","Char",2]
[1,"MC095",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Coordination of Benefits/TPL Liability Amount",null,"TBL_CORE_MEDICALCLAIM","COORDINATIONOFBENEFITSTPLLIABILITYAMOUNT","Numeric",18.2]
[1,"MC065",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Copay Amount",null,"TBL_CORE_MEDICALCLAIM","COPAYAMOUNTCLEANED","Numeric",18.2]
[1,"Derived",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"County of Service Provider",null,"TBL_SUPPLEMENT_MEDICALCLAIM","SERVICEPROVIDERCOUNTY","Char",25]
[1,"MC092",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Covered Days",null,"TBL_CORE_MEDICALCLAIM","COVEREDDAYS","Integer",4]
[1,"MC059",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Date of Service - From","YYYYMMDD","TBL_CORE_MEDICALCLAIM","DATEOFSERVICEFROM","Integer",8]
[1,"MC060",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Date of Service - To","YYYYMMDD","TBL_CORE_MEDICALCLAIM","DATEOFSERVICETO","Integer",8]
[1,"MC017",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Date Service Approved (AP Date)","YYYYMMDD","TBL_CORE_MEDICALCLAIM","DATESERVICEAPPROVEDAPDATE","Integer",8]
[1,"MC067",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Deductible Amount",null,"TBL_CORE_MEDICALCLAIM","DEDUCTIBLEAMOUNT","Numeric",18.2]
[1,"MC100",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Delegated Benefit Administrator Organization ID",null,"TBL_CORE_MEDICALCLAIM","DELEGATEDBENEFITADMINISTRATORORGANIZATIONIDCLEANED","Integer",6]
[1,"MC124",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Denial Reason","Standard or Carrier-Specific Custom Values","TBL_CORE_MEDICALCLAIM","DENIALREASONCLEANED","Char",15]
[1,"MC123",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Denied Flag",null,"TBL_CORE_MEDICALCLAIM","DENIEDFLAG","Integer",1]
[1,"MC111",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Diagnostic Pointer",null,"TBL_CORE_MEDICALCLAIM","DIAGNOSTICPOINTER","Char",4]
[1,"MC069",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Discharge Date","YYYYMMDD","TBL_CORE_MEDICALCLAIM","DISCHARGEDATE","Integer",8]
[1,"MC136",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"N\"),\"Yes\",\"No\")","v":"No"},"Discharge Diagnosis","some Dx code redaction","TBL_CORE_MEDICALCLAIM","DISCHARGEDIAGNOSISDE","Char",7]
[1,"MC023",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"N\"),\"Yes\",\"No\")","v":"No"},"Discharge Status",null,"TBL_CORE_MEDICALCLAIM","DISCHARGESTATUSDE","Char",2]
[1,"MC120",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"DRG Level",null,"TBL_CORE_MEDICALCLAIM","DRGLEVEL","Char",1]
[1,"MC075",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Drug Code",null,"TBL_CORE_MEDICALCLAIM","DRUGCODECLEANED","Char",11]
[1,"MC040",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"N\"),\"Yes\",\"No\")","v":"No"},"E-Code","some Dx code redaction","TBL_CORE_MEDICALCLAIM","ECODEDE","Char",7]
[1,"MC128",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Employment Related Indicator",null,"TBL_CORE_MEDICALCLAIM","EMPLOYMENTRELATEDINDICATOR","Char",1]
[1,"MC129",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"EPSDT Indicator",null,"TBL_CORE_MEDICALCLAIM","EPSDTINDICATOR","Char",1]
[1,"MC114",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Excluded Expenses",null,"TBL_CORE_MEDICALCLAIM","EXCLUDEDEXPENSESCLEANED","Numeric",18.2]
[1,"MC127",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Family Planning Indicator",null,"TBL_CORE_MEDICALCLAIM","FAMILYPLANNINGINDICATOR","Char",1]
[1,"MC139",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Former Claim Number",null,"TBL_CORE_MEDICALCLAIM","CHIAFORMERCLAIMNUMBER","Integer",20]
[1,"Derived",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Fully Denied Claim",null,"TBL_SUPPLEMENT_MEDICALCLAIM","FULLYDENIEDCLAIM","Char",1]
[1,"MC122",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Global Payment Flag",null,"TBL_CORE_MEDICALCLAIM","GLOBALPAYMENTFLAG","Char",1]
[1,"Derived",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Highest Version Denied","See Versioning documentation","TBL_SUPPLEMENT_MEDICALCLAIM","HIGHESTVERSIONDENIED","Integer",1]
[1,"Derived",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Highest Version Indicator","See Versioning documentation","TBL_SUPPLEMENT_MEDICALCLAIM","HIGHESTVERSIONINDICATOR","Integer",1]
[1,"Derived",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Highest Version Paid Flag","See Versioning documentation","TBL_SUPPLEMENT_MEDICALCLAIM","VERSIONINDICATOR","Integer",1]
[1,"MC107",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"ICD Indicator",null,"TBL_CORE_MEDICALCLAIM","ICDINDICATOR","Char",1]
[1,"MC058",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"ICD-CM Procedure Code",null,"TBL_CORE_MEDICALCLAIM","ICDCMPROCEDURECODECLEANED","Char",7]
[1,"MC011",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Individual Relationship Code",null,"TBL_CORE_MEDICALCLAIM","INDIVIDUALRELATIONSHIPCODE","Char",2]
[1,"MC131",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"InNetwork Indicator",null,"TBL_CORE_MEDICALCLAIM","INNETWORKINDICATOR","Char",1]
[1,"MC003",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Insurance Type Code/Product",null,"TBL_CORE_MEDICALCLAIM","INSURANCETYPECODEPRODUCT","Char",2]
[1,"MC005",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Line Counter",null,"TBL_CORE_MEDICALCLAIM","LINECOUNTER","Integer",4]
[1,"Derived",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Linking OrgID Member Eligibility",null,"TBL_CORE_MEDICALCLAIM","LINKORGIDME","Integer",6]
[1,"Derived",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Linking OrgID Product",null,"TBL_CORE_MEDICALCLAIM","LINKORGIDPR","Integer",6]
[1,"Derived",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Linking OrgID Provider",null,"TBL_CORE_MEDICALCLAIM","LINKORGIDPV","Integer",6]
[1,"Derived",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Medicaid/HSN Indicator",null,"TBL_SUPPLEMENT_MEDICALCLAIM","MEDICAIDHSNINDICATOR","Logical",1]
[1,"Derived",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Medical Claim ID",null,"TBL_CORE_MEDICALCLAIM","MEDICALCLAIMID","Integer",9]
[1,"MC115",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Medicare Indicator",null,"TBL_CORE_MEDICALCLAIM","MEDICAREINDICATOR","Char",1]
[1,"MC097",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Medicare Paid Amount",null,"TBL_CORE_MEDICALCLAIM","MEDICAREPAIDAMOUNTCLEANED","Numeric",18.2]
[1,"Derived",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"N\"),\"Yes\",\"No\")","v":"No"},"Member Age At Service","Age >89<=115 set to '90', Invalid age set to null","TBL_CORE_MEDICALCLAIM","MEMBERAGEATSERVICEINYEARSDE","Integer",3]
[1,"MC013",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"N\"),\"Yes\",\"No\")","v":"No"},"Member Birth (Month Only)",null,"TBL_CORE_MEDICALCLAIM","MEMBERBIRTHMONTHDE","Char",2]
[1,"MC013",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"N\"),\"Yes\",\"No\")","v":"No"},"Member Birth (Year Only)","Redacted for age > 89","TBL_CORE_MEDICALCLAIM","MEMBERDATEOFBIRTHYEARCLEANED","Char",4]
[1,"MC012",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"N\"),\"Yes\",\"No\")","v":"No"},"Member Gender",null,"TBL_CORE_MEDICALCLAIM","MEMBERGENDERDE","Char",1]
[]
[1,"MC077",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"National Billing Provider ID","NPI","TBL_CORE_MEDICALCLAIM","NATIONALBILLINGPROVIDERIDCLEANED","Char",10]
[1,"MC026",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"National Service Provider ID",null,"TBL_CORE_MEDICALCLAIM","NATIONALSERVICEPROVIDERIDCLEANED","Char",15]
[1,"MC093",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Non Covered Days",null,"TBL_CORE_MEDICALCLAIM","NONCOVEREDDAYS","Integer",4]
[1,"MC099",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Non-Covered Amount",null,"TBL_CORE_MEDICALCLAIM","NONCOVEREDAMOUNTCLEANED","Numeric",18.2]
[1,"MC215",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"N\"),\"Yes\",\"No\")","v":"No"},"Occurrence Code - 1",null,"TBL_CORE_MEDICALCLAIM","OCCURRENCECODEDE1","Char",2]
[1,"MC217",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"N\"),\"Yes\",\"No\")","v":"No"},"Occurrence Code - 2",null,"TBL_CORE_MEDICALCLAIM","OCCURRENCECODEDE2","Char",2]
[1,"MC219",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"N\"),\"Yes\",\"No\")","v":"No"},"Occurrence Code - 3",null,"TBL_CORE_MEDICALCLAIM","OCCURRENCECODEDE3","Char",2]
[1,"MC221",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"N\"),\"Yes\",\"No\")","v":"No"},"Occurrence Code - 4",null,"TBL_CORE_MEDICALCLAIM","OCCURRENCECODEDE4","Char",2]
[1,"MC223",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"N\"),\"Yes\",\"No\")","v":"No"},"Occurrence Code - 5",null,"TBL_CORE_MEDICALCLAIM","OCCURRENCECODEDE5","Char",2]
[1,"MC216",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Occurrence Date - 1",null,"TBL_CORE_MEDICALCLAIM","OCCURRENCECODEDATE1","Integer",8]
[1,"MC218",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Occurrence Date - 2",null,"TBL_CORE_MEDICALCLAIM","OCCURRENCECODEDATE2","Integer",8]
[1,"MC220",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Occurrence Date - 3",null,"TBL_CORE_MEDICALCLAIM","OCCURRENCECODEDATE3","Integer",8]
[1,"MC222",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Occurrence Date - 4",null,"TBL_CORE_MEDICALCLAIM","OCCURRENCECODEDATE4","Integer",8]
[1,"MC224",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Occurrence Date - 5",null,"TBL_CORE_MEDICALCLAIM","OCCURRENCECODEDATE5","Integer",8]
[1,"MC225",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Occurrence Span Code - 1",null,"TBL_CORE_MEDICALCLAIM","OCCURRENCESPANCODE1","Char",2]
[1,"MC228",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Occurrence Span Code - 2",null,"TBL_CORE_MEDICALCLAIM","OCCURRENCESPANCODE2","Char",2]
[1,"MC231",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Occurrence Span Code - 3",null,"TBL_CORE_MEDICALCLAIM","OCCURRENCESPANCODE3","Char",2]
[1,"MC234",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Occurrence Span Code - 4",null,"TBL_CORE_MEDICALCLAIM","OCCURRENCESPANCODE4","Char",2]
[1,"MC237",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Occurrence Span Code - 5",null,"TBL_CORE_MEDICALCLAIM","OCCURRENCESPANCODE5","Char",2]
[1,"MC227",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Occurrence Span End Date - 1",null,"TBL_CORE_MEDICALCLAIM","OCCURRENCESPANCODEENDDATE1","Integer",8]
[1,"MC230",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Occurrence Span End Date - 2",null,"TBL_CORE_MEDICALCLAIM","OCCURRENCESPANCODEENDDATE2","Integer",8]
[1,"MC233",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Occurrence Span End Date - 3",null,"TBL_CORE_MEDICALCLAIM","OCCURRENCESPANCODEENDDATE3","Integer",8]
[1,"MC236",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Occurrence Span End Date - 4",null,"TBL_CORE_MEDICALCLAIM","OCCURRENCESPANCODEENDDATE4","Integer",8]
[1,"MC239",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Occurrence Span End Date - 5",null,"TBL_CORE_MEDICALCLAIM","OCCURRENCESPANCODEENDDATE5","Integer",8]
[1,"MC226",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Occurrence Span Start Date - 1",null,"TBL_CORE_MEDICALCLAIM","OCCURRENCESPANCODESTARTDATE1","Integer",8]
[1,"MC229",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Occurrence Span Start Date - 2",null,"TBL_CORE_MEDICALCLAIM","OCCURRENCESPANCODESTARTDATE2","Integer",8]
[1,"MC232",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Occurrence Span Start Date - 3",null,"TBL_CORE_MEDICALCLAIM","OCCURRENCESPANCODESTARTDATE3","Integer",8]
[1,"MC235",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Occurrence Span Start Date - 4",null,"TBL_CORE_MEDICALCLAIM","OCCURRENCESPANCODESTARTDATE4","Integer",8]
[1,"MC238",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Occurrence Span Start Date - 5",null,"TBL_CORE_MEDICALCLAIM","OCCURRENCESPANCODESTARTDATE5","Integer",8]
[1,"MC042",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"N\"),\"Yes\",\"No\")","v":"No"},"Other Diagnosis - 1","some Dx code redaction","TBL_CORE_MEDICALCLAIM","OTHERDIAGNOSIS1DE","Char",7]
[1,"MC043",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"N\"),\"Yes\",\"No\")","v":"No"},"Other Diagnosis - 2","some Dx code redaction","TBL_CORE_MEDICALCLAIM","OTHERDIAGNOSIS2DE","Char",7]
[1,"MC044",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"N\"),\"Yes\",\"No\")","v":"No"},"Other Diagnosis - 3","some Dx code redaction","TBL_CORE_MEDICALCLAIM","OTHERDIAGNOSIS3DE","Char",7]
[1,"MC045",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"N\"),\"Yes\",\"No\")","v":"No"},"Other Diagnosis - 4","some Dx code redaction","TBL_CORE_MEDICALCLAIM","OTHERDIAGNOSIS4DE","Char",7]
[1,"MC046",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"N\"),\"Yes\",\"No\")","v":"No"},"Other Diagnosis - 5","some Dx code redaction","TBL_CORE_MEDICALCLAIM","OTHERDIAGNOSIS5DE","Char",7]
[1,"MC047",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"N\"),\"Yes\",\"No\")","v":"No"},"Other Diagnosis - 6","some Dx code redaction","TBL_CORE_MEDICALCLAIM","OTHERDIAGNOSIS6DE","Char",7]
[1,"MC048",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"N\"),\"Yes\",\"No\")","v":"No"},"Other Diagnosis - 7","some Dx code redaction","TBL_CORE_MEDICALCLAIM","OTHERDIAGNOSIS7DE","Char",7]
[1,"MC049",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"N\"),\"Yes\",\"No\")","v":"No"},"Other Diagnosis - 8","some Dx code redaction","TBL_CORE_MEDICALCLAIM","OTHERDIAGNOSIS8DE","Char",7]
[1,"MC050",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"N\"),\"Yes\",\"No\")","v":"No"},"Other Diagnosis - 9","some Dx code redaction","TBL_CORE_MEDICALCLAIM","OTHERDIAGNOSIS9DE","Char",7]
[1,"MC051",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"N\"),\"Yes\",\"No\")","v":"No"},"Other Diagnosis - 10","some Dx code redaction","TBL_CORE_MEDICALCLAIM","OTHERDIAGNOSIS10DE","Char",7]
[1,"MC052",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"N\"),\"Yes\",\"No\")","v":"No"},"Other Diagnosis - 11","some Dx code redaction","TBL_CORE_MEDICALCLAIM","OTHERDIAGNOSIS11DE","Char",7]
[1,"MC053",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"N\"),\"Yes\",\"No\")","v":"No"},"Other Diagnosis - 12","some Dx code redaction","TBL_CORE_MEDICALCLAIM","OTHERDIAGNOSIS12DE","Char",7]
[1,"MC142",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"N\"),\"Yes\",\"No\")","v":"No"},"Other Diagnosis - 13","some Dx code redaction","TBL_CORE_MEDICALCLAIM","OTHERDIAGNOSIS13DE","Char",7]
[1,"MC143",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"N\"),\"Yes\",\"No\")","v":"No"},"Other Diagnosis - 14","some Dx code redaction","TBL_CORE_MEDICALCLAIM","OTHERDIAGNOSIS14DE","Char",7]
[1,"MC144",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"N\"),\"Yes\",\"No\")","v":"No"},"Other Diagnosis - 15","some Dx code redaction","TBL_CORE_MEDICALCLAIM","OTHERDIAGNOSIS15DE","Char",7]
[1,"MC145",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"N\"),\"Yes\",\"No\")","v":"No"},"Other Diagnosis - 16","some Dx code redaction","TBL_CORE_MEDICALCLAIM","OTHERDIAGNOSIS16DE","Char",7]
[1,"MC146",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"N\"),\"Yes\",\"No\")","v":"No"},"Other Diagnosis - 17","some Dx code redaction","TBL_CORE_MEDICALCLAIM","OTHERDIAGNOSIS17DE","Char",7]
[1,"MC147",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"N\"),\"Yes\",\"No\")","v":"No"},"Other Diagnosis - 18","some Dx code redaction","TBL_CORE_MEDICALCLAIM","OTHERDIAGNOSIS18DE","Char",7]
[1,"MC148",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"N\"),\"Yes\",\"No\")","v":"No"},"Other Diagnosis - 19","some Dx code redaction","TBL_CORE_MEDICALCLAIM","OTHERDIAGNOSIS19DE","Char",7]
[1,"MC149",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"N\"),\"Yes\",\"No\")","v":"No"},"Other Diagnosis - 20","some Dx code redaction","TBL_CORE_MEDICALCLAIM","OTHERDIAGNOSIS20DE","Char",7]
[1,"MC150",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"N\"),\"Yes\",\"No\")","v":"No"},"Other Diagnosis - 21","some Dx code redaction","TBL_CORE_MEDICALCLAIM","OTHERDIAGNOSIS21DE","Char",7]
[1,"MC151",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"N\"),\"Yes\",\"No\")","v":"No"},"Other Diagnosis - 22","some Dx code redaction","TBL_CORE_MEDICALCLAIM","OTHERDIAGNOSIS22DE","Char",7]
[1,"MC152",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"N\"),\"Yes\",\"No\")","v":"No"},"Other Diagnosis - 23","some Dx code redaction","TBL_CORE_MEDICALCLAIM","OTHERDIAGNOSIS23DE","Char",7]
[1,"MC153",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"N\"),\"Yes\",\"No\")","v":"No"},"Other Diagnosis - 24","some Dx code redaction","TBL_CORE_MEDICALCLAIM","OTHERDIAGNOSIS24DE","Char",7]
[1,"MC083",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Other ICD-CM Procedure Code - 1",null,"TBL_CORE_MEDICALCLAIM","OTHERICDCMPROCEDURECODE1CLEANED","Char",7]
[1,"MC084",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Other ICD-CM Procedure Code - 2",null,"TBL_CORE_MEDICALCLAIM","OTHERICDCMPROCEDURECODE2CLEANED","Char",7]
[1,"MC085",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Other ICD-CM Procedure Code - 3",null,"TBL_CORE_MEDICALCLAIM","OTHERICDCMPROCEDURECODE3CLEANED","Char",7]
[1,"MC086",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Other ICD-CM Procedure Code - 4",null,"TBL_CORE_MEDICALCLAIM","OTHERICDCMPROCEDURECODE4CLEANED","Char",7]
[1,"MC087",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Other ICD-CM Procedure Code - 5",null,"TBL_CORE_MEDICALCLAIM","OTHERICDCMPROCEDURECODE5CLEANED","Char",7]
[1,"MC088",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Other ICD-CM Procedure Code - 6",null,"TBL_CORE_MEDICALCLAIM","OTHERICDCMPROCEDURECODE6CLEANED","Char",7]
[1,"MC096",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Other Insurance Paid Amount",null,"TBL_CORE_MEDICALCLAIM","OTHERINSURANCEPAIDAMOUNTCLEANED","Numeric",18.2]
[1,"MC063",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Paid Amount",null,"TBL_CORE_MEDICALCLAIM","PAIDAMOUNTCLEANED","Numeric",18.2]
[1,"MC089",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Paid Date","YYYYMMDD","TBL_CORE_MEDICALCLAIM","PAIDDATE","Integer",8]
[1,"MC121",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Patient Total Out of Pocket Amount",null,"TBL_CORE_MEDICALCLAIM","PATIENTTOTALOUTOFPOCKETAMOUNT","Numeric",18.2]
[1,"MC004",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Payer Claim Control Number",null,"TBL_CORE_MEDICALCLAIM","CHIAPAYERCLAIMCONTROLNUMBER","Integer",20]
[1,"MC113",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Payment Arrangement Type",null,"TBL_CORE_MEDICALCLAIM","PAYMENTARRANGEMENTTYPECLEANED","Char",2]
[1,"MC119",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"PCP Indicator",null,"TBL_CORE_MEDICALCLAIM","PCPINDICATOR","Char",1]
[1,"MC242",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Plan Rendering National Provider ID","NPI","TBL_CORE_MEDICALCLAIM","NATIONALPROVIDERIDPLANRENDERINGCLEANED","Char",10]
[1,"MC134",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Plan Rendering Provider Identifier",null,"TBL_CORE_MEDICALCLAIM","PLANRENDERINGPROVIDERIDENTIFIER_LINKAGE_ID","Integer",20]
[1,"MC064",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Prepaid Amount",null,"TBL_CORE_MEDICALCLAIM","PREPAIDAMOUNTCLEANED","Numeric",18.2]
[1,"MC154",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"N\"),\"Yes\",\"No\")","v":"No"},"Present on Admission Code (POA) - 01",null,"TBL_CORE_MEDICALCLAIM","PRESENTONADMISSIONDE1","Char",1]
[1,"MC155",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"N\"),\"Yes\",\"No\")","v":"No"},"Present on Admission Code (POA) - 02",null,"TBL_CORE_MEDICALCLAIM","PRESENTONADMISSIONDE2","Char",1]
[1,"MC156",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"N\"),\"Yes\",\"No\")","v":"No"},"Present on Admission Code (POA) - 03",null,"TBL_CORE_MEDICALCLAIM","PRESENTONADMISSIONDE3","Char",1]
[1,"MC157",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"N\"),\"Yes\",\"No\")","v":"No"},"Present on Admission Code (POA) - 04",null,"TBL_CORE_MEDICALCLAIM","PRESENTONADMISSIONDE4","Char",1]
[1,"MC158",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"N\"),\"Yes\",\"No\")","v":"No"},"Present on Admission Code (POA) - 05",null,"TBL_CORE_MEDICALCLAIM","PRESENTONADMISSIONDE5","Char",1]
[1,"MC159",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"N\"),\"Yes\",\"No\")","v":"No"},"Present on Admission Code (POA) - 06",null,"TBL_CORE_MEDICALCLAIM","PRESENTONADMISSIONDE6","Char",1]
[1,"MC160",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"N\"),\"Yes\",\"No\")","v":"No"},"Present on Admission Code (POA) - 07",null,"TBL_CORE_MEDICALCLAIM","PRESENTONADMISSIONDE7","Char",1]
[1,"MC161",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"N\"),\"Yes\",\"No\")","v":"No"},"Present on Admission Code (POA) - 08",null,"TBL_CORE_MEDICALCLAIM","PRESENTONADMISSIONDE8","Char",1]
[1,"MC162",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"N\"),\"Yes\",\"No\")","v":"No"},"Present on Admission Code (POA) - 09",null,"TBL_CORE_MEDICALCLAIM","PRESENTONADMISSIONDE9","Char",1]
[1,"MC163",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"N\"),\"Yes\",\"No\")","v":"No"},"Present on Admission Code (POA) - 10",null,"TBL_CORE_MEDICALCLAIM","PRESENTONADMISSIONDE10","Char",1]
[1,"MC164",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"N\"),\"Yes\",\"No\")","v":"No"},"Present on Admission Code (POA) - 11",null,"TBL_CORE_MEDICALCLAIM","PRESENTONADMISSIONDE11","Char",1]
[1,"MC165",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"N\"),\"Yes\",\"No\")","v":"No"},"Present on Admission Code (POA) - 12",null,"TBL_CORE_MEDICALCLAIM","PRESENTONADMISSIONDE12","Char",1]
[1,"MC166",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"N\"),\"Yes\",\"No\")","v":"No"},"Present on Admission Code (POA) - 13",null,"TBL_CORE_MEDICALCLAIM","PRESENTONADMISSIONDE13","Char",1]
[1,"MC167",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"N\"),\"Yes\",\"No\")","v":"No"},"Present on Admission Code (POA) - 14",null,"TBL_CORE_MEDICALCLAIM","PRESENTONADMISSIONDE14","Char",1]
[1,"MC168",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"N\"),\"Yes\",\"No\")","v":"No"},"Present on Admission Code (POA) - 15",null,"TBL_CORE_MEDICALCLAIM","PRESENTONADMISSIONDE15","Char",1]
[1,"MC169",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"N\"),\"Yes\",\"No\")","v":"No"},"Present on Admission Code (POA) - 16",null,"TBL_CORE_MEDICALCLAIM","PRESENTONADMISSIONDE16","Char",1]
[1,"MC170",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"N\"),\"Yes\",\"No\")","v":"No"},"Present on Admission Code (POA) - 17",null,"TBL_CORE_MEDICALCLAIM","PRESENTONADMISSIONDE17","Char",1]
[1,"MC171",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"N\"),\"Yes\",\"No\")","v":"No"},"Present on Admission Code (POA) - 18",null,"TBL_CORE_MEDICALCLAIM","PRESENTONADMISSIONDE18","Char",1]
[1,"MC172",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"N\"),\"Yes\",\"No\")","v":"No"},"Present on Admission Code (POA) - 19",null,"TBL_CORE_MEDICALCLAIM","PRESENTONADMISSIONDE19","Char",1]
[1,"MC173",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"N\"),\"Yes\",\"No\")","v":"No"},"Present on Admission Code (POA) - 20",null,"TBL_CORE_MEDICALCLAIM","PRESENTONADMISSIONDE20","Char",1]
[1,"MC174",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"N\"),\"Yes\",\"No\")","v":"No"},"Present on Admission Code (POA) - 21",null,"TBL_CORE_MEDICALCLAIM","PRESENTONADMISSIONDE21","Char",1]
[1,"MC175",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"N\"),\"Yes\",\"No\")","v":"No"},"Present on Admission Code (POA) - 22",null,"TBL_CORE_MEDICALCLAIM","PRESENTONADMISSIONDE22","Char",1]
[1,"MC176",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"N\"),\"Yes\",\"No\")","v":"No"},"Present on Admission Code (POA) - 23",null,"TBL_CORE_MEDICALCLAIM","PRESENTONADMISSIONDE23","Char",1]
[1,"MC177",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"N\"),\"Yes\",\"No\")","v":"No"},"Present on Admission Code (POA) - 24",null,"TBL_CORE_MEDICALCLAIM","PRESENTONADMISSIONDE24","Char",1]
[1,"MC178",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"N\"),\"Yes\",\"No\")","v":"No"},"Present on Admission Code (POA) - 25",null,"TBL_CORE_MEDICALCLAIM","PRESENTONADMISSIONDE25","Char",1]
[1,"MC215",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Occurrence Code - 1",null,"TBL_CORE_MEDICALCLAIM","OCCURRENCECODE1","Char",2]
[1,"MC217",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Occurrence Code - 2",null,"TBL_CORE_MEDICALCLAIM","OCCURRENCECODE2","Char",2]
[1,"MC219",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Occurrence Code - 3",null,"TBL_CORE_MEDICALCLAIM","OCCURRENCECODE3","Char",2]
[1,"MC221",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Occurrence Code - 4",null,"TBL_CORE_MEDICALCLAIM","OCCURRENCECODE4","Char",2]
[1,"MC223",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Occurrence Code - 5",null,"TBL_CORE_MEDICALCLAIM","OCCURRENCECODE5","Char",2]
[1,"MC041",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"N\"),\"Yes\",\"No\")","v":"No"},"Principal Diagnosis","some Dx code redaction","TBL_CORE_MEDICALCLAIM","PRINCIPALDIAGNOSISDE","Char",7]
[1,"MC055",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Procedure Code",null,"TBL_CORE_MEDICALCLAIM","PROCEDURECODECLEANED","Char",10]
[1,"MC130",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Procedure Code Type",null,"TBL_CORE_MEDICALCLAIM","PROCEDURECODETYPE","Char",1]
[1,"MC056",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Procedure Modifier - 1",null,"TBL_CORE_MEDICALCLAIM","PROCEDUREMODIFIER1","Char",2]
[1,"MC057",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Procedure Modifier - 2",null,"TBL_CORE_MEDICALCLAIM","PROCEDUREMODIFIER2","Char",2]
[1,"MC108",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Procedure Modifier - 3",null,"TBL_CORE_MEDICALCLAIM","PROCEDUREMODIFIER3","Char",2]
[1,"MC109",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Procedure Modifier - 4",null,"TBL_CORE_MEDICALCLAIM","PROCEDUREMODIFIER4","Char",2]
[1,"MC079",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Product ID Number","Surrogate key","TBL_CORE_MEDICALCLAIM","PRODUCTIDNUMBER_LINKAGE_ID","Integer",20]
[1,"MC135",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Provider Location",null,"TBL_CORE_MEDICALCLAIM","PROVIDERLOCATION_LINKAGE_ID","Integer",20]
[1,"MC061",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Quantity",null,"TBL_CORE_MEDICALCLAIM","QUANTITY","Integer",10]
[1,"MC080",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Reason for Adjustment","Standard or Carrier-Specific Custom Values","TBL_CORE_MEDICALCLAIM","PAYMENTREASONCLEANED","Char",10]
[1,"MC118",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Referral Indicator",null,"TBL_CORE_MEDICALCLAIM","REFERRALINDICATOR","Char",1]
[1,"MC112",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Referring Provider ID",null,"TBL_CORE_MEDICALCLAIM","REFERRINGPROVIDERID_LINKAGE_ID","Integer",20]
[1,"MC054",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Revenue Code",null,"TBL_CORE_MEDICALCLAIM","REVENUECODECLEANED","Char",4]
[1,"MC132",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Service Class",null,"TBL_CORE_MEDICALCLAIM","SERVICECLASS","Char",3]
[1,"MC033",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Service Provider City Name",null,"TBL_SUPPLEMENT_MEDICALCLAIM","SERVICEPROVIDERCITYNAMECLEANED","Char",30]
[1,"MC070",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Service Provider Country Code",null,"TBL_CORE_MEDICALCLAIM","SERVICEPROVIDERCOUNTRYCODE","Char",3]
[1,"MC027",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Service Provider Entity Type Qualifier",null,"TBL_CORE_MEDICALCLAIM","SERVICEPROVIDERENTITYTYPEQUALIFIER","Char",1]
[1,"MC028",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Service Provider First Name",null,"TBL_CORE_MEDICALCLAIM","SERVICEPROVIDERFIRSTNAMECLEANED","Char",25]
[1,"MC029",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Service Provider Middle Name",null,"TBL_CORE_MEDICALCLAIM","SERVICEPROVIDERMIDDLENAMECLEANED","Char",25]
[1,"MC024",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Service Provider Number",null,"TBL_CORE_MEDICALCLAIM","SERVICEPROVIDERNUMBER_LINKAGE_ID","Integer",20]
[1,"MC032",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Service Provider Specialty","Standard or Carrier-Specific Custom Values","TBL_CORE_MEDICALCLAIM","SERVICEPROVIDERSPECIALTYCLEANED","Char",10]
[1,"MC034",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Service Provider State",null,"TBL_SUPPLEMENT_MEDICALCLAIM","SERVICEPROVIDERSTATE","Char",2]
[1,"MC031",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Service Provider Suffix",null,"TBL_CORE_MEDICALCLAIM","SERVICEPROVIDERSUFFIX","Char",1]
[1,"MC035",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Service Provider ZIP Code",null,"TBL_SUPPLEMENT_MEDICALCLAIM","SERVICEPROVIDERZIPCODE_5","Char",5]
[1,"MC030",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Servicing Provider Last Name or Organization Name",null,"TBL_CORE_MEDICALCLAIM","SERVICEPROVIDERLASTNAMEORORGANIZATIONNAMECLEANED","Char",60]
[1,"MC037",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Site of Service - on NSF/CMS 1500 Claims",null,"TBL_CORE_MEDICALCLAIM","SITEOFSERVICEONNSFCMS1500CLAIMSCLEANED","Char",2]
[1,"Derived",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Submission Control ID",null,"TBL_CORE_MEDICALCLAIM","SUBMISSIONCONTROLID","Integer",8]
[1,"HD005",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Submission Year and Month","YYYYMM","TBL_CORE_MEDICALCLAIM","SUBMISSIONYEARMONTH","Char",6]
[1,"MC001",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Submitter","Submitting ORGID (Char on SG, but always Integer)","TBL_CORE_MEDICALCLAIM","ORGID","Integer",6]
[1,"Derived",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Substance Abuse Indicator",null,"TBL_SUPPLEMENT_MEDICALCLAIM","SUBSTANCEABUSEINDICATORCMS","Logical",1]
[1,"MC036",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Type of Bill - on Facility Claims",null,"TBL_CORE_MEDICALCLAIM","TYPEOFBILLONFACILITYCLAIMS","Char",2]
[1,"MC094",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Type of Claim",null,"TBL_CORE_MEDICALCLAIM","TYPEOFCLAIMCLEANED","Char",3]
[1,"MC245",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Type of Facility",null,"TBL_CORE_MEDICALCLAIM","TYPEOFFACILITY","Integer",2]
[1,"MC192",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Value Amount - 1",null,"TBL_CORE_MEDICALCLAIM","VALUECODE1","Char",10]
[1,"MC210",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Value Amount - 10",null,"TBL_CORE_MEDICALCLAIM","VALUECODE10","Char",10]
[1,"MC212",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Value Amount - 11",null,"TBL_CORE_MEDICALCLAIM","VALUECODE11","Char",10]
[1,"MC214",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Value Amount - 12",null,"TBL_CORE_MEDICALCLAIM","VALUECODE12","Char",10]
[1,"MC194",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Value Amount - 2",null,"TBL_CORE_MEDICALCLAIM","VALUECODE2","Char",10]
[1,"MC196",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Value Amount - 3",null,"TBL_CORE_MEDICALCLAIM","VALUECODE3","Char",10]
[1,"MC198",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Value Amount - 4",null,"TBL_CORE_MEDICALCLAIM","VALUECODE4","Char",10]
[1,"MC200",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Value Amount - 5",null,"TBL_CORE_MEDICALCLAIM","VALUECODE5","Char",10]
[1,"MC202",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Value Amount - 6",null,"TBL_CORE_MEDICALCLAIM","VALUECODE6","Char",10]
[1,"MC204",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Value Amount - 7",null,"TBL_CORE_MEDICALCLAIM","VALUECODE7","Char",10]
[1,"MC206",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Value Amount - 8",null,"TBL_CORE_MEDICALCLAIM","VALUECODE8","Char",10]
[1,"MC208",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Value Amount - 9",null,"TBL_CORE_MEDICALCLAIM","VALUECODE9","Char",10]
[1,"MC191",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Value Code - 1",null,"TBL_CORE_MEDICALCLAIM","VALUECODEAMOUNT1","Numeric",18.2]
[1,"MC209",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Value Code - 10",null,"TBL_CORE_MEDICALCLAIM","VALUECODEAMOUNT10","Numeric",18.2]
[1,"MC211",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Value Code - 11",null,"TBL_CORE_MEDICALCLAIM","VALUECODEAMOUNT11","Numeric",18.2]
[1,"MC213",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Value Code - 12",null,"TBL_CORE_MEDICALCLAIM","VALUECODEAMOUNT12","Numeric",18.2]
[1,"MC193",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Value Code - 2",null,"TBL_CORE_MEDICALCLAIM","VALUECODEAMOUNT2","Numeric",18.2]
[1,"MC195",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Value Code - 3",null,"TBL_CORE_MEDICALCLAIM","VALUECODEAMOUNT3","Numeric",18.2]
[1,"MC197",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Value Code - 4",null,"TBL_CORE_MEDICALCLAIM","VALUECODEAMOUNT4","Numeric",18.2]
[1,"MC199",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Value Code - 5",null,"TBL_CORE_MEDICALCLAIM","VALUECODEAMOUNT5","Numeric",18.2]
[1,"MC201",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Value Code - 6",null,"TBL_CORE_MEDICALCLAIM","VALUECODEAMOUNT6","Numeric",18.2]
[1,"MC203",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Value Code - 7",null,"TBL_CORE_MEDICALCLAIM","VALUECODEAMOUNT7","Numeric",18.2]
[1,"MC205",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Value Code - 8",null,"TBL_CORE_MEDICALCLAIM","VALUECODEAMOUNT8","Numeric",18.2]
[1,"MC207",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Value Code - 9",null,"TBL_CORE_MEDICALCLAIM","VALUECODEAMOUNT9","Numeric",18.2]
[1,"MC005A",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Version Number",null,"TBL_CORE_MEDICALCLAIM","VERSIONNUMBER","Integer",4]
[1,"MC116",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"Withhold Amount",null,"TBL_CORE_MEDICALCLAIM","WITHHOLDAMOUNT","Numeric",18.2]
[1,"MC090",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"LOINC Code",null,"TBL_CORE_MEDICALCLAIM","LOINCCODE","Char",7]
[1,"MC246",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"MassHealth Claim Type Indicator",null,"TBL_CORE_MEDICALCLAIM","MASSHEALTHCLAIMTYPE","Char",1]
[1,"MC247",{"$f":"IF('Legal Approval Form'!$B$17=\"Y\",\"Yes\", \"No\")","v":"No"},"MassHealth Rate Code",null,"TBL_CORE_MEDICALCLAIM","MASSHEALTHRATECODE","Char",3]
[]
["ID -  Medical Claim (MC) - Identifiable (L2) Elements"]
["Release Level","Data Element Source","Included   (this request)","Data Element Name","CHIA Notes","Release View Source Table","Release Column Name","Data Type","Length"]
[2,"Derived",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"Y\"),\"Yes\",\"No\")","v":"No"},"Member Age At Service","Not redacted for Age > 89","TBL_CORE_MEDICALCLAIM","MEMBERAGEATSERVICEINYEARS","Integer",3]
[2,"MC013",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"Y\"),\"Yes\",\"No\")","v":"No"},"Member Date of Birth (Year and Month)","Format YYYYMM (Not redacted for Age > 89)","TBL_CORE_MEDICALCLAIM","MEMBERDATEOFBIRTHYEARMONTH","Integer",6]
[2,"MC013",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"Y\"),\"Yes\",\"No\")","v":"No"},"Member Birth (Month Only)",null,"TBL_CORE_MEDICALCLAIM","MEMBERDATEOFBIRTHMONTH","Char",2]
[2,"MC243",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"Y\"),\"Yes\",\"No\")","v":"No"},"Benefit Plan Contract ID",null,"TBL_CORE_MEDICALCLAIM","BENEFITPLANCONTRACTID","Char",30]
[2,"MC021",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"Y\"),\"Yes\",\"No\")","v":"No"},"Admission Source",null,"TBL_CORE_MEDICALCLAIM","ADMISSIONSOURCE","Char",1]
[2,"MC023",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"Y\"),\"Yes\",\"No\")","v":"No"},"Discharge Status",null,"TBL_CORE_MEDICALCLAIM","DISCHARGESTATUSCLEANED","Char",2]
[2,"MC012",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"Y\"),\"Yes\",\"No\")","v":"No"},"Member Gender",null,"TBL_CORE_MEDICALCLAIM","MEMBERGENDERCLEANED","Char",1]
[2,"MC039",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"Y\"),\"Yes\",\"No\")","v":"No"},"Admitting Diagnosis",null,"TBL_CORE_MEDICALCLAIM","ADMITTINGDIAGNOSISCLEANED ","Char",7]
[2,"MC136",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"Y\"),\"Yes\",\"No\")","v":"No"},"Discharge Diagnosis",null,"TBL_CORE_MEDICALCLAIM","DISCHARGEDIAGNOSISCLEANED","Char",7]
[2,"MC040",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"Y\"),\"Yes\",\"No\")","v":"No"},"External Cause Code","ICD10 codes (begin w/ V, W, X, or Y)","TBL_CORE_MEDICALCLAIM","ECODECLEANED","Char",7]
[2,"MC041",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"Y\"),\"Yes\",\"No\")","v":"No"},"Principal Diagnosis",null,"TBL_CORE_MEDICALCLAIM","PRINCIPALDIAGNOSISCLEANED","Char",7]
[2,"MC042",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"Y\"),\"Yes\",\"No\")","v":"No"},"Other Diagnosis - 1",null,"TBL_CORE_MEDICALCLAIM","OTHERDIAGNOSIS1CLEANED","Char",7]
[2,"MC043",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"Y\"),\"Yes\",\"No\")","v":"No"},"Other Diagnosis - 2",null,"TBL_CORE_MEDICALCLAIM","OTHERDIAGNOSIS2CLEANED","Char",7]
[2,"MC044",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"Y\"),\"Yes\",\"No\")","v":"No"},"Other Diagnosis - 3",null,"TBL_CORE_MEDICALCLAIM","OTHERDIAGNOSIS3CLEANED","Char",7]
[2,"MC045",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"Y\"),\"Yes\",\"No\")","v":"No"},"Other Diagnosis - 4",null,"TBL_CORE_MEDICALCLAIM","OTHERDIAGNOSIS4CLEANED","Char",7]
[2,"MC046",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"Y\"),\"Yes\",\"No\")","v":"No"},"Other Diagnosis - 5",null,"TBL_CORE_MEDICALCLAIM","OTHERDIAGNOSIS5CLEANED","Char",7]
[2,"MC047",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"Y\"),\"Yes\",\"No\")","v":"No"},"Other Diagnosis - 6",null,"TBL_CORE_MEDICALCLAIM","OTHERDIAGNOSIS6CLEANED","Char",7]
[2,"MC048",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"Y\"),\"Yes\",\"No\")","v":"No"},"Other Diagnosis - 7",null,"TBL_CORE_MEDICALCLAIM","OTHERDIAGNOSIS7CLEANED","Char",7]
[2,"MC049",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"Y\"),\"Yes\",\"No\")","v":"No"},"Other Diagnosis - 8",null,"TBL_CORE_MEDICALCLAIM","OTHERDIAGNOSIS8CLEANED","Char",7]
[2,"MC050",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"Y\"),\"Yes\",\"No\")","v":"No"},"Other Diagnosis - 9",null,"TBL_CORE_MEDICALCLAIM","OTHERDIAGNOSIS9CLEANED","Char",7]
[2,"MC051",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"Y\"),\"Yes\",\"No\")","v":"No"},"Other Diagnosis - 10",null,"TBL_CORE_MEDICALCLAIM","OTHERDIAGNOSIS10CLEANED","Char",7]
[2,"MC052",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"Y\"),\"Yes\",\"No\")","v":"No"},"Other Diagnosis - 11",null,"TBL_CORE_MEDICALCLAIM","OTHERDIAGNOSIS11CLEANED","Char",7]
[2,"MC053",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"Y\"),\"Yes\",\"No\")","v":"No"},"Other Diagnosis - 12",null,"TBL_CORE_MEDICALCLAIM","OTHERDIAGNOSIS12CLEANED","Char",7]
[2,"MC142",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"Y\"),\"Yes\",\"No\")","v":"No"},"Other Diagnosis - 13",null,"TBL_CORE_MEDICALCLAIM","OTHERDIAGNOSIS13CLEANED","Char",7]
[2,"MC143",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"Y\"),\"Yes\",\"No\")","v":"No"},"Other Diagnosis - 14",null,"TBL_CORE_MEDICALCLAIM","OTHERDIAGNOSIS14CLEANED","Char",7]
[2,"MC144",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"Y\"),\"Yes\",\"No\")","v":"No"},"Other Diagnosis - 15",null,"TBL_CORE_MEDICALCLAIM","OTHERDIAGNOSIS15CLEANED","Char",7]
[2,"MC145",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"Y\"),\"Yes\",\"No\")","v":"No"},"Other Diagnosis - 16",null,"TBL_CORE_MEDICALCLAIM","OTHERDIAGNOSIS16CLEANED","Char",7]
[2,"MC146",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"Y\"),\"Yes\",\"No\")","v":"No"},"Other Diagnosis - 17",null,"TBL_CORE_MEDICALCLAIM","OTHERDIAGNOSIS17CLEANED","Char",7]
[2,"MC147",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"Y\"),\"Yes\",\"No\")","v":"No"},"Other Diagnosis - 18",null,"TBL_CORE_MEDICALCLAIM","OTHERDIAGNOSIS18CLEANED","Char",7]
[2,"MC148",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"Y\"),\"Yes\",\"No\")","v":"No"},"Other Diagnosis - 19",null,"TBL_CORE_MEDICALCLAIM","OTHERDIAGNOSIS19CLEANED","Char",7]
[2,"MC149",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"Y\"),\"Yes\",\"No\")","v":"No"},"Other Diagnosis - 20",null,"TBL_CORE_MEDICALCLAIM","OTHERDIAGNOSIS20CLEANED","Char",7]
[2,"MC150",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"Y\"),\"Yes\",\"No\")","v":"No"},"Other Diagnosis - 21",null,"TBL_CORE_MEDICALCLAIM","OTHERDIAGNOSIS21CLEANED","Char",7]
[2,"MC151",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"Y\"),\"Yes\",\"No\")","v":"No"},"Other Diagnosis - 22",null,"TBL_CORE_MEDICALCLAIM","OTHERDIAGNOSIS22CLEANED","Char",7]
[2,"MC152",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"Y\"),\"Yes\",\"No\")","v":"No"},"Other Diagnosis - 23",null,"TBL_CORE_MEDICALCLAIM","OTHERDIAGNOSIS23CLEANED","Char",7]
[2,"MC153",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"Y\"),\"Yes\",\"No\")","v":"No"},"Other Diagnosis - 24",null,"TBL_CORE_MEDICALCLAIM","OTHERDIAGNOSIS24CLEANED","Char",7]
[2,"MC071",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"Y\"),\"Yes\",\"No\")","v":"No"},"DRG",null,"TBL_CORE_MEDICALCLAIM","DRG","Char",7]
[2,"MC072",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"Y\"),\"Yes\",\"No\")","v":"No"},"DRG Version",null,"TBL_CORE_MEDICALCLAIM","DRGVERSION","Char",2]
[2,"MC179",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"Y\"),\"Yes\",\"No\")","v":"No"},"Condition Code - 1",null,"TBL_CORE_MEDICALCLAIM","CONDITIONCODE1","Char",2]
[2,"MC180",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"Y\"),\"Yes\",\"No\")","v":"No"},"Condition Code - 2",null,"TBL_CORE_MEDICALCLAIM","CONDITIONCODE2","Char",2]
[2,"MC181",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"Y\"),\"Yes\",\"No\")","v":"No"},"Condition Code - 3",null,"TBL_CORE_MEDICALCLAIM","CONDITIONCODE3","Char",2]
[2,"MC182",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"Y\"),\"Yes\",\"No\")","v":"No"},"Condition Code - 4",null,"TBL_CORE_MEDICALCLAIM","CONDITIONCODE4","Char",2]
[2,"MC183",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"Y\"),\"Yes\",\"No\")","v":"No"},"Condition Code - 5",null,"TBL_CORE_MEDICALCLAIM","CONDITIONCODE5","Char",2]
[2,"MC184",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"Y\"),\"Yes\",\"No\")","v":"No"},"Condition Code - 6",null,"TBL_CORE_MEDICALCLAIM","CONDITIONCODE6","Char",2]
[2,"MC185",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"Y\"),\"Yes\",\"No\")","v":"No"},"Condition Code - 7",null,"TBL_CORE_MEDICALCLAIM","CONDITIONCODE7","Char",2]
[2,"MC186",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"Y\"),\"Yes\",\"No\")","v":"No"},"Condition Code - 8",null,"TBL_CORE_MEDICALCLAIM","CONDITIONCODE8","Char",2]
[2,"MC187",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"Y\"),\"Yes\",\"No\")","v":"No"},"Condition Code - 9",null,"TBL_CORE_MEDICALCLAIM","CONDITIONCODE9","Char",2]
[2,"MC188",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"Y\"),\"Yes\",\"No\")","v":"No"},"Condition Code - 10",null,"TBL_CORE_MEDICALCLAIM","CONDITIONCODE10","Char",2]
[2,"MC189",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"Y\"),\"Yes\",\"No\")","v":"No"},"Condition Code - 11",null,"TBL_CORE_MEDICALCLAIM","CONDITIONCODE11","Char",2]
[2,"MC190",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"Y\"),\"Yes\",\"No\")","v":"No"},"Condition Code - 12",null,"TBL_CORE_MEDICALCLAIM","CONDITIONCODE12","Char",2]
[]
[2,"MC154",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"Y\"),\"Yes\",\"No\")","v":"No"},"Present on Admission Code (POA) - 01",null,"TBL_CORE_MEDICALCLAIM","PRESENTONADMISSION1","Char",1]
[2,"MC155",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"Y\"),\"Yes\",\"No\")","v":"No"},"Present on Admission Code (POA) - 02",null,"TBL_CORE_MEDICALCLAIM","PRESENTONADMISSION2","Char",1]
[2,"MC156",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"Y\"),\"Yes\",\"No\")","v":"No"},"Present on Admission Code (POA) - 03",null,"TBL_CORE_MEDICALCLAIM","PRESENTONADMISSION3","Char",1]
[2,"MC157",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"Y\"),\"Yes\",\"No\")","v":"No"},"Present on Admission Code (POA) - 04",null,"TBL_CORE_MEDICALCLAIM","PRESENTONADMISSION4","Char",1]
[2,"MC158",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"Y\"),\"Yes\",\"No\")","v":"No"},"Present on Admission Code (POA) - 05",null,"TBL_CORE_MEDICALCLAIM","PRESENTONADMISSION5","Char",1]
[2,"MC159",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"Y\"),\"Yes\",\"No\")","v":"No"},"Present on Admission Code (POA) - 06",null,"TBL_CORE_MEDICALCLAIM","PRESENTONADMISSION6","Char",1]
[2,"MC160",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"Y\"),\"Yes\",\"No\")","v":"No"},"Present on Admission Code (POA) - 07",null,"TBL_CORE_MEDICALCLAIM","PRESENTONADMISSION7","Char",1]
[2,"MC161",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"Y\"),\"Yes\",\"No\")","v":"No"},"Present on Admission Code (POA) - 08",null,"TBL_CORE_MEDICALCLAIM","PRESENTONADMISSION8","Char",1]
[2,"MC162",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"Y\"),\"Yes\",\"No\")","v":"No"},"Present on Admission Code (POA) - 09",null,"TBL_CORE_MEDICALCLAIM","PRESENTONADMISSION9","Char",1]
[2,"MC163",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"Y\"),\"Yes\",\"No\")","v":"No"},"Present on Admission Code (POA) - 10",null,"TBL_CORE_MEDICALCLAIM","PRESENTONADMISSION10","Char",1]
[2,"MC164",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"Y\"),\"Yes\",\"No\")","v":"No"},"Present on Admission Code (POA) - 11",null,"TBL_CORE_MEDICALCLAIM","PRESENTONADMISSION11","Char",1]
[2,"MC165",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"Y\"),\"Yes\",\"No\")","v":"No"},"Present on Admission Code (POA) - 12",null,"TBL_CORE_MEDICALCLAIM","PRESENTONADMISSION12","Char",1]
[2,"MC166",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"Y\"),\"Yes\",\"No\")","v":"No"},"Present on Admission Code (POA) - 13",null,"TBL_CORE_MEDICALCLAIM","PRESENTONADMISSION13","Char",1]
[2,"MC167",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"Y\"),\"Yes\",\"No\")","v":"No"},"Present on Admission Code (POA) - 14",null,"TBL_CORE_MEDICALCLAIM","PRESENTONADMISSION14","Char",1]
[2,"MC168",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"Y\"),\"Yes\",\"No\")","v":"No"},"Present on Admission Code (POA) - 15",null,"TBL_CORE_MEDICALCLAIM","PRESENTONADMISSION15","Char",1]
[2,"MC169",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"Y\"),\"Yes\",\"No\")","v":"No"},"Present on Admission Code (POA) - 16",null,"TBL_CORE_MEDICALCLAIM","PRESENTONADMISSION16","Char",1]
[2,"MC170",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"Y\"),\"Yes\",\"No\")","v":"No"},"Present on Admission Code (POA) - 17",null,"TBL_CORE_MEDICALCLAIM","PRESENTONADMISSION17","Char",1]
[2,"MC171",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"Y\"),\"Yes\",\"No\")","v":"No"},"Present on Admission Code (POA) - 18",null,"TBL_CORE_MEDICALCLAIM","PRESENTONADMISSION18","Char",1]
[2,"MC172",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"Y\"),\"Yes\",\"No\")","v":"No"},"Present on Admission Code (POA) - 19",null,"TBL_CORE_MEDICALCLAIM","PRESENTONADMISSION19","Char",1]
[2,"MC173",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"Y\"),\"Yes\",\"No\")","v":"No"},"Present on Admission Code (POA) - 20",null,"TBL_CORE_MEDICALCLAIM","PRESENTONADMISSION20","Char",1]
[2,"MC174",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"Y\"),\"Yes\",\"No\")","v":"No"},"Present on Admission Code (POA) - 21",null,"TBL_CORE_MEDICALCLAIM","PRESENTONADMISSION21","Char",1]
[2,"MC175",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"Y\"),\"Yes\",\"No\")","v":"No"},"Present on Admission Code (POA) - 22",null,"TBL_CORE_MEDICALCLAIM","PRESENTONADMISSION22","Char",1]
[2,"MC176",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"Y\"),\"Yes\",\"No\")","v":"No"},"Present on Admission Code (POA) - 23",null,"TBL_CORE_MEDICALCLAIM","PRESENTONADMISSION23","Char",1]
[2,"MC177",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"Y\"),\"Yes\",\"No\")","v":"No"},"Present on Admission Code (POA) - 24",null,"TBL_CORE_MEDICALCLAIM","PRESENTONADMISSION24","Char",1]
[2,"MC178",{"$f":"IF(AND('Legal Approval Form'!$B$17=\"Y\",'Legal Approval Form'!$B$33=\"Y\"),\"Yes\",\"No\")","v":"No"},"Present on Admission Code (POA) - 25",null,"TBL_CORE_MEDICALCLAIM","PRESENTONADMISSION25","Char",1]
[]
["SR - Patient Identifiable, (L3) Special Release"]
["Release Level","Data Element Source","Included   (this request)","Data Element Name","CHIA Notes","Release View Source Table","Release Column Name","SG\nData Type","SG\nLength"]
[3,"MC125","SR Only","Attending Provider","linkage-id used, but keep reported ","TBL_CORE_MEDICALCLAIM","ATTENDINGPROVIDER","Char",30]
[3,"MC076","SR Only","Billing Provider Number","linkage-id used, but keep reported ","TBL_CORE_MEDICALCLAIM","BILLINGPROVIDERNUMBER","Char",30]
[3,"MC009","SR Only","Member Suffix or Sequence Number",null,"TBL_CORE_MEDICALCLAIM","MEMBERSUFFIXORSEQUENCENUMBER","Char",20]
[3,"MC134","SR Only","Plan Rendering Provider Identifier","linkage-id used, but keep reported ","TBL_CORE_MEDICALCLAIM","PLANRENDERINGPROVIDERIDENTIFIER","Char",30]
[3,"MC008","SR Only","Plan Specific Contract Number",null,"TBL_CORE_MEDICALCLAIM","PLANSPECIFICCONTRACTNUMBER","Char",30]
[3,"MC079","SR Only","Product ID Number","linkage-id used, but keep reported ","TBL_CORE_MEDICALCLAIM","PRODUCTIDNUMBER","Char",30]
[3,"MC135","SR Only","Provider Location","linkage-id used, but keep reported ","TBL_CORE_MEDICALCLAIM","PROVIDERLOCATION","Char",30]
[3,"MC112","SR Only","Referring Provider ID","linkage-id used, but keep reported ","TBL_CORE_MEDICALCLAIM","REFERRINGPROVIDERID","Char",30]
[3,"MC024","SR Only","Service Provider Number","linkage-id used, but keep reported ","TBL_CORE_MEDICALCLAIM","SERVICEPROVIDERNUMBER","Char",30]
[3,"MC137","SR Only","Carrier Specific Unique Member ID","Reported - decrypted","TBL_CORE_MEDICALCLAIM","CARRIERSPECIFICUNIQUEMEMBERID","Char",50]
[3,"MC141","SR Only","Carrier Specific Unique Subscriber ID ","Reported - decrypted","TBL_CORE_MEDICALCLAIM","CARRIERSPECIFICUNIQUESUBSCRIBERID","Char",50]
[3,"Derived","SR Only","County of Member","Source field for derivation no longer collected on Medical Claims at submission. Users should use field in Geography file which is sourced from Member Eligibility submissions. Derivation is sparse","TBL_SUPPLEMENT_MEDICALCLAIM","MEMBERCOUNTY","Char",25]
[3,"MC015","SR Only","Member State or Province","No longer collected on Medical Claims at submission. Users should use field in Geography file which is sourced from Member Eligibility submissions. Field populated less than 1%","TBL_SUPPLEMENT_MEDICALCLAIM","MEMBERSTATEORPROVINCELDS","Char",2]
[3,"MC015","SR Only","Member State or Province","No longer collected on Medical Claims at submission. Users should use field in Geography file which is sourced from Member Eligibility submissions. Field populated less than 1%","TBL_SUPPLEMENT_MEDICALCLAIM","MEMBERSTATEORPROVINCE","Char",2]
[3,"MC016","SR Only","Member ZIP Code","No longer collected on Medical Claims at submission. Users should use field in Geography file which is sourced from Member Eligibility submissions. Field populated less than 1%","TBL_SUPPLEMENT_MEDICALCLAIM","MEMBERZIPCODECLEANED","Char",5]
[3,"MC068","SR Only","Patient Control Number",null,"TBL_CORE_MEDICALCLAIM","PATIENTCONTROLNUMBERCLEANED","Char",20]
[3,"MC004","SR Only","Payer Claim Control Number",null,"TBL_CORE_MEDICALCLAIM","PAYERCLAIMCONTROLNUMBER","Char",35]
[3,"MC139","SR Only","Former Claim Number",null,"TBL_CORE_MEDICALCLAIM","FORMERCLAIMNUMBER","Char",35]
[3,"MC006","SR Only","Insured Group or Policy Number",null,"TBL_CORE_MEDICALCLAIM","INSUREDGROUPORPOLICYNUMBER","Char",30]
[3,"MC025","SR Only","Service Provider Tax ID Number",null,"TBL_CORE_MEDICALCLAIM","SERVICEPROVIDERTAXIDNUMBER","Char",9]
["NR - No Release - Internal and/or Deprecated"]
["Release Level","Data Element Source","Included   (this request)","Data Element Name","CHIA Notes","Release View Source Table","Release Column Name","SG\nData Type","SG\nLength"]
[4,"Derived","NR","Create Date","timestamp","TBL_CORE_MEDICALCLAIM","CREATEDATE","Date:Time",23]
[4,"Derived","NR","ETL Batch ID","same as SubmissionControlId","TBL_CORE_MEDICALCLAIM","ETLBATCHID","Integer",6]
[4,"Derived","NR","Line Number","Derived - record Id unique within each Submission ","TBL_CORE_MEDICALCLAIM","LINENUMBER","Integer",9]
[4,"Derived","NR","Member Link EID","Moved to MEID File","TBL_SUPPLEMENT_MEDICALCLAIM","MEMBERLINKEID","Integer",10]

{"sheet":"ME","index":4,"n_rows":154,"n_cols":17,"rows_kept":154,"cut":false,"hidden":false,"merged":[]}
["Release Level","Data Element Source","Included   (this request)","Member Eligibility (ME) - Data Element Name","CHIA Notes","Release Column Name","Data Type","Length","FLAG Carrier Specific TLKP","Notes","CHIA Code","Redaction","De-Identified Set","OnPoint Mitigation","Onpoint De-Identification Requirement - Amended"," 2025 UVR Release Comments ","Action"]
[1,"ME120",{"$f":"IF('Legal Approval Form'!$B$18=\"Y\",\"Yes\", \"No\")","v":"No"},"Actuarial Value ",null,"ACTUARIALVALUE","Char",6,null,null,null,null,"Y","N","None"]
[1,"ME134",{"$f":"IF('Legal Approval Form'!$B$18=\"Y\",\"Yes\", \"No\")","v":"No"},"APCD ID Code",null,"APCDIDCODE","Char",1,null,null,null,null,"Y","N","None","OK per Amendment"]
[1,"ME124",{"$f":"IF('Legal Approval Form'!$B$18=\"Y\",\"Yes\", \"No\")","v":"No"},"Attributed PCP Provider ID","NPI linkage","ATTRIBUTEDPCPPROVIDERID_LINKAGE_ID","Integer",20,null,"Derived","CHIA",null,"Y","N","None"]
[1,"ME051",{"$f":"IF('Legal Approval Form'!$B$18=\"Y\",\"Yes\", \"No\")","v":"No"},"Behavioral Health Benefit Flag",null,"BEHAVIORALHEALTHBENEFITFLAG","Char",1,null,null,null,null,"Y","N","None"]
[1,"ME114",{"$f":"IF('Legal Approval Form'!$B$18=\"Y\",\"Yes\", \"No\")","v":"No"},"Behavioral Health Deductible",null,"BEHAVIORALHEALTHDEDUCTIBLE","Numeric",18.2,null,null,null,null,"Y","N","None"]
[1,"ME063",{"$f":"IF('Legal Approval Form'!$B$18=\"Y\",\"Yes\", \"No\")","v":"No"},"Benefit Status",null,"BENEFITSTATUS","Char",1,null,null,null,null,"Y","N","None"]
[1,"ME127",{"$f":"IF('Legal Approval Form'!$B$18=\"Y\",\"Yes\", \"No\")","v":"No"},"Billable Member",null,"BILLABLEMEMBER","Char",1,null,null,null,null,"Y","N","None"]
[1,"ME055",{"$f":"IF('Legal Approval Form'!$B$18=\"Y\",\"Yes\", \"No\")","v":"No"},"Business Type Code",null,"BUSINESSTYPECODE","Char",1,null,null,null,null,"Y","N","None"]
[1,"ME066",{"$f":"IF('Legal Approval Form'!$B$18=\"Y\",\"Yes\", \"No\")","v":"No"},"COBRA Status",null,"COBRASTATUS","Char",1,null,null,null,null,"Y","N","None"]
[1,"ME122",{"$f":"IF('Legal Approval Form'!$B$18=\"Y\",\"Yes\", \"No\")","v":"No"},"Coinsurance Maximum %",null,"COINSURANCEMAXIMUM","Char",1,null,null,null,null,"Y","N","None","This should be an integer (Domain 1 - 9)"]
[1,"ME007",{"$f":"IF('Legal Approval Form'!$B$18=\"Y\",\"Yes\", \"No\")","v":"No"},"Coverage Level Code",null,"COVERAGELEVELCODE","Char",3,null,null,null,null,"Y","N","None"]
[1,"ME029",{"$f":"IF('Legal Approval Form'!$B$18=\"Y\",\"Yes\", \"No\")","v":"No"},"Coverage Type",null,"COVERAGETYPE","Char",3,null,null,null,null,"Y","N","None"]
[1,"ME020",{"$f":"IF('Legal Approval Form'!$B$18=\"Y\",\"Yes\", \"No\")","v":"No"},"Dental Coverage",null,"DENTALCOVERAGE","Char",1,null,null,null,null,"Y","N","None"]
[1,"ME115",{"$f":"IF('Legal Approval Form'!$B$18=\"Y\",\"Yes\", \"No\")","v":"No"},"Dental Deductible",null,"DENTALDEDUCTIBLE","Numeric",18.2,null,null,null,null,"Y","N","None"]
[1,"ME053",{"$f":"IF('Legal Approval Form'!$B$18=\"Y\",\"Yes\", \"No\")","v":"No"},"Disease Management Enrollee Flag",null,"DISEASEMANAGEMENTENROLLEEFLAG","Char",1,null,null,null,null,"Y","N","None"]
[1,"ME064",{"$f":"IF('Legal Approval Form'!$B$18=\"Y\",\"Yes\", \"No\")","v":"No"},"Employee Type",null,"EMPLOYEETYPE","Char",1,null,null,null,null,"Y","N","None"]
[1,"ME073",{"$f":"IF('Legal Approval Form'!$B$18=\"Y\",\"Yes\", \"No\")","v":"No"},"Fully insured member",null,"FULLYINSUREDMEMBER","Char",1,null,null,null,null,"Y","N","None"]
[1,"ME035",{"$f":"IF('Legal Approval Form'!$B$18=\"Y\",\"Yes\", \"No\")","v":"No"},"Health Care Home Assigned Flag",null,"HEALTHCAREHOMEASSIGNEDFLAG","Char",1,null,null,null,null,"Y","N","None"]
[1,"ME038",{"$f":"IF('Legal Approval Form'!$B$18=\"Y\",\"Yes\", \"No\")","v":"No"},"Health Care Home National Provider ID","NPI value","HEALTHCAREHOMENATIONALPROVIDERIDCLEANED","Char",10,null,"Cleaned",null,null,"Y","N","None"]
[1,"ME036",{"$f":"IF('Legal Approval Form'!$B$18=\"Y\",\"Yes\", \"No\")","v":"No"},"Health Care Home Number",null,"HEALTHCAREHOMENUMBER_LINKAGE_ID","Integer",20,null,"Derived","Y",null,"Y","N","None"]
[1,"ME012",{"$f":"IF('Legal Approval Form'!$B$18=\"Y\",\"Yes\", \"No\")","v":"No"},"Individual Relationship Code",null,"INDIVIDUALRELATIONSHIPCODE","Char",2,null,null,null,null,"Y","N","None"]
[1,"ME003",{"$f":"IF('Legal Approval Form'!$B$18=\"Y\",\"Yes\", \"No\")","v":"No"},"Insurance Type Code/Product",null,"INSURANCETYPECODEPRODUCT","Char",2,null,null,null,null,"Y","N","None"]
[1,"ME074",{"$f":"IF('Legal Approval Form'!$B$18=\"Y\",\"Yes\", \"No\")","v":"No"},"Interpreter",null,"INTERPRETERCLEANED","Char",1,null,"Cleaned",null,null,"Y","N","None"]
[1,"ME052",{"$f":"IF('Legal Approval Form'!$B$18=\"Y\",\"Yes\", \"No\")","v":"No"},"Laboratory Benefit Flag",null,"LABORATORYBENEFITFLAG","Char",1,null,null,null,null,"Y","N","None"]
[1,"ME056",{"$f":"IF('Legal Approval Form'!$B$18=\"Y\",\"Yes\", \"No\")","v":"No"},"Last Activity Date",null,"LASTACTIVITYDATE","Integer",8,null,"YYYYMMDD",null,null,"Y","N","None"]
[1,"ME056",{"$f":"IF('Legal Approval Form'!$B$18=\"Y\",\"Yes\", \"No\")","v":"No"},"Last Activity Date - Month",null,"LASTACTIVITYDATEMONTH","Char",2,null,"MM",null,null,"Y","N","None"]
[1,"ME056",{"$f":"IF('Legal Approval Form'!$B$18=\"Y\",\"Yes\", \"No\")","v":"No"},"Last Activity Date - Year",null,"LASTACTIVITYDATEYEAR","Char",4,null,"YYYY",null,null,"Y","N","None"]
[1,"Derived",{"$f":"IF('Legal Approval Form'!$B$18=\"Y\",\"Yes\", \"No\")","v":"No"},"Linking OrgID Product",null,"LINKORGIDPR","Integer",6,null,null,null,null,"Y","N","None"]
[1,"Derived",{"$f":"IF('Legal Approval Form'!$B$18=\"Y\",\"Yes\", \"No\")","v":"No"},"Linking OrgID Provider",null,"LINKORGIDPV","Integer",6,null,null,null,null,"Y","N","None"]
[1,"ME030",{"$f":"IF('Legal Approval Form'!$B$18=\"Y\",\"Yes\", \"No\")","v":"No"},"Market Category Code",null,"MARKETCATEGORYCODE","Char",4,null,null,null,null,"Y","N","None"]
[1,"Derived",{"$f":"IF('Legal Approval Form'!$B$18=\"Y\",\"Yes\", \"No\")","v":"No"},"Medicaid/HSN Indicator",null,"MEDICAIDHSNINDICATOR","Logical",1,null,"1,0",null,null,"Y","N","None"]
[1,"ME113",{"$f":"IF('Legal Approval Form'!$B$18=\"Y\",\"Yes\", \"No\")","v":"No"},"Medical and Pharmacy Deductible",null,"MEDICALANDPHARMACYDEDUCTIBLE","Numeric",18.2,null,null,null,null,"Y","N","None"]
[1,"ME018",{"$f":"IF('Legal Approval Form'!$B$18=\"Y\",\"Yes\", \"No\")","v":"No"},"Medical Coverage",null,"MEDICALCOVERAGE","Char",1,null,null,null,null,"Y","N","None"]
[1,"ME111",{"$f":"IF('Legal Approval Form'!$B$18=\"Y\",\"Yes\", \"No\")","v":"No"},"Medical Deductible",null,"MEDICALDEDUCTIBLE","Numeric",18.2,null,null,null,null,"Y","N","None"]
[1,"ME081",{"$f":"IF('Legal Approval Form'!$B$18=\"Y\",\"Yes\", \"No\")","v":"No"},"Medicare Code",null,"MEDICARECODE","Char",1,null,null,null,null,"Y","N","None"]
[1,"Derived",{"$f":"IF(AND('Legal Approval Form'!$B$18=\"Y\",'Legal Approval Form'!$B$33=\"N\"),\"Yes\",\"No\")","v":"No"},"Member Age At Enrollment","Age >89<=115 set to '90', Invalid age set to null","MEMBERAGEYEARSASOFSUBDE","Integer",3,null,"Cleaned",null,null,"Y","Y","If age 90 or older, CHIA will suppress or recode to denote 'over 89' ","We will use 90… conforming to OCDW standard. ","Create New column: MEMBERAGEYEARSASOFSUBDE\nCase when MEMBERAGEYEARSASOFSUBREDACTED > \"89\"\nSet MEMBERAGEYEARSASOFSUBDE = \"90\" (char 2)\nElse  Set MEMBERAGEYEARSASOFSUBDE = MEMBERAGEYEARSASOFSUBREDACTED"]
[1,"ME130",{"$f":"IF('Legal Approval Form'!$B$18=\"Y\",\"Yes\", \"No\")","v":"No"},"Member Benefit Plan Contract Enrollment End Date",null,"MEMBERBENEFITPLANCONTRACTENROLLMENTENDDATE","Integer",8,null,"YYYYMMDD",null,null,"Y","N","None"]
[1,"ME130",{"$f":"IF('Legal Approval Form'!$B$18=\"Y\",\"Yes\", \"No\")","v":"No"},"Member Benefit Plan Contract Enrollment End Date - Month",null,"MEMBERBENEFITPLANCONTRACTENROLLMENTENDDATEMONTH","Char",2,null,"MM",null,null,"Y","N","None"]
[1,"ME130",{"$f":"IF('Legal Approval Form'!$B$18=\"Y\",\"Yes\", \"No\")","v":"No"},"Member Benefit Plan Contract Enrollment End Date - Year",null,"MEMBERBENEFITPLANCONTRACTENROLLMENTENDDATEYEAR","Char",4,null,"YYYY",null,null,"Y","N","None"]
[1,"ME129",{"$f":"IF('Legal Approval Form'!$B$18=\"Y\",\"Yes\", \"No\")","v":"No"},"Member Benefit Plan Contract Enrollment Start Date",null,"MEMBERBENEFITPLANCONTRACTENROLLMENTSTARTDATE","Integer",8,null,"YYYYMMDD",null,null,"Y","N","None"]
[1,"ME129",{"$f":"IF('Legal Approval Form'!$B$18=\"Y\",\"Yes\", \"No\")","v":"No"},"Member Benefit Plan Contract Enrollment Start Date - Month",null,"MEMBERBENEFITPLANCONTRACTENROLLMENTSTARTDATEMONTH","Char",2,null,"MM",null,null,"Y","N","None"]
[1,"ME129",{"$f":"IF('Legal Approval Form'!$B$18=\"Y\",\"Yes\", \"No\")","v":"No"},"Member Benefit Plan Contract Enrollment Start Date - Year",null,"MEMBERBENEFITPLANCONTRACTENROLLMENTSTARTDATEYEAR","Char",4,null,"YYYY","CHIA",null,"Y","N","None"]
[1,"ME014",{"$f":"IF(AND('Legal Approval Form'!$B$18=\"Y\",'Legal Approval Form'!$B$33=\"N\"),\"Yes\",\"No\")","v":"No"},"Member Birth (Month Only)",null,"memberbirthmonthde","Char",2,null,null,null,null,"Y","Y","If age 90 or older, CHIA will suppress or recode to denote 'over 89' ","Scott confirmed redaction required.  We will use '999' as default redaction value here. ","Set MEMBERDATEOFBIRTHMONTH = \"99\" (Char 2) when MEMBERDATEOFBIRTHYEARCLEANED = \"999\""]
[1,"ME014",{"$f":"IF(AND('Legal Approval Form'!$B$18=\"Y\",'Legal Approval Form'!$B$33=\"N\"),\"Yes\",\"No\")","v":"No"},"Member Birth (Year Only)","Redacted for age > 89","MEMBERDATEOFBIRTHYEARCLEANED","Char",4,null,"Cleaned",null,null,"Y","Y","If age 90 or older, CHIA will suppress or recode to denote 'over 89' ","Currently older than 89 is being set to \"999\"","No action needed"]
[1,"ME049",{"$f":"IF('Legal Approval Form'!$B$18=\"Y\",\"Yes\", \"No\")","v":"No"},"Member Deductible",null,"MEMBERDEDUCTIBLE","Numeric",18.2,null,null,null,null,"Y","N","None"]
[1,"ME050",{"$f":"IF('Legal Approval Form'!$B$18=\"Y\",\"Yes\", \"No\")","v":"No"},"Member Deductible Used",null,"MEMBERDEDUCTIBLEUSED","Numeric",18.2,null,null,null,null,"Y","N","None"]
[1,"Derived",{"$f":"IF('Legal Approval Form'!$B$18=\"Y\",\"Yes\", \"No\")","v":"No"},"Member Eligibility ID","This is the ME unique record id ","MEMBERELIGIBILITYID","Integer",9,null,"Derived",null,null,"Y","N","None"]
[1,"ME013",{"$f":"IF(AND('Legal Approval Form'!$B$18=\"Y\",'Legal Approval Form'!$B$33=\"N\"),\"Yes\",\"No\")","v":"No"},"Member Gender",null,"MEMBERGENDERDE","Char",1,null,"Cleaned",null,null,"Y","Y","Male, Female, Unknown","Note: MEMBERGENDERCLEANED is currently  99+% (M, F, U)","See \"UVR - Deidentify Gender.docx\""]
[1,"ME033",{"$f":"IF(AND('Legal Approval Form'!$B$18=\"Y\",'Legal Approval Form'!$B$33=\"N\"),\"Yes\",\"No\")","v":"No"},"Member language preference",null,"MEMBERLANGUAGEPREFERENCEDE","Char",3,null,"Cleaned",null,null,"Y","Y","Field will be updated in CHIA's Submission Guide to only allow entries of codes for English, Spanish, Other, Unknown/Not Specified (Transformed in See Section 6.2.4)","Allow only English, Spanish, or Other.… Group everything else into Other (997). Note: cleaning glitch - 995 should not be showing up in cleaned (tiny percentage ).","Release spec:   Where  MEMBERLANGUAGEPREFERENCECLEANED not in ('600','625','997') then set MEMBERLANGUAGEPREFERENCEDE = '997'"]
[]
[1,"ME047",{"$f":"IF('Legal Approval Form'!$B$18=\"Y\",\"Yes\", \"No\")","v":"No"},"Member PCP Effective Date",null,"MEMBERPCPEFFECTIVEDATE","Integer",8,null,"YYYYMMDD",null,null,"Y","N","None"]
[1,"ME047",{"$f":"IF('Legal Approval Form'!$B$18=\"Y\",\"Yes\", \"No\")","v":"No"},"Member PCP Effective Date - Month",null,"MEMBERPCPEFFECTIVEDATEMONTH","Char",2,null,"MM",null,null,"Y","N","None"]
[1,"ME047",{"$f":"IF('Legal Approval Form'!$B$18=\"Y\",\"Yes\", \"No\")","v":"No"},"Member PCP Effective Date - Year",null,"MEMBERPCPEFFECTIVEDATEYEAR","Char",4,null,"YYYY",null,null,"Y","N","None"]
[1,"ME046",{"$f":"IF('Legal Approval Form'!$B$18=\"Y\",\"Yes\", \"No\")","v":"No"},"Member PCP ID",null,"MEMBERPCPID_LINKAGE_ID","Integer",20,null,"Derived","Y",null,"Y","N","None"]
[1,"ME048",{"$f":"IF('Legal Approval Form'!$B$18=\"Y\",\"Yes\", \"No\")","v":"No"},"Member PCP Termination Date",null,"MEMBERPCPTERMINATIONDATE","Integer",8,null,"YYYYMMDD",null,null,"Y","N","None"]
[1,"ME048",{"$f":"IF('Legal Approval Form'!$B$18=\"Y\",\"Yes\", \"No\")","v":"No"},"Member PCP Termination Date - Month",null,"MEMBERPCPTERMINATIONDATEMONTH","Char",2,null,"MM",null,null,"Y","N","None"]
[1,"ME048",{"$f":"IF('Legal Approval Form'!$B$18=\"Y\",\"Yes\", \"No\")","v":"No"},"Member PCP Termination Date - Year",null,"MEMBERPCPTERMINATIONDATEYEAR","Char",4,null,"YYYY",null,null,"Y","N","None"]
[1,"ME077",{"$f":"IF('Legal Approval Form'!$B$18=\"Y\",\"Yes\", \"No\")","v":"No"},"Members SIC Code",null,"MEMBERSSICCODE","Char",6,null,null,null,null,"Y","N","None"]
[1,"ME121",{"$f":"IF('Legal Approval Form'!$B$18=\"Y\",\"Yes\", \"No\")","v":"No"},"Metal Level",null,"METALLEVEL","Char",1,null,null,null,null,"Y","N","None"]
[1,"ME005",{"$f":"IF('Legal Approval Form'!$B$18=\"Y\",\"Yes\", \"No\")","v":"No"},"Month",null,"MONTH","Integer",2,null,null,null,null,"Y","N","None"]
[1,"ME123",{"$f":"IF('Legal Approval Form'!$B$18=\"Y\",\"Yes\", \"No\")","v":"No"},"Monthly Premium",null,"MONTHLYPREMIUM","Numeric",18.2,null,null,null,null,"Y","N","None"]
[1,"ME075",{"$f":"IF('Legal Approval Form'!$B$18=\"Y\",\"Yes\", \"No\")","v":"No"},"NewMMISID",null,"CHIANEWMMISID","Integer",20,null,null,"CHIA",null,"Y","N","None"]
[1,"ME107",{"$f":"IF('Legal Approval Form'!$B$18=\"Y\",\"Yes\", \"No\")","v":"No"},"Carrier Specific Unique Member ID",null,"CHIACARRIERSPECIFICUNIQUEMEMBERID","Integer",20,null,null,"CHIA",null,"Y","N","None"]
[1,"ME117",{"$f":"IF('Legal Approval Form'!$B$18=\"Y\",\"Yes\", \"No\")","v":"No"},"Carrier Specific Unique Subscriber ID",null,"CHIACARRIERSPECIFICUNIQUESUBSCRIBERID","Integer",20,null,null,"CHIA",null,"Y","N","None"]
[1,"ME112",{"$f":"IF('Legal Approval Form'!$B$18=\"Y\",\"Yes\", \"No\")","v":"No"},"Pharmacy Deductible",null,"PHARMACYDEDUCTIBLE","Numeric",18.2,null,null,null,null,"Y","N","None"]
[1,"ME019",{"$f":"IF('Legal Approval Form'!$B$18=\"Y\",\"Yes\", \"No\")","v":"No"},"Prescription Drug Coverage",null,"PRESCRIPTIONDRUGCOVERAGE","Char",1,null,null,null,null,"Y","N","None"]
[1,"ME028",{"$f":"IF('Legal Approval Form'!$B$18=\"Y\",\"Yes\", \"No\")","v":"No"},"Primary Insurance Indicator",null,"PRIMARYINSURANCEINDICATOR","Char",1,null,null,null,null,"Y","N","None"]
[1,"ME042",{"$f":"IF('Legal Approval Form'!$B$18=\"Y\",\"Yes\", \"No\")","v":"No"},"Product Enrollment End Date",null,"PRODUCTENROLLMENTENDDATE","Integer",8,null,"YYYYMMDD",null,null,"Y","N","None"]
[1,"ME042",{"$f":"IF('Legal Approval Form'!$B$18=\"Y\",\"Yes\", \"No\")","v":"No"},"Product Enrollment End Date - Month",null,"PRODUCTENROLLMENTENDDATEMONTH","Char",2,null,"MM",null,null,"Y","N","None"]
[1,"ME042",{"$f":"IF('Legal Approval Form'!$B$18=\"Y\",\"Yes\", \"No\")","v":"No"},"Product Enrollment End Date - Year",null,"PRODUCTENROLLMENTENDDATEYEAR","Char",4,null,"YYYY",null,null,"Y","N","None"]
[1,"ME041",{"$f":"IF('Legal Approval Form'!$B$18=\"Y\",\"Yes\", \"No\")","v":"No"},"Product Enrollment Start Date",null,"PRODUCTENROLLMENTSTARTDATE","Integer",8,null,"YYYYMMDD",null,null,"Y","N","None"]
[1,"ME041",{"$f":"IF('Legal Approval Form'!$B$18=\"Y\",\"Yes\", \"No\")","v":"No"},"Product Enrollment Start Date - Month",null,"PRODUCTENROLLMENTSTARTDATEMONTH","Char",2,null,"MM",null,null,"Y","N","None"]
[1,"ME041",{"$f":"IF('Legal Approval Form'!$B$18=\"Y\",\"Yes\", \"No\")","v":"No"},"Product Enrollment Start Date - Year",null,"PRODUCTENROLLMENTSTARTDATEYEAR","Char",4,null,"YYYY",null,null,"Y","N","None"]
[1,"ME040",{"$f":"IF('Legal Approval Form'!$B$18=\"Y\",\"Yes\", \"No\")","v":"No"},"Product ID Number","Surrogate key","PRODUCTIDNUMBER_LINKING_ID","Char",20,null,"Derived","Y",null,"Y","N","None"]
[1,"ME045",{"$f":"IF('Legal Approval Form'!$B$18=\"Y\",\"Yes\", \"No\")","v":"No"},"Purchased through Massachusetts Exchange Flag","Eg. values 0,1,2,3,5,N,Y","PURCHASEDTHROUGHMASSACHUSETTSEXCHANGEFLAG","Char",1,null,null,null,null,"Y","N","None"]
[1,"ME126",{"$f":"IF('Legal Approval Form'!$B$18=\"Y\",\"Yes\", \"No\")","v":"No"},"Risk Adjustment Covered Plan (RACP)",null,"RISKADJUSTMENTCOVEREDBENEFITPLAN","Char",1,null,null,null,null,"Y","N","None"]
[1,"ME031",{"$f":"IF('Legal Approval Form'!$B$18=\"Y\",\"Yes\", \"No\")","v":"No"},"Special Coverage",null,"SPECIALCOVERAGE","Char",3,null,null,null,null,"Y","N","None"]
[1,"Derived",{"$f":"IF('Legal Approval Form'!$B$18=\"Y\",\"Yes\", \"No\")","v":"No"},"Submission Control ID",null,"SUBMISSIONCONTROLID","Integer",8,null,"Derived",null,null,"Y","N","None"]
[1,"Derived",{"$f":"IF('Legal Approval Form'!$B$18=\"Y\",\"Yes\", \"No\")","v":"No"},"Line Number ","CHIA Derived - Sequence record Id unique w/in Submission control id","LINENUMBER","Integer",10,null,null,null,null,null,null,null,"C. Kane added this to DeIdentified- using same logic as submissioncontrolid"]
[1,"HD005",{"$f":"IF('Legal Approval Form'!$B$18=\"Y\",\"Yes\", \"No\")","v":"No"},"Submission Year and Month",null,"SUBMISSIONYEARMONTH","Integer",6,null,"YYYYMM",null,null,"Y","N","None"]
[1,"ME001",{"$f":"IF('Legal Approval Form'!$B$18=\"Y\",\"Yes\", \"No\")","v":"No"},"Submitter","Submitting ORGID","ORGID","Integer",6,null,"Defined as Char on SG - Integer in all CHIA tables & views.",null,null,"Y","N","None"]
[1,"ME131",{"$f":"IF('Legal Approval Form'!$B$18=\"Y\",\"Yes\", \"No\")","v":"No"},"TME Global Budget/Payment Indicator",null,"TMEGLOBALBUDGETPAYMENTINDICATOR","Char",1,null,null,null,null,"Y","N","None"]
[1,"ME125",{"$f":"IF('Legal Approval Form'!$B$18=\"Y\",\"Yes\", \"No\")","v":"No"},"TME OrgID - Physician Group of the Member’s PCP","ORGID - always Integer","TMEPROVIDERORGID","Integer",6,null,null,null,null,"Y","N","None"]
[1,"ME132",{"$f":"IF('Legal Approval Form'!$B$18=\"Y\",\"Yes\", \"No\")","v":"No"},"Total Monthly Premium",null,"TOTALCONTRIBUTION","Numeric",18.2,null,"Max value a/o 2019 = $274,518.00",null,null,"Y","N","None"]
[1,"ME118",{"$f":"IF('Legal Approval Form'!$B$18=\"Y\",\"Yes\", \"No\")","v":"No"},"Vision Benefit",null,"VISIONBENEFIT","Char",1,null,null,null,null,"Y","N","None"]
[1,"ME116",{"$f":"IF('Legal Approval Form'!$B$18=\"Y\",\"Yes\", \"No\")","v":"No"},"Vision Deductible",null,"VISIONDEDUCTIBLE","Numeric",18.2,null,null,null,null,"Y","N","None"]
[1,"ME004",{"$f":"IF('Legal Approval Form'!$B$18=\"Y\",\"Yes\", \"No\")","v":"No"},"Year",null,"YEAR","Integer",4,null,null,null,null,"Y","N","None"]
[1,"ME065",{"$f":"IF('Legal Approval Form'!$B$18=\"Y\",\"Yes\", \"No\")","v":"No"},"Date of Retirement - GIC Only",null,"DATEOFRETIREMENT","Integer",8,null,null,null,null,"Y","N","None","OK per Amendment"]
[1,"ME054",{"$f":"IF('Legal Approval Form'!$B$18=\"Y\",\"Yes\", \"No\")","v":"No"},"Eligibility Determination Date - GIC Only",null,"ELIGIBILITYDETERMINATIONDATE","Integer",8,null,null,null,null,"Y","N","None","OK per Amendment"]
[1,"ME060",{"$f":"IF('Legal Approval Form'!$B$18=\"Y\",\"Yes\", \"No\")","v":"No"},"Employment Status - GIC Only",null,"EMPLOYMENTSTATUS","Char",1,null,null,null,null,"Y","N","None","OK per Amendment"]
[1,"ME071",{"$f":"IF('Legal Approval Form'!$B$18=\"Y\",\"Yes\", \"No\")","v":"No"},"Pool Indicator - GIC Only",null,"POOLINDICATOR","Char",1,null,null,null,null,"Y","N","None","OK per Amendment"]
[1,"ME078",{"$f":"IF(AND('Legal Approval Form'!$B$18=\"Y\",'Legal Approval Form'!$B$33=\"N\"),\"Yes\",\"No\")","v":"No"},"Employer Zip Code",null,"employerzipcodeDE","Char",5,null,null,null,null,"Y","Y","FileSecure software will map ZIP codes as prescribed prior to data being uploaded to CHIA (see Table 4, CHIA Remapped Geocodes) (See Section 6.2.2)","Employer zip - note released AS IS in Identifiable (Gov).  Redact and Remap using same approach as member zip","Derive new deidentified column:  employerzipcodeDE   1. Must be a valid MA zip code 2. Remap MA validated Zip code.  See document: Universal Release - Deidentify Zip Code.docx"]
[]
["ID - Member Eligibility (ME) - Identifiable (L2) Elements"]
["Release Level","Data Element Source","Included   (this request)","Data Element Name","CHIA Notes","Release Column Name","Data Type","Length","FLAG Carrier Specific TLKP","Notes","CHIA Code","Redaction","De-Identified Set","OnPoint Mitigation","Onpoint De-Identification Requirement"," 2025 UVR Release Comments ","Action"]
[2,"Derived",{"$f":"IF(AND('Legal Approval Form'!$B$18=\"Y\",'Legal Approval Form'!$B$33=\"Y\"),\"Yes\",\"No\")","v":"No"},"Member Age At Enrollment","Not redacted for Age > 89","MEMBERAGEYEARSASOFSUB","Integer",null,null,null,null,null,"N",null,"Not reviewed","Unredacted age, includes ages >89"]
[2,"ME014",{"$f":"IF(AND('Legal Approval Form'!$B$18=\"Y\",'Legal Approval Form'!$B$33=\"Y\"),\"Yes\",\"No\")","v":"No"},"Member Date of Birth (Year and Month)","Format YYYYMM (Not redacted for Age > 89)","MEMBERDATEOFBIRTHYEARMONTH","Integer",6,null,"YYYYMM",null,null,"N",null,"Not reviewed","Unredacted MEMBERDATEOFBIRTHYEARMONTH is OK for identifiable release. ","Confirmed - No action"]
[2,"ME128",{"$f":"IF(AND('Legal Approval Form'!$B$18=\"Y\",'Legal Approval Form'!$B$33=\"Y\"),\"Yes\",\"No\")","v":"No"},"Benefit Plan Contract ID",null,"BENEFITPLANCONTRACTID","Char ",30,null,null,null,null,"N ",null,"Not reviewed","Benefit Plan Contract ID"]
[2,"ME076",{"$f":"IF(AND('Legal Approval Form'!$B$18=\"Y\",'Legal Approval Form'!$B$33=\"Y\"),\"Yes\",\"No\")","v":"No"},"Member rating category",null,"MEMBERRATINGCATEGORY","Char",2,1,null,null,null,"N ",null,"Not reviewed"]
[2,"ME013",{"$f":"IF(AND('Legal Approval Form'!$B$18=\"Y\",'Legal Approval Form'!$B$33=\"Y\"),\"Yes\",\"No\")","v":"No"},"Member Gender",null,"MEMBERGENDERCLEANED","Char",1,null,"Cleaned",null,null,"N",null,"See: MEMBERGENDERDE","Note: MEMBERGENDERCLEANED is currently 99+% (M, F, U). But all valid domain values are included here… ","Incude this column in Gov (identified data) Release, with no redaction or transformations. "]
[2,"ME033",{"$f":"IF(AND('Legal Approval Form'!$B$18=\"Y\",'Legal Approval Form'!$B$33=\"Y\"),\"Yes\",\"No\")","v":"No"},"Member language preference",null,"MEMBERLANGUAGEPREFERENCECLEANED","Char",3,null,"Cleaned",null,null,"N",null,"As reported. See also DE version. ",null,"No action"]
[2,"ME078",{"$f":"IF(AND('Legal Approval Form'!$B$18=\"Y\",'Legal Approval Form'!$B$33=\"Y\"),\"Yes\",\"No\")","v":"No"},"Employer Zip Code",null,"EMPLOYERZIPCODE","Char",5,null,null,null,null,"N",null,"FileSecure software currently maps ZIP codes as prescribed prior to data being uploaded to CHIA (see Table 4, CHIA Remapped Geocodes) (See Section 6.2.2)","Employer zip - CHIA may release AS IS in Identifiable (GOV) release.  Currently is already remapped but in future FileSecure should not remap.","Incude this column in Gov (identified data) Release, with no redaction or transformations. "]
[]
["SR - Patient Identifiable, (L3) Special Release"]
["Release Level","Data Element Source","Included   (this request)","Data Element Name","CHIA Notes","Release Column Name","Data Type","Length","FLAG Carrier Specific TLKP","Notes","CHIA Code","Redaction","De-Identified Set","OnPoint Mitigation","Onpoint De-Identification Requirement"," 2025 UVR Release Comments ","Action"]
[3,"ME107","SR Only","Carrier Specific Unique Member ID","Reported - decrypted","CARRIERSPECIFICUNIQUEMEMBERID","Char",50,null,null,"Encryp",null,"N",null,"Not reviewed","Moved from L3  for UR - Rarely requested. We can decrypt and release as Identifiable if approved. "]
[3,"ME117","SR Only","Carrier Specific Unique Subscriber ID","Reported - decrypted","CARRIERSPECIFICUNIQUESUBSCRIBERID","Char",50,null,null,"Encryp",null,"N",null,"Not reviewed","Moved from L3  for UR - Rarely requested. We can decrypt and release as Identifiable if approved. "]
[3,"ME124","SR Only","Attributed PCP Provider ID","linkage-id used L2, but keep reported ","ATTRIBUTEDPCPPROVIDERID","Char",30,null,null,null,null,"N",null,"Not reviewed","SR (direct identifiers, sensitive or Internal use)"]
[3,"ME083","SR Only","Employer EIN",null,"EMPLOYEREIN","Char",9,null,null,null,null,"N",null,"Not reviewed","formerly L3 - changed to SR per Scott in Legal 2/11/2020"]
[3,"ME082","SR Only","Employer Name  ",null,"EMPLOYERNAMECLEANED","Char",60,null,null,null,"Y","N",null,"Not reviewed","formerly L3 - changed to SR per Scott in Legal 2/11/2020"]
[3,"ME032","SR Only","Group Name",null,"GROUPNAME","Char",50,null,null,"Encryp",null,"N",null,"Not reviewed","If approved for release - Decrypt on extract or rendering view."]
[3,"ME036","SR Only","Healthcare Home Number","linkage-id used, but keep reported ","HEALTHCAREHOMENUMBER","Char",30,null,null,null,null,"N",null,"Not reviewed","SR (direct identifiers, sensitive or Internal use)"]
[3,"ME046","SR Only","Member PCP ID","linkage-id used, but keep reported ","MEMBERPCPIDCLEANED","Char",30,null,null,null,null,"N",null,"Not reviewed","SR (direct identifiers, sensitive or Internal use)"]
[3,"ME010","SR Only","Member Suffix or Sequence Number",null,"MEMBERSUFFIXORSEQUENCENUMBER","Char",20,null,null,null,null,"N",null,"Not reviewed","SR (direct identifiers, sensitive or Internal use)"]
[3,"ME075","SR Only","NewMMISID","Reported - decrypted","NEWMMISID","Char",12,null,null,"Encryp",null,"N",null,"Not reviewed","If approved for release - Decrypt on extract or rendering view."]
[3,"ME009","SR Only","Plan Specific Contract Number"," ","PLANSPECIFICCONTRACTNUMBER","Char",30,null,null,"Encryp",null,"N",null,"Not reviewed","If approved for release - Decrypt on extract or rendering view."]
[3,"ME040","SR Only","Product ID Number","linkage-id used, but keep reported ","PRODUCTIDNUMBER","Char",30,null,null,null,null,"N",null,"Not reviewed","SR (direct identifiers, sensitive or Internal use)"]
[3,"ME080","SR Only","Recipient Historical Number (MassHealth only)",null,"RECIPIENTHISTORICALNUMBER","Char",15,null,null,"Encryp",null,"N",null,"Not reviewed","If approved for release - Decrypt on extract or rendering view."]
[3,"ME079","SR Only","Recipient Identification Number (MassHealth only)",null,"RECIPIENTIDENTIFICATIONNUMBER","Char",15,null,null,"Encryp",null,"N",null,"Not reviewed","If approved for release - Decrypt on extract or rendering view."]
[3,"ME069","SR Only","Spouse Medical Coverage - GIC Only",null,"SPOUSEMEDICALCOVERAGE","Char",2,1,null,null,null,"N",null,"Remove","Remove per Amendment"]
[3,"ME070","SR Only","Spouse Medicare Indicator - GIC Only",null,"SPOUSEMEDICAREINDICATOR","Char",2,1,null,null,null,"N",null,"Remove","Remove per Amendment"]
[3,"ME068","SR Only","Spouse Plan - GIC Only",null,"SPOUSEPLAN","Char",2,1,null,null,null,"N",null,"Remove","Remove per Amendment"]
[3,"ME067","SR Only","Spouse Plan Type - GIC Only",null,"SPOUSEPLANTYPE","Char",2,1,null,null,null,"N",null,"Remove","Remove per Amendment"]
[3,"ME006","SR Only","Insured Group or Policy Number",null,"INSUREDGROUPORPOLICYNUMBER","Char",30,null,null,"Encryp",null,"N",null,"Not reviewed","If approved for release - Decrypt on extract or rendering view. (Moved to Level 3 CY021)","Moved to SR per Scott 8/20/25"]
[3,"ME037","SR Only","Health Care Home Tax ID Number",null,"HEALTHCAREHOMETAXIDNUMBER","Char",9,null,null,null,null,"N",null,"Not reviewed","Moved to L3 CY2022 for consistency across TaxId's","Moved to SR per Scott 8/20/25"]
[]
["NR - No Release - Internal Use and/or Deprecated Columns"]
["Release Level","Data Element Source","Included   (this request)","Data Element Name","CHIA Notes","Release Column Name","Data Type","Length","FLAG Carrier Specific TLKP","Notes","CHIA Code","Redaction","De-Identified Set","OnPoint Mitigation","Onpoint De-Identification Requirement"," 2025 UVR Release Comments ","Action"]
[4,"Derived","NR","Create Date",null,"CREATEDATE","Date:Time",23,null,"timestamp",null,null,"N",null,"Not reviewed","NR (direct identifiers, sensitive or Internal use)"]
[4,"Derived","NR","RELEASEETLBATCHID",null,"RELEASEETLBATCHID","Integer",10,null,"ETL batch (Max value 490 a/o 2019)",null,null,"N",null,"Not reviewed","NR (direct identifiers, sensitive or Internal use)"]
[4,"ME135","NR","Aid Category",null,"AIDCATEGORY","Char",4,null,null,null,null,"N ",null,"CHIA will map codes as prescribed (See Section 6.2.1)","See MHEE if customer needs Aid Category. ","Originally planned to create new column: AIDCATEGORYDE - but determined that this column is no longer collected on the ME filing… therefore deprecating this column from future release."]
[4,"Derived","NR","Aid Category Disability Indicator","Domain Y, N, Null","AIDCATDISABILITYINDICATOR","Char",1,null,"Y, N",null,null,"N ",null,"This is a derived column based on reported AidCategory",null,"Deprecate this column"]
[4,"Derived","NR","Aid Category Premium assistance indicator",null,"AIDCATPREMIUMASSISTANCEINDICATOR","Char",1,null,"Y, N",null,null,"N ",null,"This is a derived column based on reported AidCategory",null,"Deprecate this column"]
[4,"Derived","NR","Aid Category Coverage type",null,"AIDCATCOVERAGETYPE","Char",30,null,"Derived",null,null,"N ",null,"This is a derived column based on reported AidCategory",null,"Deprecate this column"]
[4,"Derived","NR","Aid Category Population","CommCare,MassHealth, HSN etc. (Max 10 currently)","AIDCATPOPULATION","Char",10,null,"Derived",null,null,"Y","N","No remapping needed based on current aidcategory reassignment",null,"Deprecate this column"]
[4,"Derived","NR","Aid Category Temporary Coverage Type",null,"AIDCATTEMPORARYCOVERAGEINDICATOR","Char",1,null,"Y, N",null,null,"Y","N","No remapping needed based on current aidcategory reassignment",null,"Deprecate this column"]
[4,"Derived","NR","Member Zip (3)","Legacy LDS transformation -Deprecate ","memberzipcode_3_lds","Text",3,null,null,null,null,"N",null,null,"Drop 3 byte Zip - All de-identified request will get mapped 5-digit ZIP codes.All identified request will get reported 5-digit ZIP codes.","Deprecate all Zip Code and Geo Columns column"]
[4,"Derived","NR","Member Zip (5)","Legacy LDS transformation -Deprecate ","memberzipcode_5_lds","Text",3,null,null,null,null,"N",null,null,"Drop 5 byte LDS Zip - All de-identified request will get mapped 5-digit ZIP codes.","Deprecate all Zip Code and Geo Columns column"]
[4,"Derived","NR","Subscriber Zip (3)","Legacy LDS transformation -Deprecate ","subscriberzipcode_3_lds","Text",3,null,null,null,null,"N",null,null,"Drop 3 byte Zip - All de-identified request will get mapped 5-digit ZIP codes.All identified request will get reported 5-digit ZIP codes.","Deprecate all Zip Code and Geo Columns column"]
[4,"Derived","NR","Subscriber Zip (5)","Legacy LDS transformation -Deprecate ","subscriberzipcode_5_lds","Text",3,null,null,null,null,"N",null,null,"Drop 5 byte LDS Zip - All de-identified request will get mapped 5-digit ZIP codes.","Deprecate all Zip Code and Geo Columns column"]
[4,"Derived","NR","Member Zip (5)","Legacy LDS transformation ","memberzipcodeDE","Text",5,null,null,null,null,"Y","Y","FileSecure  (mostly)  remaps ZIP codes per Onpoint spec (see Table 4, CHIA Remapped Geocodes, Section 6.2.2)","New column: memberzipcodeDE        (replaces the LDS column, source MEMBERZIPCODECLEANED)","Derive memberzipcodeDE   1. Must be a valid MA zip code 2. Remap MA validated Zip code.  See document: Universal Release - Deidentify Zip Code.docx"]
[4,"ME016","NR","Member State or Province",null,"MEMBERSTATEORPROVINCEDE","Char",2,null,"Derived",null,null,"Y","Y","CHIA will map codes as prescribed. States would be reported as CT, MA, ME, NH, NY, RI, VT, or Other (Transformed according to Section 6.2.2)","Domain release values for LDS are congruent with Onpoint: LDS State transformation (NE + NY else XX).","Rename MEMBERSTATEORPROVINCELDS: MEMBERSTATEORPROVINCEDE   Or see specifications here: UVR - Deidentify State or Province.docx"]
[4,"Derived","NR","County of Member",null,"MEMBERCOUNTYDE","Char",24,null,"See \"County Derivation TRD Release 6.0.docx\"",null,null,"Y","Y","CHIA will update Member County to reflect assignment from mapped ZIP codes (Transformed according to Section 6.2.2)","New work - County remap after zip rollup . Create MEMBERCOUNTYDE","Create MEMBERCOUNTYDE     See specifications here: UVR - Deidentify State or Province.docx"]
[4,"Derived","NR","Subscriber Zip (5)","Legacy LDS transformation ","subscriberzipcodeDE","Text",5,null,null,null,null,"Y","Y","Remap small population zip codes. ","New column: subscriberzipcodeDE          (replaces the LDS column, source MEMBERZIPCODECLEANED)","Derive subscriberzipcodeDE     1. Must be a valid MA zip code 2. Remap MA validated Zip code.  See document: Universal Release - Deidentify Zip Code.docx"]
[4,"ME109","NR","Subscriber State or Province",null,"SUBSCRIBERSTATEORPROVINCEDE","Char",2,null,"Derived",null,null,"Y","Y","CHIA will map codes as prescribed. States would be reported as CT, MA, ME, NH, NY, RI, VT, or Other (Transformed according to Section 6.2.2)","Note domain release values for LDS are congruent with Onpoint - LDS State transformation (NE + NY else XX). ","Rename SUBSCRIBERSTATEORPROVINCELDS: SUBSCRIBERSTATEORPROVINCEDE     Or see specifications here: UVR - Deidentify State or Province.docx"]
[4,"Derived","NR","County of Subscriber",null,"SUBSCRIBERCOUNTYDE","Char",24,null,"See \"County Derivation TRD Release 6.0.docx\"",null,null,"Y","Y","CHIA will update Member County to reflect assignment from mapped ZIP codes (Transformed according to Section 6.2.2)","New work - County remap after zip rollup.  Create SUBSCRIBERCOUNTYDE","Create SUBSCRIBERCOUNTYDE   See specifications here: UVR - Deidentify State or Province.docx"]
[4,"ME017","NR","Member ZIP Code","No supression","MEMBERZIPCODECLEANED","Char",5,null,null,"Cleaned",null,"N",null,null,"Currently remapped on Intake for small zips but in the future will be as reported","No action"]
[4,"ME016","NR","Member State or Province","No supression","MEMBERSTATEORPROVINCE","Char",2,null,null,null,null,"N",null,null,"no suppression"]
[4,"Derived","NR","County of Member",null,"MEMBERCOUNTY","Char",24,null,"See \"County Derivation TRD Release 6.0.docx\"",null,null,"N",null,"See also deidentified version",null,"No action"]
[4,"ME110","NR","Subscriber ZIP Code","No supression","SUBSCRIBERZIPCODECLEANED","Char",5,null,null,"Cleaned",null,"N",null,null,"Currently remapped on Intake for small zips but in the future will be as reported","No action"]
[4,"ME109","NR","Subscriber State or Province","No supression","SUBSCRIBERSTATEORPROVINCE","Char",2,null,null,null,null,"N",null,null,"no suppression"]
[4,"Derived","NR","County of Subscriber",null,"SUBSCRIBERCOUNTY","Char",24,null,"See \"County Derivation TRD Release 6.0.docx\"",null,null,"N",null,"See also deidentified version",null,"No action"]
[4,"Derived","NR","Member Link EID","Moved to MEID File","MEMBERLINKEID","Integer",10,null,"Derived",null,null,"Y","N","None","MEMBERLINKEID is an alias for MEMBERMDMID, which is sourced from tbl_MDM_Member","Moved to separate MEID table"]

{"sheet":"PC","index":5,"n_rows":137,"n_cols":18,"rows_kept":137,"cut":false,"hidden":false,"merged":[]}
["Release Level","Data Element Source","Included   (this request)","Pharmacy Claims (PC) - Data Element Name","CHIA Notes","Release View Source Table","Release Column Name","Data Type","Length","FLAG Carrier Specific TLKP","Notes","CHIA Code","Redaction","De-Identififed Set","OnPoint Mitigation","Onpoint De-Identification Requirement - Amended"," 2025 UVR Release Comments ","Action"]
[1,"PC068",{"$f":"IF('Legal Approval Form'!$B$19=\"Y\",\"Yes\", \"No\")","v":"No"},"Allowed amount ",null,"TBL_CORE_PHARMACYCLAIM","ALLOWEDAMOUNTCLEANED","Numeric",18.2,null,"Cleaned",null,null,"Y","N","None"]
[1,"PC120",{"$f":"IF('Legal Approval Form'!$B$19=\"Y\",\"Yes\", \"No\")","v":"No"},"APCD ID Code",null,"TBL_CORE_PHARMACYCLAIM","APCDIDCODE","Char",1,null,null,null,null,"Y","N","None","OK per Amendment"]
[1,"PC107",{"$f":"IF('Legal Approval Form'!$B$19=\"Y\",\"Yes\", \"No\")","v":"No"},"Carrier Specific Unique Member ID","Surrogate key","TBL_CORE_PHARMACYCLAIM","CHIACARRIERSPECIFICUNIQUEMEMBERID","Integer",20,null,"Derived","CHIA",null,"Y","N","None"]
[1,"PC108",{"$f":"IF('Legal Approval Form'!$B$19=\"Y\",\"Yes\", \"No\")","v":"No"},"Carrier Specific Unique Subscriber ID","Surrogate key","TBL_CORE_PHARMACYCLAIM","CHIACARRIERSPECIFICUNIQUESUBSCRIBERID","Integer",20,null,"Derived","CHIA",null,"Y","N","None"]
[1,"PC035",{"$f":"IF('Legal Approval Form'!$B$19=\"Y\",\"Yes\", \"No\")","v":"No"},"Charge Amount",null,"TBL_CORE_PHARMACYCLAIM","CHARGEAMOUNTCLEANED","Numeric",18.2,null,"Cleaned",null,null,"Y","N","None"]
[1,"Derived",{"$f":"IF('Legal Approval Form'!$B$19=\"Y\",\"Yes\", \"No\")","v":"No"},"CHIA Incurred Full Date","YYYYMMDD","TBL_CORE_PHARMACYCLAIM","INCURREDFULLDATE","Integer",8,null,"Derived",null,null,"Y","N","None"]
[1,"Derived",{"$f":"IF('Legal Approval Form'!$B$19=\"Y\",\"Yes\", \"No\")","v":"No"},"CHIA Incurred Date (Year Month only)","YYYYMM","TBL_CORE_PHARMACYCLAIM","INCURREDYEARMONTH","Char",6,null,"Derived",null,null,"Y","N","None","YYYYMM"]
[1,"PC121",{"$f":"IF('Legal Approval Form'!$B$19=\"Y\",\"Yes\", \"No\")","v":"No"},"Claim Line Paid Flag",null,"TBL_CORE_PHARMACYCLAIM","CLAIMLINEPAIDFLAG","Integer",1,null,null,null,null,"Y","N","None"]
[1,"PC110",{"$f":"IF('Legal Approval Form'!$B$19=\"Y\",\"Yes\", \"No\")","v":"No"},"Claim Line Type",null,"TBL_CORE_PHARMACYCLAIM","CLAIMLINETYPECLEANED","Char",1,null,"Cleaned",null,null,"Y","N","None"]
[1,"PC025",{"$f":"IF('Legal Approval Form'!$B$19=\"Y\",\"Yes\", \"No\")","v":"No"},"Claim Status",null,"TBL_CORE_PHARMACYCLAIM","CLAIMSTATUSCLEANED","Char",2,null,"Cleaned",null,null,"Y","N","None"]
[1,"PC041",{"$f":"IF('Legal Approval Form'!$B$19=\"Y\",\"Yes\", \"No\")","v":"No"},"Coinsurance Amount",null,"TBL_CORE_PHARMACYCLAIM","COINSURANCEAMOUNT","Numeric",18.2,null,null,null,null,"Y","N","None"]
[1,"PC031",{"$f":"IF('Legal Approval Form'!$B$19=\"Y\",\"Yes\", \"No\")","v":"No"},"Compound Drug Indicator",null,"TBL_CORE_PHARMACYCLAIM","COMPOUNDDRUGINDICATORCLEANED","Integer",1,null,"Cleaned",null,null,"Y","N","None"]
[1,"PC040",{"$f":"IF('Legal Approval Form'!$B$19=\"Y\",\"Yes\", \"No\")","v":"No"},"Copay Amount",null,"TBL_CORE_PHARMACYCLAIM","COPAYAMOUNTCLEANED","Numeric",18.2,null,"Cleaned",null,null,"Y","N","None"]
[1,"Derived",{"$f":"IF('Legal Approval Form'!$B$19=\"Y\",\"Yes\", \"No\")","v":"No"},"County of Pharmacy Location City",null,"TBL_SUPPLEMENT_PHARMACYCLAIM","PHARMACYLOCATIONCOUNTY","Char",25,null,"Derived",null,null,"Y","N","None"]
[1,"Derived",{"$f":"IF('Legal Approval Form'!$B$19=\"Y\",\"Yes\", \"No\")","v":"No"},"County of Prescribing Physician",null,"TBL_SUPPLEMENT_PHARMACYCLAIM","PRESCRIBINGPHYSICIANCOUNTY","Char",25,null,"Derived",null,null,"Y","N","None"]
[1,"PC032",{"$f":"IF('Legal Approval Form'!$B$19=\"Y\",\"Yes\", \"No\")","v":"No"},"Date Prescription Filled",null,"TBL_CORE_PHARMACYCLAIM","DATEPRESCRIPTIONFILLED","Integer",8,null,"YYYYMMDD",null,null,"Y","N","None"]
[1,"PC032",{"$f":"IF('Legal Approval Form'!$B$19=\"Y\",\"Yes\", \"No\")","v":"No"},"Date Prescription Filled  (Year Only)",null,"TBL_CORE_PHARMACYCLAIM","DATEPRESCRIPTIONFILLEDYEAR","Char",4,null,"YYYY",null,null,"Y","N","None"]
[1,"PC032",{"$f":"IF('Legal Approval Form'!$B$19=\"Y\",\"Yes\", \"No\")","v":"No"},"Date Prescription Filled (Month Only)",null,"TBL_CORE_PHARMACYCLAIM","DATEPRESCRIPTIONFILLEDMONTH","Char",2,null,"MM",null,null,"Y","N","None"]
[1,"PC064",{"$f":"IF('Legal Approval Form'!$B$19=\"Y\",\"Yes\", \"No\")","v":"No"},"Date Prescription Written",null,"TBL_CORE_PHARMACYCLAIM","DATEPRESCRIPTIONWRITTEN","Integer",8,null,"YYYYMMDD",null,null,"Y","N","None"]
[1,"PC064",{"$f":"IF('Legal Approval Form'!$B$19=\"Y\",\"Yes\", \"No\")","v":"No"},"Date Prescription Written  (Year Only)",null,"TBL_CORE_PHARMACYCLAIM","DATEPRESCRIPTIONWRITTENYEAR","Char",4,null,"YYYY",null,null,"Y","N","None"]
[1,"PC064",{"$f":"IF('Legal Approval Form'!$B$19=\"Y\",\"Yes\", \"No\")","v":"No"},"Date Prescription Written (Month Only)",null,"TBL_CORE_PHARMACYCLAIM","DATEPRESCRIPTIONWRITTENMONTH","Char",2,null,"MM",null,null,"Y","N","None"]
[1,"PC017",{"$f":"IF('Legal Approval Form'!$B$19=\"Y\",\"Yes\", \"No\")","v":"No"},"Date Service Approved (AP Date)",null,"TBL_CORE_PHARMACYCLAIM","DATESERVICEAPPROVEDAPDATE","Integer",8,null,"YYYYMMDD",null,null,"Y","N","None"]
[1,"PC017",{"$f":"IF('Legal Approval Form'!$B$19=\"Y\",\"Yes\", \"No\")","v":"No"},"Date Service Approved (AP Date) - Month",null,"TBL_CORE_PHARMACYCLAIM","DATESERVICEAPPROVEDAPDATEMONTH","Char",2,null,"MM",null,null,"Y","N","None"]
[1,"PC017",{"$f":"IF('Legal Approval Form'!$B$19=\"Y\",\"Yes\", \"No\")","v":"No"},"Date Service Approved (AP Date) - Year",null,"TBL_CORE_PHARMACYCLAIM","DATESERVICEAPPROVEDAPDATEYEAR","Char",4,null,"YYYY",null,null,"Y","N","None"]
[1,"PC034",{"$f":"IF('Legal Approval Form'!$B$19=\"Y\",\"Yes\", \"No\")","v":"No"},"Days Supply",null,"TBL_CORE_PHARMACYCLAIM","DAYSSUPPLY","Numeric",18.2,null,null,null,null,"Y","N","None"]
[1,"PC042",{"$f":"IF('Legal Approval Form'!$B$19=\"Y\",\"Yes\", \"No\")","v":"No"},"Deductible Amount",null,"TBL_CORE_PHARMACYCLAIM","DEDUCTIBLEAMOUNT","Numeric",18.2,null,null,null,null,"Y","N","None"]
[1,"PC072",{"$f":"IF('Legal Approval Form'!$B$19=\"Y\",\"Yes\", \"No\")","v":"No"},"Delegated Benefit Administrator Organization ID","CHIA ORGID value","TBL_CORE_PHARMACYCLAIM","DELEGATEDBENEFITADMINISTRATORORGANIZATIONIDCLEANED","Integer",6,null,"Cleaned",null,null,"Y","N","None"]
[1,"PC117",{"$f":"IF('Legal Approval Form'!$B$19=\"Y\",\"Yes\", \"No\")","v":"No"},"Denial Reason",null,"TBL_CORE_PHARMACYCLAIM","DENIALREASONCLEANED","Char",30,null,null,null,"Y","Y","N","None"]
[1,"PC116",{"$f":"IF('Legal Approval Form'!$B$19=\"Y\",\"Yes\", \"No\")","v":"No"},"Denied Flag",null,"TBL_CORE_PHARMACYCLAIM","DENIEDFLAG","Integer",1,null,null,null,null,"Y","N","None"]
[1,"PC114",{"$f":"IF(AND('Legal Approval Form'!$B$19=\"Y\",'Legal Approval Form'!$B$33=\"N\"),\"Yes\",\"No\")","v":"No"},"Diagnosis Code","some suppressed codes","TBL_CORE_PHARMACYCLAIM","DIAGNOSISDE","Char",7,null,null,null,null,"Y","Y","CHIA will map codes as prescribed. See Section 6.2.3 of the assessment.","Found both ICD10 and ICD9 qualifying codes reported (to be suppressed)","Create column: DIAGNOSISDE                     See specs: UVR - Deidentify Diagnosis Codes.docx   "]
[1,"PC030",{"$f":"IF('Legal Approval Form'!$B$19=\"Y\",\"Yes\", \"No\")","v":"No"},"Dispense as Written Code",null,"TBL_CORE_PHARMACYCLAIM","DISPENSEASWRITTENCODE","Char",1,null,null,null,null,"Y","N","None"]
[1,"PC039",{"$f":"IF('Legal Approval Form'!$B$19=\"Y\",\"Yes\", \"No\")","v":"No"},"Dispensing Fee",null,"TBL_CORE_PHARMACYCLAIM","DISPENSINGFEECLEANED","Numeric",18.2,null,"Cleaned",null,null,"Y","N","None"]
[1,"PC026",{"$f":"IF('Legal Approval Form'!$B$19=\"Y\",\"Yes\", \"No\")","v":"No"},"Drug Code",null,"TBL_CORE_PHARMACYCLAIM","DRUGCODECLEANED","Char",11,null,null,null,"Y","Y","N","None"]
[1,"PC027",{"$f":"IF('Legal Approval Form'!$B$19=\"Y\",\"Yes\", \"No\")","v":"No"},"Drug Name",null,"TBL_CORE_PHARMACYCLAIM","DRUGNAMECLEANED","Char",80,null,null,null,"Y","Y","N","None"]
[1,"PC075",{"$f":"IF('Legal Approval Form'!$B$19=\"Y\",\"Yes\", \"No\")","v":"No"},"Drug Unit of Measure",null,"TBL_CORE_PHARMACYCLAIM","DRUGUNITOFMEASURE","Char",3,null,null,null,null,"Y","N","None"]
[1,"PC111",{"$f":"IF('Legal Approval Form'!$B$19=\"Y\",\"Yes\", \"No\")","v":"No"},"Former Claim Number",null,"TBL_CORE_PHARMACYCLAIM","CHIAFORMERCLAIMNUMBER","Integer",20,null,"Derived","CHIA",null,"Y","N","None"]
[1,"PC073",{"$f":"IF('Legal Approval Form'!$B$19=\"Y\",\"Yes\", \"No\")","v":"No"},"Formulary Code",null,"TBL_CORE_PHARMACYCLAIM","FORMULARYCODE","Char",1,null,null,null,null,"Y","N","None"]
[1,"PC029",{"$f":"IF('Legal Approval Form'!$B$19=\"Y\",\"Yes\", \"No\")","v":"No"},"Generic Drug Indicator",null,"TBL_CORE_PHARMACYCLAIM","GENERICDRUGINDICATORCLEANED","Char",1,null,"Cleaned",null,null,"Y","N","None"]
[1,"Derived",{"$f":"IF('Legal Approval Form'!$B$19=\"Y\",\"Yes\", \"No\")","v":"No"},"Highest Version Paid Flag","See Versioning documentation","TBL_CORE_PHARMACYCLAIM","VERSIONINDICATOR","Integer",1,null,"Derived",null,null,"Y","N","None"]
[1,"PC115",{"$f":"IF('Legal Approval Form'!$B$19=\"Y\",\"Yes\", \"No\")","v":"No"},"ICD Indicator",null,"TBL_CORE_PHARMACYCLAIM","ICDINDICATOR","Char",1,null,null,null,null,"Y","N","None"]
[1,"PC011",{"$f":"IF('Legal Approval Form'!$B$19=\"Y\",\"Yes\", \"No\")","v":"No"},"Individual Relationship Code",null,"TBL_CORE_PHARMACYCLAIM","INDIVIDUALRELATIONSHIPCODE","Char",2,null,null,null,null,"Y","N","None"]
[1,"PC037",{"$f":"IF('Legal Approval Form'!$B$19=\"Y\",\"Yes\", \"No\")","v":"No"},"Ingredient Cost/List Price",null,"TBL_CORE_PHARMACYCLAIM","INGREDIENTCOSTLISTPRICE","Numeric",18.2,null,null,null,null,"Y","N","None"]
[1,"PC003",{"$f":"IF('Legal Approval Form'!$B$19=\"Y\",\"Yes\", \"No\")","v":"No"},"Insurance Type Code/Product",null,"TBL_CORE_PHARMACYCLAIM","INSURANCETYPECODEPRODUCT","Char",2,null,null,null,null,"Y","N","None"]
[1,"PC005",{"$f":"IF('Legal Approval Form'!$B$19=\"Y\",\"Yes\", \"No\")","v":"No"},"Line Counter",null,"TBL_CORE_PHARMACYCLAIM","LINECOUNTER","Integer",4,null,null,null,null,"Y","N","None"]
[1,"Derived",{"$f":"IF('Legal Approval Form'!$B$19=\"Y\",\"Yes\", \"No\")","v":"No"},"Linking OrgID Member Eligibility",null,"TBL_CORE_PHARMACYCLAIM","LINKORGIDME","Integer",6,null,null,null,null,"Y","N","None"]
[1,"Derived",{"$f":"IF('Legal Approval Form'!$B$19=\"Y\",\"Yes\", \"No\")","v":"No"},"Linking OrgID Product",null,"TBL_CORE_PHARMACYCLAIM","LINKORGIDPR","Integer",6,null,null,null,null,"Y","N","None"]
[1,"Derived",{"$f":"IF('Legal Approval Form'!$B$19=\"Y\",\"Yes\", \"No\")","v":"No"},"Linking OrgID Provider",null,"TBL_CORE_PHARMACYCLAIM","LINKORGIDPV","Integer",6,null,null,null,null,"Y","N","None"]
[1,"PC057",{"$f":"IF('Legal Approval Form'!$B$19=\"Y\",\"Yes\", \"No\")","v":"No"},"Mail Order pharmacy",null,"TBL_CORE_PHARMACYCLAIM","MAILORDERPHARMACY","Char",1,null,"1 thru 5",null,null,"Y","N","None"]
[1,"Derived",{"$f":"IF('Legal Approval Form'!$B$19=\"Y\",\"Yes\", \"No\")","v":"No"},"Medicaid/HSN Indicator",null,"TBL_SUPPLEMENT_PHARMACYCLAIM","MEDICAIDHSNINDICATOR","Logical",1,null,"1,0",null,null,"Y","N","None"]
[1,"PC112",{"$f":"IF('Legal Approval Form'!$B$19=\"Y\",\"Yes\", \"No\")","v":"No"},"Medicare Indicator",null,"TBL_CORE_PHARMACYCLAIM","MEDICAREINDICATOR","Char",1,null,null,null,null,"Y","N","None"]
[1,"Derived",{"$f":"IF(AND('Legal Approval Form'!$B$19=\"Y\",'Legal Approval Form'!$B$33=\"N\"),\"Yes\",\"No\")","v":"No"},"Member Age At Service","Age >89<=115 set to '90', Invalid age set to null","TBL_CORE_PHARMACYCLAIM","MEMBERAGEATSERVICEINYEARSDE","Integer",3,null,"Derived",null,"Y","Y","Y","If age 90 or older, CHIA will suppress or recode to denote 'over 89' ","We will set the 'Over 89' group to '90' - conforming to OCDW .","Create New column: MEMBERAGEATSERVICEINYEARSDE               Case when MEMBERAGEATSERVICEINYEARSREDACTED > \"89\"    Set MEMBERAGEATSERVICEINYEARSDE = \"90\" (char 2) ,   Else  Set MEMBERAGEATSERVICEINYEARSDE = MEMBERAGEATSERVICEINYEARSREDACTED"]
[1,"PC013",{"$f":"IF(AND('Legal Approval Form'!$B$19=\"Y\",'Legal Approval Form'!$B$33=\"N\"),\"Yes\",\"No\")","v":"No"},"Member Birth (Month Only)",null,"TBL_CORE_PHARMACYCLAIM","MEMBERBIRTHMONTHDE","Char",2,null,"MM",null,null,"Y","Y","If age 90 or older, CHIA will suppress or recode to denote 'over 89' ","Scott confirmed redaction required when age > 89. Create new column, using '99' as default redaction value here. ","Create New column: MEMBERBIRTHMONTHDE              Case when  MEMBERAGEATSERVICEINYEARSREDACTED > \"89\"      Set MEMBERBIRTHMONTHDE = \"99\" (char 2)   ,ELSE Set MEMBERBIRTHMONTHDE = MEMBERBIRTHOFBIRTHMONTH "]
[1,"PC013",{"$f":"IF(AND('Legal Approval Form'!$B$19=\"Y\",'Legal Approval Form'!$B$33=\"N\"),\"Yes\",\"No\")","v":"No"},"Member Birth (Year Only)","Redacted when age > 89","TBL_CORE_PHARMACYCLAIM","MEMBERDATEOFBIRTHYEARCLEANED","Char",4,null,"YYYY",null,null,"Y","Y","If age 90 or older, CHIA will suppress or recode to denote 'over 89' ","When age older than 89, CHIA sets value to \"999\". Confirmed in data.","No action needed"]
[1,"PC012",{"$f":"IF(AND('Legal Approval Form'!$B$19=\"Y\",'Legal Approval Form'!$B$33=\"N\"),\"Yes\",\"No\")","v":"No"},"Member Gender",null,"TBL_CORE_PHARMACYCLAIM","membergenderDE","Char",1,null,"Cleaned",null,null,"Y","Y","Male, Female, Unknown","M, F, U only","See \"UVR - Deidentify Gender.docx\""]
[]
[1,"PC069",{"$f":"IF('Legal Approval Form'!$B$19=\"Y\",\"Yes\", \"No\")","v":"No"},"Member Self Pay Amount",null,"TBL_CORE_PHARMACYCLAIM","MEMBERSELFPAYAMOUNT","Numeric",18.2,null,null,null,null,"Y","N","None"]
[1,"PC021",{"$f":"IF('Legal Approval Form'!$B$19=\"Y\",\"Yes\", \"No\")","v":"No"},"National Provider ID - Pharmacy",null,"TBL_CORE_PHARMACYCLAIM","NATIONALPHARMACYIDNUMBERCLEANED","Char",10,null,"Cleaned",null,null,"Y","N","None","NPI - Pharmacy"]
[1,"PC028",{"$f":"IF('Legal Approval Form'!$B$19=\"Y\",\"Yes\", \"No\")","v":"No"},"New Prescription or Refill",null,"TBL_CORE_PHARMACYCLAIM","NEWPRESCRIPTIONORREFILLCLEANED","Char",2,null,"Cleaned",null,null,"Y","N","None"]
[1,"PC066",{"$f":"IF('Legal Approval Form'!$B$19=\"Y\",\"Yes\", \"No\")","v":"No"},"Other Insurance Paid Amount",null,"TBL_CORE_PHARMACYCLAIM","OTHERINSURANCEPAIDAMOUNTCLEANED","Numeric",18.2,null,"Cleaned",null,null,"Y","N","None"]
[1,"PC036",{"$f":"IF('Legal Approval Form'!$B$19=\"Y\",\"Yes\", \"No\")","v":"No"},"Paid Amount",null,"TBL_CORE_PHARMACYCLAIM","PAIDAMOUNTCLEANED","Numeric",18.2,null,"Cleaned",null,null,"Y","N","None"]
[1,"PC063",{"$f":"IF('Legal Approval Form'!$B$19=\"Y\",\"Yes\", \"No\")","v":"No"},"Paid Date",null,"TBL_CORE_PHARMACYCLAIM","PAIDDATE","Integer",8,null,"YYYYMMDD",null,null,"Y","N","None"]
[1,"PC063",{"$f":"IF('Legal Approval Form'!$B$19=\"Y\",\"Yes\", \"No\")","v":"No"},"Paid Date - Month",null,"TBL_CORE_PHARMACYCLAIM","PAIDDATEMONTH","Char",2,null,"MM",null,null,"Y","N","None"]
[1,"PC063",{"$f":"IF('Legal Approval Form'!$B$19=\"Y\",\"Yes\", \"No\")","v":"No"},"Paid Date - Year",null,"TBL_CORE_PHARMACYCLAIM","PAIDDATEYEAR","Char",4,null,"YYYY",null,null,"Y","N","None"]
[1,"PC004",{"$f":"IF('Legal Approval Form'!$B$19=\"Y\",\"Yes\", \"No\")","v":"No"},"Payer Claim Control Number","Surrogate key","TBL_CORE_PHARMACYCLAIM","CHIAPAYERCLAIMCONTROLNUMBER","Integer",20,null,"Derived","CHIA",null,"Y","N","None"]
[1,"PC118",{"$f":"IF('Legal Approval Form'!$B$19=\"Y\",\"Yes\", \"No\")","v":"No"},"Payment Arrangement Type",null,"TBL_CORE_PHARMACYCLAIM","PAYMENTARRANGEMENTTYPE","Char",2,null,null,null,null,"Y","N","None"]
[1,"Derived",{"$f":"IF('Legal Approval Form'!$B$19=\"Y\",\"Yes\", \"No\")","v":"No"},"Pharmacy Claim ID",null,"TBL_CORE_PHARMACYCLAIM","PHARMACYCLAIMID","Integer",9,null,"Derived",null,null,"Y","N","None"]
[1,"PC022",{"$f":"IF('Legal Approval Form'!$B$19=\"Y\",\"Yes\", \"No\")","v":"No"},"Pharmacy Location City",null,"TBL_SUPPLEMENT_PHARMACYCLAIM","PHARMACYLOCATIONCITYCLEANED","Char",30,null,"Derived",null,"Y","Y","N","None"]
[1,"PC023",{"$f":"IF('Legal Approval Form'!$B$19=\"Y\",\"Yes\", \"No\")","v":"No"},"Pharmacy Location State",null,"TBL_SUPPLEMENT_PHARMACYCLAIM","PHARMACYLOCATIONSTATE","Char",2,null,"Derived",null,null,"Y","N","None"]
[1,"PC020",{"$f":"IF('Legal Approval Form'!$B$19=\"Y\",\"Yes\", \"No\")","v":"No"},"Pharmacy Name",null,"TBL_CORE_PHARMACYCLAIM","PHARMACYNAMECLEANED","Char",100,null,null,null,"Y","Y","N","None"]
[1,"PC018",{"$f":"IF('Legal Approval Form'!$B$19=\"Y\",\"Yes\", \"No\")","v":"No"},"Pharmacy Number",null,"TBL_CORE_PHARMACYCLAIM","PHARMACYNUMBERCLEANED","Char",7,null,null,null,"Y","Y","N","None"]
[1,"PC024",{"$f":"IF('Legal Approval Form'!$B$19=\"Y\",\"Yes\", \"No\")","v":"No"},"Pharmacy ZIP Code",null,"TBL_SUPPLEMENT_PHARMACYCLAIM","PHARMACYLOCATIONZIPCODE_5","Char",5,null,"Derived",null,null,"Y","N","None","Left([PHARMACYLOCATIONZIPCODECLEANED],5) "]
[1,"PC038",{"$f":"IF('Legal Approval Form'!$B$19=\"Y\",\"Yes\", \"No\")","v":"No"},"Postage Amount Claimed",null,"TBL_CORE_PHARMACYCLAIM","POSTAGEAMOUNTCLAIMED","Numeric",18.2,null,null,null,null,"Y","N","None"]
[1,"PC053",{"$f":"IF('Legal Approval Form'!$B$19=\"Y\",\"Yes\", \"No\")","v":"No"},"Prescribing Physician City",null,"TBL_SUPPLEMENT_PHARMACYCLAIM","PRESCRIBINGPHYSICIANCITYCLEANED","Char",30,null,"Derived",null,"Y","Y","N","None"]
[1,"PC044",{"$f":"IF('Legal Approval Form'!$B$19=\"Y\",\"Yes\", \"No\")","v":"No"},"Prescribing Physician First Name",null,"TBL_CORE_PHARMACYCLAIM","PRESCRIBINGPHYSICIANFIRSTNAMECLEANED","Char",25,null,null,null,"Y","Y","N","None"]
[1,"PC046",{"$f":"IF('Legal Approval Form'!$B$19=\"Y\",\"Yes\", \"No\")","v":"No"},"Prescribing Physician Last Name",null,"TBL_CORE_PHARMACYCLAIM","PRESCRIBINGPHYSICIANLASTNAMECLEANED","Char",60,null,null,null,"Y","Y","N","None"]
[1,"PC050",{"$f":"IF('Legal Approval Form'!$B$19=\"Y\",\"Yes\", \"No\")","v":"No"},"Prescribing Physician License Number",null,"TBL_CORE_PHARMACYCLAIM","PRESCRIBINGPHYSICIANLICENSENUMBERCLEANED","Char",30,null,null,null,"Y","Y","N","None"]
[1,"PC045",{"$f":"IF('Legal Approval Form'!$B$19=\"Y\",\"Yes\", \"No\")","v":"No"},"Prescribing Physician Middle Name",null,"TBL_CORE_PHARMACYCLAIM","PRESCRIBINGPHYSICIANMIDDLENAMECLEANED","Char",25,null,null,null,"Y","Y","N","None"]
[1,"PC048",{"$f":"IF('Legal Approval Form'!$B$19=\"Y\",\"Yes\", \"No\")","v":"No"},"Prescribing Physician NPI - National Provider ID",null,"TBL_CORE_PHARMACYCLAIM","PRESCRIBINGPHYSICIANNPICLEANED","Integer",10,null,"Cleaned",null,null,"Y","N","None"]
[1,"PC049",{"$f":"IF('Legal Approval Form'!$B$19=\"Y\",\"Yes\", \"No\")","v":"No"},"Prescribing Physician Plan Number",null,"TBL_CORE_PHARMACYCLAIM","PRESCRIBINGPHYSICIANPLANNUMBERECLEANED","Char",30,null,null,null,"Y","Y","N","None"]
[1,"PC054",{"$f":"IF('Legal Approval Form'!$B$19=\"Y\",\"Yes\", \"No\")","v":"No"},"Prescribing Physician State",null,"TBL_SUPPLEMENT_PHARMACYCLAIM","PRESCRIBINGPHYSICIANSTATE","Char",2,null,"Derived",null,null,"Y","N","None"]
[1,"PC051",{"$f":"IF('Legal Approval Form'!$B$19=\"Y\",\"Yes\", \"No\")","v":"No"},"Prescribing Physician Street Address",null,"TBL_SUPPLEMENT_PHARMACYCLAIM","PRESCRIBINGPHYSICIANSTREETADDRESSCLEANED","Char",50,null,"Derived",null,"Y","Y","N","None"]
[1,"PC052",{"$f":"IF('Legal Approval Form'!$B$19=\"Y\",\"Yes\", \"No\")","v":"No"},"Prescribing Physician Street Address 2",null,"TBL_SUPPLEMENT_PHARMACYCLAIM","PRESCRIBINGPHYSICIANSTREETADDRESS2CLEANED","Char",50,null,"Derived",null,"Y","Y","N","None"]
[1,"PC055",{"$f":"IF('Legal Approval Form'!$B$19=\"Y\",\"Yes\", \"No\")","v":"No"},"Prescribing Physician Zip",null,"TBL_SUPPLEMENT_PHARMACYCLAIM","PRESCRIBINGPHYSICIANZIPCODE_5","Char",5,null,"Derived",null,null,"Y","N","None","Left([PRESCRIBINGPHYSICIANZIPCLEANED],5) "]
[1,"PC043",{"$f":"IF('Legal Approval Form'!$B$19=\"Y\",\"Yes\", \"No\")","v":"No"},"Prescribing ProviderID",null,"TBL_CORE_PHARMACYCLAIM","PRESCRIBINGPROVIDERID_LINKAGE_ID","Integer",20,null,"Derived","CHIA",null,"Y","N","None"]
[1,"PC056",{"$f":"IF('Legal Approval Form'!$B$19=\"Y\",\"Yes\", \"No\")","v":"No"},"Product ID Number","Surrogate key","TBL_CORE_PHARMACYCLAIM","PRODUCTIDNUMBER_LINKAGE_ID","Integer",20,null,"Derived","CHIA",null,"Y","N","None"]
[1,"PC033",{"$f":"IF('Legal Approval Form'!$B$19=\"Y\",\"Yes\", \"No\")","v":"No"},"Quantity Dispensed",null,"TBL_CORE_PHARMACYCLAIM","QUANTITYDISPENSED","Integer",10,null,null,null,null,"Y","N","None"]
[1,"PC033",{"$f":"IF('Legal Approval Form'!$B$19=\"Y\",\"Yes\", \"No\")","v":"No"},"Quantity Dispensed - Dosage quantity decimal",null,"TBL_CORE_PHARMACYCLAIM","quantitydispensed_decimal","Numeric",19.899999999999999,null,null,null,null,"Y","N","None","Decimal reported version of QUANTITYDISPENSED"]
[1,"PC070",{"$f":"IF('Legal Approval Form'!$B$19=\"Y\",\"Yes\", \"No\")","v":"No"},"Rebate Indicator",null,"TBL_CORE_PHARMACYCLAIM","REBATEINDICATOR","Integer",1,null,null,null,null,"Y","N","None"]
[1,"PC059",{"$f":"IF('Legal Approval Form'!$B$19=\"Y\",\"Yes\", \"No\")","v":"No"},"Recipient PCP ID",null,"TBL_CORE_PHARMACYCLAIM","RECIPIENTPCPID_LINKAGE_ID","Integer",20,null,"Derived","CHIA",null,"Y","N","None"]
[1,"PC074",{"$f":"IF('Legal Approval Form'!$B$19=\"Y\",\"Yes\", \"No\")","v":"No"},"Route of Administration",null,"TBL_CORE_PHARMACYCLAIM","ROUTEOFADMINISTRATIONCLEANED","Char",2,null,"Cleaned",null,null,"Y","N","None"]
[1,"PC058",{"$f":"IF('Legal Approval Form'!$B$19=\"Y\",\"Yes\", \"No\")","v":"No"},"Script number",null,"TBL_CORE_PHARMACYCLAIM","SCRIPTNUMBER","Char",20,null,null,null,null,"Y","N","None"]
[1,"PC060",{"$f":"IF('Legal Approval Form'!$B$19=\"Y\",\"Yes\", \"No\")","v":"No"},"Single/Multiple Source Indicator",null,"TBL_CORE_PHARMACYCLAIM","SINGLEMULTIPLESOURCEINDICATOR","Char",1,null,null,null,null,"Y","N","None"]
[1,"PC071",{"$f":"IF('Legal Approval Form'!$B$19=\"Y\",\"Yes\", \"No\")","v":"No"},"State Sales Tax",null,"TBL_CORE_PHARMACYCLAIM","STATESALESTAX","Numeric",18.2,null,null,null,null,"Y","N","None"]
[1,"Derived",{"$f":"IF('Legal Approval Form'!$B$19=\"Y\",\"Yes\", \"No\")","v":"No"},"Submission Control ID",null,"TBL_CORE_PHARMACYCLAIM","SUBMISSIONCONTROLID","Integer",8,null,"Derived",null,null,"Y","N","None"]
[1,"HD005",{"$f":"IF('Legal Approval Form'!$B$19=\"Y\",\"Yes\", \"No\")","v":"No"},"Submission Year Month","YYYYMM","TBL_CORE_PHARMACYCLAIM","SUBMISSIONYEARMONTH","Char",6,null,"YYYYMM",null,null,"Y","N","None"]
[1,"PC001",{"$f":"IF('Legal Approval Form'!$B$19=\"Y\",\"Yes\", \"No\")","v":"No"},"Submitter",null,"TBL_CORE_PHARMACYCLAIM","ORGID","Integer",6,null,null,null,null,"Y","N","None","Defined as Char on SG but stored as Integer in all CHIA tables & views."]
[1,"PC005A",{"$f":"IF('Legal Approval Form'!$B$19=\"Y\",\"Yes\", \"No\")","v":"No"},"Version Number",null,"TBL_CORE_PHARMACYCLAIM","VERSIONNUMBER","Integer",4,null,null,null,null,"Y","N","None"]
[1,"PC113",{"$f":"IF('Legal Approval Form'!$B$19=\"Y\",\"Yes\", \"No\")","v":"No"},"Pregnancy Indicator",null,"TBL_CORE_PHARMACYCLAIM","PREGNANCYINDICATOR","Char",1,null,null,null,null,"Y","N","None","OK per Amendment"]
[]
["ID -  Pharmacy Claims (PC) - Identifiable (L2) Elements"]
["Release Level","Data Element Source","Included   (this request)","Data Element Name","CHIA Notes","Release View Source Table","Release Column Name","Data Type","Length","FLAG Carrier Specific TLKP","Notes","CHIA Code","Redaction","De-Identififed Set","OnPoint Mitigation","Onpoint De-Identification Requirement"," 2025 UVR Release Comments ","Action"]
[]
[2,"Derived",{"$f":"IF(AND('Legal Approval Form'!$B$19=\"Y\",'Legal Approval Form'!$B$33=\"Y\"),\"Yes\",\"No\")","v":"No"},"Member Age At Service","Not redacted for Age > 89","TBL_CORE_PHARMACYCLAIM","MEMBERAGEATSERVICEINYEARS","Integer",3,null,"Derived",null,null,"N",null,"Not reviewed","Unredacted age, includes ages >89"]
[2,"PC013",{"$f":"IF(AND('Legal Approval Form'!$B$19=\"Y\",'Legal Approval Form'!$B$33=\"Y\"),\"Yes\",\"No\")","v":"No"},"Member Date of Birth (Year and Month)","Format YYYYMM (Not redacted for Age > 89)","TBL_CORE_PHARMACYCLAIM","MEMBERDATEOFBIRTHYEARMONTH","Integer",6,null,null,"Encryp",null,"N",null,"Not reviewed","Note: Day no longer stored, and Column should be encrypted"]
[2,"PC114",{"$f":"IF(AND('Legal Approval Form'!$B$19=\"Y\",'Legal Approval Form'!$B$33=\"Y\"),\"Yes\",\"No\")","v":"No"},"Diagnosis Code",null,"TBL_CORE_PHARMACYCLAIM","DIAGNOSISCLEANED","Char",7,null,null,null,null,"N",null,"See DE version - DiagnosisDE","No suppression needed for Identifieable release"]
[2,"PC012",{"$f":"IF(AND('Legal Approval Form'!$B$19=\"Y\",'Legal Approval Form'!$B$33=\"Y\"),\"Yes\",\"No\")","v":"No"},"Member Gender",null,"TBL_CORE_PHARMACYCLAIM","MEMBERGENDERCLEANED","Char",1,null,"Cleaned",null,null,"N",null,"See DE version - MEMBERGENDERDE","No suppression needed for Identifieable release"]
[2,"PC013",{"$f":"IF(AND('Legal Approval Form'!$B$19=\"Y\",'Legal Approval Form'!$B$33=\"Y\"),\"Yes\",\"No\")","v":"No"},"Member Birth (Month Only)",null,"TBL_CORE_PHARMACYCLAIM","MEMBERDATEOFBIRTHMONTH","Char",2,null,"MM",null,null,"N",null,"See DE version - MEMBERBIRTHMONTHDE","No suppression needed for Identifieable release"]
[2,"PC065",{"$f":"IF(AND('Legal Approval Form'!$B$19=\"Y\",'Legal Approval Form'!$B$33=\"Y\"),\"Yes\",\"No\")","v":"No"},"Coordination of Benefits/TPL Liability Amount - GIC Only",null,"TBL_CORE_PHARMACYCLAIM","COORDINATIONOFBENEFITSTPLLIABILITYAMOUNT","Numeric",18.2,null,null,null,null,"N",null,null,"Moved to L3 deidentified (from NR) per Scott email."]
[2,"PC067",{"$f":"IF(AND('Legal Approval Form'!$B$19=\"Y\",'Legal Approval Form'!$B$33=\"Y\"),\"Yes\",\"No\")","v":"No"},"Medicare Paid Amount - GIC Only",null,"TBL_CORE_PHARMACYCLAIM","MEDICAREPAIDAMOUNTCLEANED","Numeric",18.2,null,"Cleaned",null,null,"N",null,"Not reviewed","Moved to L3 deidentified (from NR) per Scott email."]
[]
["SR - Patient Identifiable, (L3) Special Release"]
["Release Level","Data Element Source","Included   (this request)","Data Element Name","CHIA Notes","Release View Source Table","Release Column Name","SG\nData Type","SG\nLength","FLAG Carrier Specific TLKP","Field Type","CHIA Code","Redaction","De-Identififed Set","OnPoint Mitigation","Onpoint De-Identification Requirement"," 2025 UVR Release Comments ","Action"]
[3,"PC009","SR Only","Member Suffix or Sequence Number",null,"TBL_CORE_PHARMACYCLAIM","MEMBERSUFFIXORSEQUENCENUMBER","Char",20,null,null,null,null,"N",null,"Not reviewed","No Release - should be Encrypted  in source table"]
[3,"PC008","SR Only","Plan Specific Contract Number",null,"TBL_CORE_PHARMACYCLAIM","PLANSPECIFICCONTRACTNUMBER","Char",30,null,null,"Encryp",null,"N",null,"Not reviewed"]
[3,"PC043","SR Only","Prescribing ProviderID",null,"TBL_CORE_PHARMACYCLAIM","PRESCRIBINGPROVIDERID","Char",30,null,null,null,null,"N",null,null,"See Surrogate"]
[3,"PC056","SR Only","Product ID Number",null,"TBL_CORE_PHARMACYCLAIM","PRODUCTIDNUMBER","Char",30,null,null,null,null,"N",null,null,"See Surrogate - PRODUCTIDNUMBER_LINKAGE_ID"]
[3,"PC059","SR Only","Recipient PCP ID",null,"TBL_CORE_PHARMACYCLAIM","RECIPIENTPCPID","Char",30,null,null,null,null,"N",null,null,"See Surrogate - RECIPIENTPCPID_LINKAGE_ID"]
[3,"PC107","SR Only","Carrier Specific Unique Member ID","Reported - decrypted","TBL_CORE_PHARMACYCLAIM","CARRIERSPECIFICUNIQUEMEMBERID","Char",50,null,"Derived","Encryp",null,"N",null,"Not reviewed","Moved to SR for UR - Rarely requested. We can decrypt and release as Identifiable if approved. "]
[3,"PC108","SR Only","Carrier Specific Unique Subscriber ID","Reported - decrypted","TBL_CORE_PHARMACYCLAIM","CARRIERSPECIFICUNIQUESUBSCRIBERID","Char",50,null,"Derived","Encryp",null,"N",null,"Not reviewed","Moved to SR for UR - Rarely requested. We can decrypt and release as Identifiable if approved. "]
[3,"PC004","SR Only","Payer Claim Control Number",null,"TBL_CORE_PHARMACYCLAIM","PAYERCLAIMCONTROLNUMBER","Char",35,null,null,null,null,"N",null,"Not reviewed","Column should be Encrypted ","Moved to SR per Scott 7/1/2025"]
[3,"PC111","SR Only","Former Claim Number",null,"TBL_CORE_PHARMACYCLAIM","FORMERCLAIMNUMBER","Char",35,null,null,"Encryp",null,"N",null,"Not reviewed",null,"Moved to SR per Scott 7/1/2025"]
[3,"PC019","SR Only","Pharmacy Tax ID Number",null,"TBL_CORE_PHARMACYCLAIM","PHARMACYTAXIDNUMBER","Char",9,null,null,null,null,"N",null,"Not reviewed","Field should be Encrypted - moved Level 3 CY2021 for Legal usage concerns, and also consistent with other TaxID's","Moved to SR per Scott 7/1/2025"]
[3,"PC062","SR Only","Billing Provider Tax ID Number",null,"TBL_CORE_PHARMACYCLAIM","BILLINGPROVIDERTAXIDNUMBER","Char",9,null,null,null,null,"N",null,"Not reviewed",null,"Moved to SR per Scott 7/1/2025"]
[3,"PC016","SR Only","Member ZIP Code","No longer collected on Pharmacy Claims at submission. Users should use field in Geography file which is sourced from Member Eligibility submissions. Field populated less than 1%","TBL_SUPPLEMENT_PHARMACYCLAIM","MEMBERZIPCODECLEANED","Char",5,null,null,"Cleaned",null,"N",null,null,"Reported on less than 6% of PC claims in 2022 - low value. ","Drop from Release begin Universal CY2022"]
[3,"PC015","SR Only","Member State","No longer collected on Pharmacy Claims at submission. Users should use field in Geography file which is sourced from Member Eligibility submissions. Field populated less than 1%","TBL_SUPPLEMENT_PHARMACYCLAIM","MEMBERSTATE","Char",2,null,null,null,null,"N",null,null,"Reported on less than 6% of PC claims in 2022 - low value. ","Drop from Release begin Universal CY2022"]
[3,"PC015","SR Only","Member State","No longer collected on Pharmacy Claims at submission. Users should use field in Geography file which is sourced from Member Eligibility submissions. Field populated less than 1%","TBL_SUPPLEMENT_PHARMACYCLAIM","MEMBERSTATELDS","Char",2,null,"Derived",null,null,"N","Y","CHIA will map codes as prescribed. States would be reported as CT, MA, ME, NH, NY, RI, VT, or Other (Transformed according to Section 6.2.2)","Reported on less than 6% of PC claims in 2022 - low value. ","Drop from Release begin Universal CY2022"]
[3,"Derived","SR Only","County of Member","Source field for derivation no longer collected on Pharmacy Claims at submission. Users should use field in Geography file which is sourced from Member Eligibility submissions. Derivation is sparse","TBL_SUPPLEMENT_PHARMACYCLAIM","MEMBERCOUNTY","Char",25,null,"Derived",null,null,"N","Y","CHIA will update Member County to reflect assignment from mapped ZIP codes (Transformed according to Section 6.2.2)","Reported on less than 6% of PC claims in 2022 - low value. ","Drop from Release begin Universal CY2022"]
[3,"PC047","SR Only","Prescribing Physician DEA Number",null,"TBL_CORE_PHARMACYCLAIM","PRESCRIBINGPHYSICIANDEANUMBER","Char",9,null,null,null,null,"N",null,"Not reviewed","No Release - should be Encrypted  in source - Moved to Level 3 CY2021 for Legal usage concerns","Moved to SR per Scott 8/20/25"]
[3,"PC006","SR Only","Insured Group or Policy Number",null,"TBL_CORE_PHARMACYCLAIM","INSUREDGROUPORPOLICYNUMBER","Char",30,null,null,"Encryp",null,"N",null,"Not reviewed",null,"Moved to SR per Scott 8/20/25"]
["NR - No Release - Internal and/or Deprecated"]
["Release Level","Data Element Source","Included   (this request)","Data Element Name","CHIA Notes","Release View Source Table","Release Column Name","SG\nData Type","SG\nLength","FLAG Carrier Specific TLKP","Field Type","CHIA Code","Redaction","De-Identififed Set","OnPoint Mitigation","Onpoint De-Identification Requirement"," 2025 UVR Release Comments ","Action"]
[4,"Derived","NR","Create Date",null,"TBL_CORE_PHARMACYCLAIM","CREATEDATE","Date:Time",23,null,null,null,null,"N",null,null,"keep for auditing"]
[4,"Derived","NR","ETL Batch ID",null,"TBL_CORE_PHARMACYCLAIM","ETLBATCHID","Integer",6,null,null,null,null,"N",null,null,"keep for auditing"]
[4,"Derived","NR","Line Number",null,"TBL_CORE_PHARMACYCLAIM","LINENUMBER","Integer",9,null,null,null,null,"N"]
[4,"Derived","NR","CHIA Incurred Date (Year and Month Only)","To be deprecated","TBL_CORE_PHARMACYCLAIM","INCURREDDATE","Integer",6,null,"Derived",null,null,"N",null,null,"to be deprecated"]
[4,"Derived","NR","Member Link EID","Moved to MEID File","TBL_SUPPLEMENT_PHARMACYCLAIM","MEMBERLINKEID","Integer",10,null,"Derived",null,null,"Y","N","None","MEMBERLINKEID is an alias for MEMBERMDMID, which is sourced from TBL_SUPPLEMENT_PHARMACYCLAIM","Moved to separate MEID table"]

{"sheet":"PR","index":6,"n_rows":42,"n_cols":17,"rows_kept":42,"cut":false,"hidden":false,"merged":[]}
["Release Level","Data Element Source","Included   (this request)","Product (PR) - Data Element Name","CHIA Notes","Release Column Name","Data Type","Length","FLAG Carrier Specific TLKP","Notes","CHIA Code","Redaction","De-Identified Set","OnPoint Mitigation","Onpoint De-Identification Requirement"," 2025 UVR Release Comments ","Action"]
[1,"PR013",{"$f":"IF('Legal Approval Form'!$B$20=\"Y\",\"Yes\", \"No\")","v":"No"},"Annual Per Family Deductible Code ",null,"ANNUALPERFAMILYDEDUCTIBLECODECLEANED","Char",3,null,"Cleaned",null,null,"Y","N","None"," "]
[1,"PR012",{"$f":"IF('Legal Approval Form'!$B$20=\"Y\",\"Yes\", \"No\")","v":"No"},"Annual Per Person Deductible Code",null,"ANNUALPERPERSONDEDUCTIBLECODECLEANED","Char",3,null,"Cleaned",null,null,"Y","N","None"]
[1,"PR003",{"$f":"IF('Legal Approval Form'!$B$20=\"Y\",\"Yes\", \"No\")","v":"No"},"Carrier License Type",null,"CARRIERLICENSETYPE","Char",3,null,null,null,null,"Y","N","None"]
[1,"PR014",{"$f":"IF('Legal Approval Form'!$B$20=\"Y\",\"Yes\", \"No\")","v":"No"},"Coordinated Care model",null,"COORDINATEDCAREMODEL","Integer",1,null,null,null,null,"Y","N","None"]
[1,"PR005",{"$f":"IF('Legal Approval Form'!$B$20=\"Y\",\"Yes\", \"No\")","v":"No"},"Insurance Plan Market",null,"INSURANCEPLANMARKETCLEANED","Char",4,null,"Cleaned",null,null,"Y","N","None"]
[1,"Derived",{"$f":"IF('Legal Approval Form'!$B$20=\"Y\",\"Yes\", \"No\")","v":"No"},"Medicaid/HSN Indicator",null,"MEDICAIDHSNINDICATOR","Logical",1,null,"1,0",null,null,"Y","N","None"]
[1,"PR017",{"$f":"IF('Legal Approval Form'!$B$20=\"Y\",\"Yes\", \"No\")","v":"No"},"NAIC Code",null,"NAICCODE","Integer",5,null,null,null,null,"Y","N","None"]
[1,"PR011",{"$f":"IF('Legal Approval Form'!$B$20=\"Y\",\"Yes\", \"No\")","v":"No"},"Product Active Flag",null,"PRODUCTACTIVEFLAGCLEANED","Integer",1,null,"Cleaned",null,null,"Y","N","None"]
[1,"PR006",{"$f":"IF('Legal Approval Form'!$B$20=\"Y\",\"Yes\", \"No\")","v":"No"},"Product Benefit Type",null,"PRODUCTBENEFITTYPE","Integer",1,null,null,null,null,"Y","N","None"]
[1,"Derived",{"$f":"IF('Legal Approval Form'!$B$20=\"Y\",\"Yes\", \"No\")","v":"No"},"Product Delegate",null,"LINKINGPRODUCTDELEGATE","Logical",1,null,"1,0",null,null,"Y","N","None"]
[1,"PR010",{"$f":"IF('Legal Approval Form'!$B$20=\"Y\",\"Yes\", \"No\")","v":"No"},"Product End Date",null,"PRODUCTENDDATE","Integer",8,null,"YYYYMMDD",null,null,"Y","N","None"]
[1,"PR010",{"$f":"IF('Legal Approval Form'!$B$20=\"Y\",\"Yes\", \"No\")","v":"No"},"Product End Date - Month",null,"PRODUCTENDDATEMONTH","Char",2,null,"MM",null,null,"Y","N","None"]
[1,"PR010",{"$f":"IF('Legal Approval Form'!$B$20=\"Y\",\"Yes\", \"No\")","v":"No"},"Product End Date - Year",null,"PRODUCTENDDATEYEAR","Char",4,null,"YYYY",null,null,"Y","N","None"]
[1,"Derived",{"$f":"IF('Legal Approval Form'!$B$20=\"Y\",\"Yes\", \"No\")","v":"No"},"Product ID",null,"PRODUCTID","Integer",9,null,"Derived",null,null,"Y","N","None"]
[1,"PR001",{"$f":"IF('Legal Approval Form'!$B$20=\"Y\",\"Yes\", \"No\")","v":"No"},"Product ID number ",null,"LINKINGPRODUCTID","Integer",20,null,"Derived","CHIA",null,"Y","N","None"]
[1,"PR004",{"$f":"IF('Legal Approval Form'!$B$20=\"Y\",\"Yes\", \"No\")","v":"No"},"Product Line of Business Model",null,"PRODUCTLINEOFBUSINESSMODEL","Char",2,null,null,null,null,"Y","N","None"]
[1,"PR009",{"$f":"IF('Legal Approval Form'!$B$20=\"Y\",\"Yes\", \"No\")","v":"No"},"Product Start Date",null,"PRODUCTSTARTDATE","Integer",8,null,"YYYYMMDD",null,null,"Y","N","None"]
[1,"PR009",{"$f":"IF('Legal Approval Form'!$B$20=\"Y\",\"Yes\", \"No\")","v":"No"},"Product Start Date - Month",null,"PRODUCTSTARTDATEMONTH","Char",2,null,"MM",null,null,"Y","N","None"]
[1,"PR009",{"$f":"IF('Legal Approval Form'!$B$20=\"Y\",\"Yes\", \"No\")","v":"No"},"Product Start Date - Year",null,"PRODUCTSTARTDATEYEAR","Char",4,null,"YYYY",null,null,"Y","N","None"]
[1,"Derived",{"$f":"IF('Legal Approval Form'!$B$20=\"Y\",\"Yes\", \"No\")","v":"No"},"Release ID ",null,"RELEASEID","Integer",7,null,"Derived",null,null,"Y","N","None","Created on Release - Autonumber primary key"]
[1,"PR008",{"$f":"IF('Legal Approval Form'!$B$20=\"Y\",\"Yes\", \"No\")","v":"No"},"Risk Type",null,"RISKTYPE","Integer",1,null,null,null,null,"Y","N","None"]
[1,"PR018",{"$f":"IF('Legal Approval Form'!$B$20=\"Y\",\"Yes\", \"No\")","v":"No"},"Situs",null,"SITUS","Char",2,null,null,null,null,"Y","N","None"]
[1,"Derived",{"$f":"IF('Legal Approval Form'!$B$20=\"Y\",\"Yes\", \"No\")","v":"No"},"Submission Control ID",null,"SUBMISSIONCONTROLID","Integer",8,null,"Derived",null,null,"Y","N","None"]
[1,"HD005",{"$f":"IF('Legal Approval Form'!$B$20=\"Y\",\"Yes\", \"No\")","v":"No"},"Submission Year Month",null,"SUBMISSIONYEARMONTH","Integer",6,null,"Derived",null,null,"Y","N","None"]
[1,"HD002",{"$f":"IF('Legal Approval Form'!$B$20=\"Y\",\"Yes\", \"No\")","v":"No"},"Submitter","Submitting Carrier ORGID","ORGID","Integer",6,null,null,null,null,"Y","N","None","Defined as Char on SG but stored as Integer in all CHIA tables & views."]
[]
["ID - Product File (PR) - Identifiable (L2) Elements"]
["Release Level","Data Element Source","Included   (this request)","Data Element Name","CHIA Notes","Release Column Name","Data Type","Length","FLAG Carrier Specific TLKP","Notes","CHIA Code","Redaction","De-Identified Set","OnPoint Mitigation","Onpoint De-Identification Requirement"," 2025 UVR Release Comments ","Action"]
[2,"PR007",{"$f":"IF(AND('Legal Approval Form'!$B$20=\"Y\",'Legal Approval Form'!$B$33=\"Y\"),\"Yes\",\"No\")","v":"No"},"Other Product Benefit Description","text string","OTHERPRODUCTBENEFITDESCRIPTIONCLEANED","Char",80,null,"Cleaned",null,null,"N",null,"Not reviewed","moved to identifiable from L2 since not reviewed. "]
[2,"PR015",{"$f":"IF(AND('Legal Approval Form'!$B$20=\"Y\",'Legal Approval Form'!$B$33=\"Y\"),\"Yes\",\"No\")","v":"No"},"Other Product Line of Business Model","text string","OTHERPRODUCTLINEOFBUSINESSMODELCLEANED","Char",30,null,"Cleaned",null,"Y","N",null,"Not reviewed","moved to identifiable from L2 since not reviewed. "]
[2,"PR016",{"$f":"IF(AND('Legal Approval Form'!$B$20=\"Y\",'Legal Approval Form'!$B$33=\"Y\"),\"Yes\",\"No\")","v":"No"},"Other Risk Type","text string","OTHERRISKTYPECLEANED","Char",30,null,"Cleaned",null,"Y","N",null,"Not reviewed","moved to identifiable from L2 since not reviewed. "]
[null,null,null,null,null,null,null,null,null,null,null,null,"N"]
[]
["SR - Patient Identifiable, Special Release"]
["Release Level","Data Element Source","Included   (this request)","Data Element Name","CHIA Notes","Release Column Name","Data Type","Length","FLAG Carrier Specific TLKP","Notes","CHIA Code","Redaction",null,"OnPoint Mitigation","Onpoint De-Identification Requirement"," 2025 UVR Release Comments ","Action"]
[3,"PR002","SR Only","Product Name","Small group sensitivity","PRODUCTNAME","Char",70,null,null,null,null,"N",null,"Not reviewed","May contain direct PI, moved to SR per Legal"]
[3,"PR001","SR Only","Product ID number ",null,"PRODUCTIDNUMBER","Char",30,null,null,null,null,"N",null,"Not reviewed","audit… not for release"]
["NR - No Release - Internal and/or Deprecated"]
["Release Level","Data Element Source","Included   (this request)","Data Element Name","CHIA Notes","Release Column Name","Data Type","Length","FLAG Carrier Specific TLKP","Notes","CHIA Code","Redaction",null,"OnPoint Mitigation","Onpoint De-Identification Requirement"," 2025 UVR Release Comments ","Action"]
[4,"NA","SR Only","Release Table batch id",null,"RELEASEETLBATCHID","Integer",6,null,null,null,null,"N",null,"Not reviewed","audit… not for release"]
[4,"NA","SR Only","Create date stamp",null,"CREATEDATE","Date:Time",23,null,null,null,null,"N",null,"Not reviewed","audit… not for release"]

{"sheet":"PV","index":7,"n_rows":90,"n_cols":17,"rows_kept":90,"cut":false,"hidden":false,"merged":[]}
["Release Level","Data Element Source","Included   (this request)","Provider (PV) File - Data Element Name","CHIA Notes","Release Column Name","Data Type","Length","FLAG Carrier Specific TLKP","Notes","CHIA Code","Redaction","De-Identified Set","OnPoint Mitigation","Onpoint De-Identification Requirement per Scott"," 2025 UVR Release Comments ","Action"]
[1,"PV049",{"$f":"IF('Legal Approval Form'!$B$21=\"Y\",\"Yes\", \"No\")","v":"No"},"Accepting New Patients ",null,"ACCEPTINGNEWPATIENTSCLEANED","Char",1,null,"Cleaned",null,null,"Y","N","None"]
[1,"PV037",{"$f":"IF('Legal Approval Form'!$B$21=\"Y\",\"Yes\", \"No\")","v":"No"},"Begin Date",null,"BEGINDATE","Integer",8,null,"YYYYMMDD",null,null,"Y","N","None"]
[1,"PV037",{"$f":"IF('Legal Approval Form'!$B$21=\"Y\",\"Yes\", \"No\")","v":"No"},"Begin Date - Month",null,"BEGINDATEMONTH","Char",2,null,"MM",null,null,"Y","N","None"]
[1,"PV037",{"$f":"IF('Legal Approval Form'!$B$21=\"Y\",\"Yes\", \"No\")","v":"No"},"Begin Date - Year",null,"BEGINDATEYEAR","Char",4,null,"YYYY",null,null,"Y","N","None"]
[1,"PV018",{"$f":"IF('Legal Approval Form'!$B$21=\"Y\",\"Yes\", \"No\")","v":"No"},"City Name",null,"CITYNAMECLEANED","Char",35,null,"Derived",null,"Y","Y","N","None"]
[1,"PV020",{"$f":"IF('Legal Approval Form'!$B$21=\"Y\",\"Yes\", \"No\")","v":"No"},"Country Code",null,"COUNTRYCODE","Char",3,null,null,null,null,"Y","N","None"]
[1,"Derived",{"$f":"IF('Legal Approval Form'!$B$21=\"Y\",\"Yes\", \"No\")","v":"No"},"County of Provider",null,"COUNTY","Char",25,null,"Derived",null,null,"Y","N","None"]
[1,"Derived",{"$f":"IF('Legal Approval Form'!$B$21=\"Y\",\"Yes\", \"No\")","v":"No"},"County of Provider Mailing Address",null,"MAILINGCOUNTY","Char",25,null,"Derived",null,null,"Y","N","None"]
[1,"PV058",{"$f":"IF('Legal Approval Form'!$B$21=\"Y\",\"Yes\", \"No\")","v":"No"},"Delegated Provider Record Flag",null,"DELEGATEDPROVIDERRECORDFLAGCLEANED","Char",1,null,"Cleaned",null,null,"Y","N","None"]
[1,"PV038",{"$f":"IF('Legal Approval Form'!$B$21=\"Y\",\"Yes\", \"No\")","v":"No"},"End Date",null,"ENDDATE","Integer",8,null,"YYYYMMDD",null,null,"Y","N","None"]
[1,"PV038",{"$f":"IF('Legal Approval Form'!$B$21=\"Y\",\"Yes\", \"No\")","v":"No"},"End Date - Month",null,"ENDDATEMONTH","Char",2,null,"MM",null,null,"Y","N","None"]
[1,"PV038",{"$f":"IF('Legal Approval Form'!$B$21=\"Y\",\"Yes\", \"No\")","v":"No"},"End Date - Year",null,"ENDDATEYEAR","Char",4,null,"YYYY",null,null,"Y","N","None"]
[1,"PV013",{"$f":"IF('Legal Approval Form'!$B$21=\"Y\",\"Yes\", \"No\")","v":"No"},"Entity Code",null,"ENTITYCODECLEANED","Char",2,null,"Cleaned",null,null,"Y","N","None"]
[1,"PV012",{"$f":"IF('Legal Approval Form'!$B$21=\"Y\",\"Yes\", \"No\")","v":"No"},"Entity Name",null,"ENTITYNAMECLEANED","Char",100,null,null,null,"Y","Y","N","None"]
[1,"PV009",{"$f":"IF('Legal Approval Form'!$B$21=\"Y\",\"Yes\", \"No\")","v":"No"},"First Name",null,"FIRSTNAMECLEANED","Char",50,null,null,null,"Y","Y","N","None"]
[1,"PV014",{"$f":"IF('Legal Approval Form'!$B$21=\"Y\",\"Yes\", \"No\")","v":"No"},"Gender Code",null,"GENDERCODECLEANED","Char",1,null,"Cleaned",null,null,"Y","N","None"]
[1,"PV052",{"$f":"IF('Legal Approval Form'!$B$21=\"Y\",\"Yes\", \"No\")","v":"No"},"Has multiple offices",null,"HASMULTIPLEOFFICESCLEANED","Char",1,null,"Cleaned",null,null,"Y","N","None"]
[1,"PV008",{"$f":"IF('Legal Approval Form'!$B$21=\"Y\",\"Yes\", \"No\")","v":"No"},"Last Name",null,"LASTNAMECLEANED","Char",50,null,null,null,"Y","Y","N","None"]
[1,"PV006",{"$f":"IF('Legal Approval Form'!$B$21=\"Y\",\"Yes\", \"No\")","v":"No"},"License Id",null,"LICENSEIDCLEANED","Char",25,null,null,null,"Y","Y","N","None"]
[1,"PV025",{"$f":"IF('Legal Approval Form'!$B$21=\"Y\",\"Yes\", \"No\")","v":"No"},"Mailing City Name",null,"MAILINGCITYNAMECLEANED","Char",35,null,"Derived",null,"Y","Y","N","None"]
[1,"PV027",{"$f":"IF('Legal Approval Form'!$B$21=\"Y\",\"Yes\", \"No\")","v":"No"},"Mailing Country Code",null,"MAILINGCOUNTRYCODE","Char",3,null,null,null,null,"Y","N","None"]
[1,"PV026",{"$f":"IF('Legal Approval Form'!$B$21=\"Y\",\"Yes\", \"No\")","v":"No"},"Mailing State Code",null,"MAILINGSTATECODE","Char",2,null,"Derived",null,null,"Y","N","None"]
[1,"PV023",{"$f":"IF('Legal Approval Form'!$B$21=\"Y\",\"Yes\", \"No\")","v":"No"},"Mailing Street Address1 Name",null,"MAILINGSTREETADDRESS1NAMECLEANED","Char",50,null,"Derived",null,"Y","Y","N","None"]
[1,"PV024",{"$f":"IF('Legal Approval Form'!$B$21=\"Y\",\"Yes\", \"No\")","v":"No"},"Mailing Street Address2 Name",null,"MAILINGSTREETADDRESS2NAMECLEANED","Char",50,null,"Derived",null,"Y","Y","N","None"]
[1,"PV028",{"$f":"IF('Legal Approval Form'!$B$21=\"Y\",\"Yes\", \"No\")","v":"No"},"Mailing Zip Code",null,"MAILINGZIPCODE_5","Char",5,null,"Derived",null,null,"Y","N","None","trim to 5 char"]
[1,"PV007",{"$f":"IF('Legal Approval Form'!$B$21=\"Y\",\"Yes\", \"No\")","v":"No"},"Medicaid Id",null,"MEDICAIDIDCLEANED","Char",25,null,null,null,"Y","Y","N","None"]
[1,"Derived",{"$f":"IF('Legal Approval Form'!$B$21=\"Y\",\"Yes\", \"No\")","v":"No"},"Medicaid/HSN Indicator",null,"MEDICAIDHSNINDICATOR","Logical",1,null,"1,0",null,null,"Y","N","None"]
[1,"PV054",{"$f":"IF('Legal Approval Form'!$B$21=\"Y\",\"Yes\", \"No\")","v":"No"},"Medical/Healthcare Home ID",null,"MEDICALHEALTHCAREHOMEID_LINKAGE_ID","Integer",20,null,null,"CHIA",null,"Y","N","None"]
[1,"PV036",{"$f":"IF('Legal Approval Form'!$B$21=\"Y\",\"Yes\", \"No\")","v":"No"},"Medicare Id",null,"MEDICAREIDCLEANED","Char",30,null,null,null,"Y","Y","N","None"]
[1,"PV010",{"$f":"IF('Legal Approval Form'!$B$21=\"Y\",\"Yes\", \"No\")","v":"No"},"Middle Initial",null,"MIDDLEINITIALCLEANED","Char",1,null,"Cleaned",null,null,"Y","N","None"]
[1,"PV039",{"$f":"IF('Legal Approval Form'!$B$21=\"Y\",\"Yes\", \"No\")","v":"No"},"National Provider ID",null,"NATIONALPROVIDERIDCLEANED","Char",10,null,"Cleaned",null,null,"Y","N","None","NPI"]
[1,"PV040",{"$f":"IF('Legal Approval Form'!$B$21=\"Y\",\"Yes\", \"No\")","v":"No"},"National Provider2 ID",null,"NATIONALPROVIDER2IDCLEANED","Char",10,null,"Cleaned",null,null,"Y","N","None","NPI"]
[1,"PV046",{"$f":"IF('Legal Approval Form'!$B$21=\"Y\",\"Yes\", \"No\")","v":"No"},"NonClaimsFlag",null,"NONCLAIMSFLAG","Char",1,null,"1,2,3,4,5",null,null,"Y","N","None"]
[1,"PV060",{"$f":"IF('Legal Approval Form'!$B$21=\"Y\",\"Yes\", \"No\")","v":"No"},"Office Type",null,"OFFICETYPECLEANED","Char",1,null,"Cleaned",null,null,"Y","N","None"]
[1,"PV045",{"$f":"IF('Legal Approval Form'!$B$21=\"Y\",\"Yes\", \"No\")","v":"No"},"P4PFlag",null,"P4PFLAG","Char",1,null,"1,2,3,4,5",null,null,"Y","N","None"]
[1,"PV055",{"$f":"IF('Legal Approval Form'!$B$21=\"Y\",\"Yes\", \"No\")","v":"No"},"PCP Flag",null,"PCPFLAGCLEANED","Char",1,null,"Cleaned",null,null,"Y","N","None"]
[1,"PV002",{"$f":"IF('Legal Approval Form'!$B$21=\"Y\",\"Yes\", \"No\")","v":"No"},"Plan Provider ID","Unique Provider Indentifier Reference for linkage use. ","LINKINGPROVIDERID","Integer",20,null,null,"CHIA",null,"Y","N","None","derived from PLANPROVIDERID in ETL"]
[1,"PV064",{"$f":"IF('Legal Approval Form'!$B$21=\"Y\",\"Yes\", \"No\")","v":"No"},"PPO Indicator",null,"PPOINDICATOR","Char",1,null,null,null,null,"Y","N","None"]
[1,"PV061",{"$f":"IF('Legal Approval Form'!$B$21=\"Y\",\"Yes\", \"No\")","v":"No"},"Prescribing Provider",null,"PRESCRIBINGPROVIDER","Char",1,null,null,null,null,"Y","N","None"]
[1,"PV030",{"$f":"IF('Legal Approval Form'!$B$21=\"Y\",\"Yes\", \"No\")","v":"No"},"Primary Specialty Code ","Standard and Carrier-Specific Custom Values","PRIMARYSPECIALTYCODE","Char",15,1,null,null,null,"Y","N","None"]
[1,"PV056",{"$f":"IF('Legal Approval Form'!$B$21=\"Y\",\"Yes\", \"No\")","v":"No"},"Provider Affiliation",null,"PROVIDERAFFILIATION_LINKAGE_ID","Integer",20,null,null,"CHIA",null,"Y","N","None"]
[1,"PV063",{"$f":"IF('Legal Approval Form'!$B$21=\"Y\",\"Yes\", \"No\")","v":"No"},"Provider Affiliation End Date",null,"PROVIDERAFFILIATIONENDDATE","Integer",8,null,"YYYYMMDD",null,null,"Y","N","None"]
[1,"PV063",{"$f":"IF('Legal Approval Form'!$B$21=\"Y\",\"Yes\", \"No\")","v":"No"},"Provider Affiliation End Date - Month",null,"PROVIDERAFFILIATIONENDDATEMONTH","Char",2,null,"MM",null,null,"Y","N","None"]
[1,"PV063",{"$f":"IF('Legal Approval Form'!$B$21=\"Y\",\"Yes\", \"No\")","v":"No"},"Provider Affiliation End Date - Year",null,"PROVIDERAFFILIATIONENDDATEYEAR","Char",4,null,"YYYY",null,null,"Y","N","None"]
[1,"PV062",{"$f":"IF('Legal Approval Form'!$B$21=\"Y\",\"Yes\", \"No\")","v":"No"},"Provider Affiliation Start Date",null,"PROVIDERAFFILIATIONSTARTDATE","Integer",8,null,"YYYYMMDD",null,null,"Y","N","None"]
[1,"PV062",{"$f":"IF('Legal Approval Form'!$B$21=\"Y\",\"Yes\", \"No\")","v":"No"},"Provider Affiliation Start Date - Month",null,"PROVIDERAFFILIATIONSTARTDATEMONTH","Char",2,null,"MM",null,null,"Y","N","None"]
[1,"PV062",{"$f":"IF('Legal Approval Form'!$B$21=\"Y\",\"Yes\", \"No\")","v":"No"},"Provider Affiliation Start Date - Year",null,"PROVIDERAFFILIATIONSTARTDATEYEAR","Char",4,null,"YYYY",null,null,"Y","N","None"]
[1,"Derived",{"$f":"IF('Legal Approval Form'!$B$21=\"Y\",\"Yes\", \"No\")","v":"No"},"Provider Delegate",null,"LINKINGPROVIDERDELEGATE","Integer",1,null,"Derived",null,null,"Y","N","None","values (1,0) - Use where='1' to get unique on 1:many"]
[1,"PV015",{"$f":"IF('Legal Approval Form'!$B$21=\"Y\",\"Yes\", \"No\")","v":"No"},"Provider DOB (Month Only)",null,"DOBDATEMONTH","Char",2,null,"MM",null,null,"Y","N","None"]
[1,"PV015",{"$f":"IF('Legal Approval Form'!$B$21=\"Y\",\"Yes\", \"No\")","v":"No"},"Provider DOB (Year Only)",null,"DOBDATEYEAR","Char",4,null,"YYYY",null,null,"Y","N","None"]
[1,"Derived",{"$f":"IF('Legal Approval Form'!$B$21=\"Y\",\"Yes\", \"No\")","v":"No"},"Provider ID","Submission record id - not for Provider identification!","PROVIDERID","Integer",10,null,null,null,null,"Y","N","None"]
[1,"PV031",{"$f":"IF('Legal Approval Form'!$B$21=\"Y\",\"Yes\", \"No\")","v":"No"},"Provider Organization ID","TME","PROVIDERORGANIZATIONID","Integer",6,null,null,null,null,"Y","N","None","all OrgId is Integer "]
[1,"PV016",{"$f":"IF('Legal Approval Form'!$B$21=\"Y\",\"Yes\", \"No\")","v":"No"},"Provider Street Address 1",null,"STREETADDRESS1NAMECLEANED","Char",50,null,"Derived",null,"Y","Y","N","None"]
[1,"PV017",{"$f":"IF('Legal Approval Form'!$B$21=\"Y\",\"Yes\", \"No\")","v":"No"},"Provider Street Address 2",null,"STREETADDRESS2NAMECLEANED","Char",50,null,"Derived",null,"Y","Y","N","None"]
[1,"PV057",{"$f":"IF('Legal Approval Form'!$B$21=\"Y\",\"Yes\", \"No\")","v":"No"},"Provider Telephone",null,"PROVIDERTELEPHONECLEANED","Char",10,null,"Derived",null,"Y","Y","N","None"]
[1,"PV029",{"$f":"IF('Legal Approval Form'!$B$21=\"Y\",\"Yes\", \"No\")","v":"No"},"Provider Type Code",null,"PROVIDERTYPECODECLEANED","Char",10,1,null,null,"Y","Y","N","None"]
[1,"PV034",{"$f":"IF('Legal Approval Form'!$B$21=\"Y\",\"Yes\", \"No\")","v":"No"},"ProviderIDCode",null,"PROVIDERIDCODECLEANED","Char",5,null,"Cleaned",null,null,"Y","N","None"]
[1,"Derived",{"$f":"IF('Legal Approval Form'!$B$21=\"Y\",\"Yes\", \"No\")","v":"No"},"Release ID",null,"RELEASEID","Integer",10,null,"Derived",null,null,"Y","N","None","Created on release - Autonumber primary key"]
[1,"PV042",{"$f":"IF('Legal Approval Form'!$B$21=\"Y\",\"Yes\", \"No\")","v":"No"},"Secondary Specialty2 Code","Standard and Carrier-Specific Custom Values","SECONDARYSPECIALTY2CODECLEANED","Char",10,1,null,null,"Y","Y","N","None"]
[1,"PV043",{"$f":"IF('Legal Approval Form'!$B$21=\"Y\",\"Yes\", \"No\")","v":"No"},"Secondary Specialty3 Code","Standard and Carrier-Specific Custom Values","SECONDARYSPECIALTY3CODECLEANED","Char",10,1,null,null,"Y","Y","N","None"]
[1,"PV044",{"$f":"IF('Legal Approval Form'!$B$21=\"Y\",\"Yes\", \"No\")","v":"No"},"Secondary Specialty4 Code ","Standard and Carrier-Specific Custom Values","SECONDARYSPECIALTY4CODECLEANED","Char",10,1,null,null,"Y","Y","N","None"]
[1,"PV019",{"$f":"IF('Legal Approval Form'!$B$21=\"Y\",\"Yes\", \"No\")","v":"No"},"State Code",null,"STATECODE","Char",2,null,"Derived",null,null,"Y","N","None"]
[1,"Derived",{"$f":"IF('Legal Approval Form'!$B$21=\"Y\",\"Yes\", \"No\")","v":"No"},"Submission Control ID",null,"SUBMISSIONCONTROLID","Integer",8,null,null,null,null,"Y","N","None"]
[1,"HD005",{"$f":"IF('Legal Approval Form'!$B$21=\"Y\",\"Yes\", \"No\")","v":"No"},"Submission Year Month",null,"SUBMISSIONYEARMONTH","Integer",6,null,"YYYYMM",null,null,"Y","N","None"]
[1,"PV001",{"$f":"IF('Legal Approval Form'!$B$21=\"Y\",\"Yes\", \"No\")","v":"No"},"Submitter",null,"ORGID","Integer",6,null,null,null,null,"Y","N","None","Defined as Char on SG but stored as Integer in all CHIA tables & views."]
[1,"PV011",{"$f":"IF('Legal Approval Form'!$B$21=\"Y\",\"Yes\", \"No\")","v":"No"},"Suffix",null,"SUFFIX","Char",8,null,null,null,null,"Y","N","None"]
[1,"PV022",{"$f":"IF('Legal Approval Form'!$B$21=\"Y\",\"Yes\", \"No\")","v":"No"},"Taxonomy",null,"TAXONOMYCLEANED","Char",10,null,null,null,"Y","Y","N","None"]
[1,"PV004",{"$f":"IF('Legal Approval Form'!$B$21=\"Y\",\"Yes\", \"No\")","v":"No"},"UPIN Id - GIC Only",null,"UPINID","Char",6,null,null,null,null,"Y","N","None"]
[1,"PV021",{"$f":"IF('Legal Approval Form'!$B$21=\"Y\",\"Yes\", \"No\")","v":"No"},"ZIP Code",null,"ZIPCODE_5","Char",5,null,"Derived",null,null,"Y","N","None","trim to 5 char"]
[]
["ID - Provider File (PV) - Identifiable (L2) Elements",null,null,null,null,null,null,null,null,null,null,null,null,null,"None"]
["Release Level","Data Element Source","Included   (this request)","Data Element Name","CHIA Notes","Release Column Name","Data Type","Length","FLAG Carrier Specific TLKP","Notes","CHIA Code","Redaction",null,"OnPoint Mitigation","Onpoint De-Identification Requirement per Scott"," 2025 UVR Release Comments ","Action"]
[]
[2,"PV065",{"$f":"IF(AND('Legal Approval Form'!$B$21=\"Y\",'Legal Approval Form'!$B$33=\"Y\"),\"Yes\",\"No\")","v":"No"},"Disbursement Code",null,"DISBURSEMENTCODE","Char",1,null,null,null,null,"N",null,"Not reviewed","Moved to Level 3 CY2020 UVR","Move to Level 3 - Identified"]
[2,"PV015",{"$f":"IF(AND('Legal Approval Form'!$B$21=\"Y\",'Legal Approval Form'!$B$33=\"Y\"),\"Yes\",\"No\")","v":"No"},"Provider DOB Date",null,"DOBDATE","Integer",8,null,"YYYYMMDD","Encrp",null,"N",null,"Not reviewed","Moved to Level 3 CY2020 UVR","Move to Level 3 - Identified"]
[2,"PV032",{"$f":"IF(AND('Legal Approval Form'!$B$21=\"Y\",'Legal Approval Form'!$B$33=\"Y\"),\"Yes\",\"No\")","v":"No"},"Registered Provider Organization ID (RPO)","Sparsely populated (HPC-RPO)","REGISTEREDPROVIDERORGANIZATIONIDCLEANED","Char",30,null,null,null,"Y","N",null,"Not reviewed","Moved to Level 3 CY2020 UVR","Move to Level 3 - Identified"]
[]
["SR - Patient Identifiable, Special Release"]
["Release Level","Data Element Source","Included   (this request)","Data Element Name","CHIA Notes","Release Column R10","Data Type","Length","FLAG Carrier Specific TLKP","Notes","CHIA Code","Redaction",null,"OnPoint Mitigation","Onpoint De-Identification Requirement per Scott"," 2025 UVR Release Comments ","Action"]
[3,"PV054","SR Only","Medical/Healthcare Home ID",null,"MEDICALHEALTHCAREHOMEID","Char",30,null,null,null,null,"N",null,"Not reviewed","See Surrogate key - linkage_id, but keep "]
[3,"PV002","SR Only","Plan Provider ID",null,"PLANPROVIDERID","Char",30,null,null,null,null,"N",null,"Not reviewed","See Surrogate key - linkage_id, but keep - decrypt when released "]
[3,"PV056","SR Only","Provider Affiliation",null,"PROVIDERAFFILIATION","Char",30,null,null,null,null,"N",null,null,"See Surrogate key - linkage_id, but keep "]
[3,"PV035","SR Only","SSN Id",null,"SSNID","Char",9,null,null,"Encrp",null,"N",null,"Not reviewed","decrypt on release"]
[3,"PV005","SR Only","DEA ID",null,"DEAID","Char",9,null,null,null,null,"N",null,"Not reviewed","Moved to Level 3 (SR) CY2020 UVR"]
[3,"PV003","SR Only","Tax Id",null,"TAXID","Char",9,null,null,"Encrp",null,"N",null,"Not reviewed","decrypt on release Level 3 in CY2021 - PI concerns and Legal usage concerns","Moved to SR per Scott 8/20/25"]
[]
["NR - No Release - Internal and/or Deprecated"]
[4,"Derived","SR Only","CREATE DATE",null,"CREATEDATE","Date:Time",23,null,null,null,null,"N",null,"Not reviewed","ETL date stamp"]
[4,"Derived","SR Only","RELEASE ETL BATCHID",null,"RELEASEETLBATCHID","Integer",6,null,null,null,null,"N",null,"Not reviewed","ETL Batch id"]

{"sheet":"BP","index":8,"n_rows":19,"n_cols":17,"rows_kept":19,"cut":false,"hidden":false,"merged":[]}
["Release Level","Data Element Source","Included   (this request)","Benefit Plan (BP)- Data Element Name","CHIA Notes","Release Column Name","Data Type","Length","FLAG Carrier Specific TLKP","Notes","CHIA Code","Redaction","De-Identified Set","OnPoint Mitigation","Onpoint De-Identification Requirement per Scott"," 2025 UVR Release Comments ","Action"]
[]
[1,null,{"$f":"IF('Legal Approval Form'!$B$22=\"Y\",\"Yes\", \"No\")","v":"No"},"Note: No De-Identifiable (L1) BP Data Elements in this Release "]
[]
["ID -  Benefit Plan (BP) - Identifiable (L2) Elements"]
["Release Level","Data Element Source","Included   (this request)","Data Element Name","CHIA Notes","Release Column Name","Data Type","Length","FLAG Carrier Specific TLKP","Notes","CHIA Code","Redaction",null,null,"Onpoint De-Identification Requirement per Scott"," 2025 UVR Release Comments ","Action"]
[2,"BP002",{"$f":"IF(AND('Legal Approval Form'!$B$22=\"Y\",'Legal Approval Form'!$B$33=\"Y\"),\"Yes\",\"No\")","v":"No"},"Benefit Plan Name",null,"BENEFITPLANNAME","Char",70,null,null,null,null,null,null,"Not reviewed","Small group PHI risk"]
[2,"BP003",{"$f":"IF(AND('Legal Approval Form'!$B$22=\"Y\",'Legal Approval Form'!$B$33=\"Y\"),\"Yes\",\"No\")","v":"No"},"Actuarial Value",null,"ACTUARIALVALUE","Numeric",1.4,null,null,null,null,"N",null,"Not reviewed"]
[2,"BP001",{"$f":"IF(AND('Legal Approval Form'!$B$22=\"Y\",'Legal Approval Form'!$B$33=\"Y\"),\"Yes\",\"No\")","v":"No"},"Benefit Plan Contract ID",null,"BENEFITPLANCONTRACTID","Char",30,null,null,null,null,"N",null,"Not reviewed"]
[2,"Derived",{"$f":"IF(AND('Legal Approval Form'!$B$22=\"Y\",'Legal Approval Form'!$B$33=\"Y\"),\"Yes\",\"No\")","v":"No"},"Benefit Plan Control ID",null,"BENEFITPLANCONTROLID","Integer",5,null,null,null,null,"N",null,"Not reviewed"]
[2,"BP009",{"$f":"IF(AND('Legal Approval Form'!$B$22=\"Y\",'Legal Approval Form'!$B$33=\"Y\"),\"Yes\",\"No\")","v":"No"},"Benefit Plan End Date",null,"BENEFITPLANENDDATE","Integer",8,null,"YYYYMMDD",null,null,"N",null,"Not reviewed"]
[2,"BP008",{"$f":"IF(AND('Legal Approval Form'!$B$22=\"Y\",'Legal Approval Form'!$B$33=\"Y\"),\"Yes\",\"No\")","v":"No"},"Benefit Plan Start Date",null,"BENEFITPLANSTARTDATE","Integer",8,null,"YYYYMMDD",null,null,"N",null,"Not reviewed"]
[2,"BP004",{"$f":"IF(AND('Legal Approval Form'!$B$22=\"Y\",'Legal Approval Form'!$B$33=\"Y\"),\"Yes\",\"No\")","v":"No"},"Claim Type Qualifier",null,"CLAIMTYPEQUALIFIER","Integer",1,null,null,null,null,"N",null,"Not reviewed"]
[2,"BP005",{"$f":"IF(AND('Legal Approval Form'!$B$22=\"Y\",'Legal Approval Form'!$B$33=\"Y\"),\"Yes\",\"No\")","v":"No"},"Monthly Claims Paid Number for the Benefit Plan",null,"TOTALNUMBEROFCLAIMSPAID","Integer",9,null,null,null,null,"N",null,"Not reviewed"]
[2,"BP006",{"$f":"IF(AND('Legal Approval Form'!$B$22=\"Y\",'Legal Approval Form'!$B$33=\"Y\"),\"Yes\",\"No\")","v":"No"},"Monthly Net Dollars Paid for the Benefit Plan",null,"TOTALPAIDAMOUNT","Numeric",15.2,null,null,null,null,"N",null,"Not reviewed"]
[2,"Derived",{"$f":"IF(AND('Legal Approval Form'!$B$22=\"Y\",'Legal Approval Form'!$B$33=\"Y\"),\"Yes\",\"No\")","v":"No"},"OrgID","Submitting Carrier ORGID","ORGID","Integer",6,null,null,null,null,"N",null,"Not reviewed","Defined as Char on SG but stored as Integer in all CHIA tables & views."]
[2,"Derived",{"$f":"IF(AND('Legal Approval Form'!$B$22=\"Y\",'Legal Approval Form'!$B$33=\"Y\"),\"Yes\",\"No\")","v":"No"},"Submission Control ID",null,"SUBMISSIONCONTROLID","Integer",8,null,null,null,null,"N",null,"Not reviewed"]
[2,"HD003",{"$f":"IF(AND('Legal Approval Form'!$B$22=\"Y\",'Legal Approval Form'!$B$33=\"Y\"),\"Yes\",\"No\")","v":"No"},"Submission Year Month",null,"SUBMISSIONYEARMONTH","Integer",6,null,null,null,null,"N",null,"Not reviewed"]
[2,"BP007",{"$f":"IF(AND('Legal Approval Form'!$B$22=\"Y\",'Legal Approval Form'!$B$33=\"Y\"),\"Yes\",\"No\")","v":"No"},"Total Monthly Eligible Members by Benefit Plan ID Period Date",null,"TOTALELIGIBLEMEMBERS","Integer",9,null,null,null,null,"N",null,"Not reviewed"]

{"sheet":"CHIA Internal-Checklist","index":9,"n_rows":51,"n_cols":6,"rows_kept":51,"cut":false,"hidden":true,"merged":[[0,1,0,4],[1,1,1,4]]}
[" ","APCD Data Request Checklist"]
[null,"Standards and Enhancement Group –  Version 9/16/15 "]
[null,"Step","Process","Date","Initials","Notes"]
[null,1,"Request Template complete - Release forms received by CHIA-IT should contain the following:"]
[null,"1.a","Completed teal-shaded Data Requestor section"]
[null,"1.b","Completed yellow-shaded section with the following information:"]
[null,"1.b.i","CHIA contact name (e.g. Adam Tapply/David Netherton/Jessica Barnett)"]
[null,"1.b.ii","CHIA/Non-CHIA user"]
[null,"1.b.iii","Governmental/non-Governmental user "]
[null,2,"Review and save Authorization documents – including signed CHIA approval form/ letter and justification for data elements requested (attachments). "]
[null,"2.a","If applicable - APCD approval by DRC or CHIA Legal"]
[null,"2.b","If applicable - Medicaid approval by CHIA Legal"]
[null,"2.c","If applicable – Medicare (CMS) approval by CHIA Legal"]
[null,"2.d","If applicable – Case-mix approval by DRC or CHIA Legal"]
[null,"2.e","Email legal to prepare release letter and prepare materials for delivery at the start of IT processing so that this work is ready when CHIA-IT completes Request process. "]
[null,3,"CHIA-IT registers request."]
[null,"3.a","Assign an Extract Request Number, using the master APCD requests tracking document."]
[null,"3.b","CHIA-IT creates a folder for this request on the appropriate share drive to store the request form, additional work, and authorization documents related to this request."]
[null,4,"CHIA-IT reviews request for consistency. Any questions or concerns are referred to designated CHIA contact."]
[null,5,"Final reviewed request specification form is sent to IT to write code and create outputs."]
[null,"5.a","File extraction requested - external requestors (currently CHLOEN creates)."]
[null,"5.b","Helpdesk Ticket entered - (DBA assigned) for internal database access and views."]
[null,6,"Final Q/A by S&E group – For each requested year and file type or view:"]
[null,"6.a","Structure/contents, and record counts"]
[null,"6.b","If any discrepancies are found, cycle back issues to IT - step 4. "]
[null,7,"CHIA-IT fills in extract format and completion dates related to release extraction in the master tracking log."]
[null,8,"Final Release:"]
[null,"8.a","Compile documentation for recipient including file contents, layout, and record counts."]
[null,"8.b","If External Request, prepare hard drive and user documentation:"]
[null,"8.b.i","Copy data to encrypted Padlock external Hard Drive*"]
[null,"8.b.ii","Create user documentation – including screen shot of hard drive directory."]
[null,"8.b.iii","Copy user documentation to hard drive."]
[null,"8.b.iv","Store passwords in appropriate spreadsheet on the Network Drive"]
[null,"8.b.v","Deliver to Legal office for shipping and delivery – include Padlock User Guide (paper copy)"]
[null,"8.c","If Internal Request, notify internal users:"]
[null,"8.c.i","Send access information (View/Other) to CHIA contact person."]
[null,"8.d","Email Legal and HIT Account Management Team. (include the completed spreadsheet request document as an attachment)"]
[null,9,"Follow up with Legal to make sure Drives are shipped out timely – especially when timeframe expectations are heightened."]
[null,10,"Checklist – To make sure all these steps have been completed – begin and complete this process by filling out and checking off each step in the document: Process for APCD Data Request Checklist.docx"]
[]
[]
[]
[null,null,"*Encrypted Padlock external Hard Drive:"]
[null,null,"Currently utilizing an Aegis Padlock DT 4 TB hard Drive which is encrypted and includes a keypad for access to data. "]
[null,null,"Uses Advanced Encryption System - AES 256 Bit Encryption"]
[null,null,"Drives will be branded with a CHIA logo and number ID"]
[null,null,"Package will include a pre-addressed UPS delivery envelop for Return to CHIA"]
[null,null,"Drive locks after 6 unsuccessful attempts, and will self-destruct if repeated attempts to unlock the drive are attempted. Users are advised to contact CHIA after 6 failed attempts."]
[null,null,"See Encrypted Drive administrative procedures for drive reset and PW administration."]
[]
[null,null,"See: W:\\W_HIT\\DataStandardization\\APCD-Release\\Process-and-Filters\\EncryptedDriveAdmin"]

{"sheet":"MHEE","index":10,"n_rows":125,"n_cols":24,"rows_kept":125,"cut":false,"hidden":false,"merged":[]}
["Release Level","Included   (this request)","MassHealth Enhanced Eligibility (MHEE) - Column Name","Data Elements (related MH Source Fields)","Comments","Release Column Name","tbl_release_masshealthenhancedeligibility","Dev Requirement Notes","Data Type","Field Length","Format","MH Warehouse Reference","CHIA Code","De-Identified Set","OnPoint Mitigation"," 2025 UVR Release Comments ","Action","Data Element Name","Data Element Source","Data Element Name (Onpoint -used MassHealth column name - not best)","Risk Status","Risk Type","CHIA Action on ALL Historical Data","Group 1"]
[1,{"$f":"IF(AND('Legal Approval Form'!$B$26=\"Y\",'Legal Approval Form'!$B$33=\"N\"),\"Yes\",\"No\")","v":"No"},"Member mailing zip code","ADR_MAIL_ZIP","Note '+' value = missing, '#' value = 'N/A'","ADR_MAIL_ZIPDE","adr_mail_zip","trim to 5 char","CHAR",5,null,"nw_state_eligibility",null,"Y","Y","MA codes only, Standard small zip suppression","create new DE column","ADR_MAIL_ZIP","Member mailing zip code","ADR_MAIL_ZIP","Moderate","Geography","ZIP code rules - see section 6.2.2.","ZIP code rules - see section 6.2.2."]
[1,{"$f":"IF(AND('Legal Approval Form'!$B$26=\"Y\",'Legal Approval Form'!$B$33=\"N\"),\"Yes\",\"No\")","v":"No"},"Aid Category - Coverage type","CDE_AID_CATEGORY",null,"AIDCATCOVERAGETYPEDE","aidcatcoveragetype","Derivation see: Aid Category Derivation of New Data Elements - ME and MHEE.xlsx","CHAR",50,null,"nw_state_eligibility",null,"Y","Y","Create DE mitigated version","see UVR specs","AIDCATCOVERAGETYPE","Aid Category Coverage Type","CDE_AID_CATEGORY","Low","-","NONE","NONE"]
[1,{"$f":"IF(AND('Legal Approval Form'!$B$26=\"Y\",'Legal Approval Form'!$B$33=\"N\"),\"Yes\",\"No\")","v":"No"},"Aid Category - Disability Indicator","CDE_AID_CATEGORY",null,"AIDCATDISABILITYINDICATORDE","aidcatdisabilityindicator","Derivation see: Aid Category Derivation of New Data Elements - ME and MHEE.xlsx","CHAR",1,null,"nw_state_eligibility",null,"Y","Y","Create DE mitigated version","see UVR specs","AIDCATDISABILITYINDICATOR","Aid Category Disability Indicator","CDE_AID_CATEGORY","Low","-","NONE","NONE"]
[1,{"$f":"IF(AND('Legal Approval Form'!$B$26=\"Y\",'Legal Approval Form'!$B$33=\"N\"),\"Yes\",\"No\")","v":"No"},"Aid Category - Population","CDE_AID_CATEGORY",null,"AIDCATPOPULATIONDE","aidcatpopulation","Derivation see: Aid Category Derivation of New Data Elements - ME and MHEE.xlsx","CHAR",50,null,"nw_state_eligibility",null,"Y","Y","Create DE mitigated version","see UVR specs","AIDCATPOPULATION","Aid Category Population","CDE_AID_CATEGORY","Low","-","NONE","NONE"]
[1,{"$f":"IF(AND('Legal Approval Form'!$B$26=\"Y\",'Legal Approval Form'!$B$33=\"N\"),\"Yes\",\"No\")","v":"No"},"Aid Category - Premium assistance indicator","CDE_AID_CATEGORY",null,"AIDCATPREMIUMASSISTANCEINDICATORDE","aidcatpremiumassistanceindicator","Derivation see: Aid Category Derivation of New Data Elements - ME and MHEE.xlsx","CHAR",1,null,"nw_state_eligibility",null,"Y","Y","Create DE mitigated version","see UVR specs","AIDCATPREMIUMASSISTANCEINDICATOR","Aid Category Premium assistance indicator","CDE_AID_CATEGORY","Low","-","NONE","NONE"]
[1,{"$f":"IF(AND('Legal Approval Form'!$B$26=\"Y\",'Legal Approval Form'!$B$33=\"N\"),\"Yes\",\"No\")","v":"No"},"Aid Category - Temporary Coverage Type","CDE_AID_CATEGORY",null,"AIDCATTEMPORARYCOVERAGETYPEDE","aidcattemporarycoveragetype","Derivation see: Aid Category Derivation of New Data Elements - ME and MHEE.xlsx","CHAR",1,null,"nw_state_eligibility",null,"Y","Y","Create DE mitigated version","see UVR specs","AIDCATTEMPORARYCOVERAGETYPE","Aid Category Temporary Coverage Type","CDE_AID_CATEGORY","Low","-","NONE","NONE"]
[1,{"$f":"IF('Legal Approval Form'!$B$26=\"Y\",\"Yes\",\"No\")","v":"No"},"Age Group","CDE_AGE_GROUP","APCD Lookup table ref: TLKP_MHEE_CDE_AGE_GROUP","CDE_AGE_GROUP","cde_age_group",null,"CHAR",1,null,"nw_state_eligibility",null,"Y","N","Already rolled up 65+ cohort","No action","CDE_AGE_GROUP","Age Group","CDE_AGE_GROUP","Moderate","Age","If age 90 or older, CHIA will suppress or recode to denote 'over 89' ","If age 90 or older, CHIA will suppress or recode to denote 'over 89' "]
[1,{"$f":"IF(AND('Legal Approval Form'!$B$26=\"Y\",'Legal Approval Form'!$B$33=\"N\"),\"Yes\",\"No\")","v":"No"},"Aid Category - Richest MassHealth Aid Category Code","CDE_AID_CATEGORY","Identifiable release only. See 5 derived release elts.","CDE_AID_CATEGORYDE","cde_aid_category",null,"CHAR",2,null,"nw_state_eligibility",null,"Y","Y","remap per Onpoint specs","create new DE column","CDE_AID_CATEGORY","Aid Category","CDE_AID_CATEGORY","Moderate","Public event, Age","Transform according to MHEEE Aid Categories","Transform according to MHEEE Aid Categories"]
[1,{"$f":"IF(AND('Legal Approval Form'!$B$26=\"Y\",'Legal Approval Form'!$B$33=\"N\"),\"Yes\",\"No\")","v":"No"},"Behavioral Health (MBHP) Enrollment Aid Category","CDE_AID_CATEGORY_BH","Identifiable release only. See 5 derived release elts.","CDE_AID_CATEGORY_BHDE","cde_aid_category_bh",null,"CHAR",2,null,"nw_state_eligibility",null,"Y","Y","Create DE mitigated version","see UVR specs"]
[1,{"$f":"IF(AND('Legal Approval Form'!$B$26=\"Y\",'Legal Approval Form'!$B$33=\"N\"),\"Yes\",\"No\")","v":"No"},"Managed Care (MCO) Enrollment Aid Category","CDE_AID_CATEGORY_MC","Identifiable release only. See 5 derived release elts.","CDE_AID_CATEGORY_MCDE","cde_aid_category_mc",null,"CHAR",2,null,"nw_state_eligibility",null,"Y","Y","Create DE mitigated version","see UVR specs"]
[1,{"$f":"IF(AND('Legal Approval Form'!$B$26=\"Y\",'Legal Approval Form'!$B$33=\"N\"),\"Yes\",\"No\")","v":"No"},"Accountable Care Organization B Aid Category","CDE_AID_CATEGORY_ACOB","New R8 - See ref table for CDE_AID_CATEGORY","CDE_AID_CATEGORY_ACOBDE","cde_aid_category_acob",null,"CHAR",2,null,null,null,"Y","Y","Create DE mitigated version","see UVR specs","CDE_AID_CATEGORY_ACOB","Accountable Care Organization B Aid Category","CDE_AID_CATEGORY_ACOB","Low","-","NONE","NONE"]
[1,{"$f":"IF(AND('Legal Approval Form'!$B$26=\"Y\",'Legal Approval Form'!$B$33=\"N\"),\"Yes\",\"No\")","v":"No"},"Community Partners Aid Category","CDE_AID_CATEGORY_CP","New R8 - See ref table for CDE_AID_CATEGORY","CDE_AID_CATEGORY_CPDE","cde_aid_category_cp",null,"CHAR",2,null,null,null,"Y","Y","Create DE mitigated version","see UVR specs","CDE_AID_CATEGORY_CP","Community Partners Aid Category","CDE_AID_CATEGORY_CP","Low","-","NONE","NONE"]
[1,{"$f":"IF('Legal Approval Form'!$B$26=\"Y\",\"Yes\",\"No\")","v":"No"},"Behavioral Health Plan Assignment","CDE_BH_ENROLL","APCD Lookup reference table: TLKP_MHEE_REFERENCE","CDE_BH_ENROLL","cde_bh_enroll",null,"CHAR",32,null,"nw_state_eligibility",null,"Y","N",null,null,"CDE_BH_ENROLL","Behavioral Health Plan Assignment","CDE_BH_ENROLL","Low","-","NONE","NONE"]
[1,{"$f":"IF('Legal Approval Form'!$B$26=\"Y\",\"Yes\",\"No\")","v":"No"},"Behavioral Health Plan Assignment Detail","CDE_BH_ENROLL_L2","APCD Lookup reference table: TLKP_MHEE_REFERENCE","CDE_BH_ENROLL_L2","cde_bh_enroll_l2",null,"CHAR",32,null,"nw_state_eligibility",null,"Y","N",null,null,"CDE_BH_ENROLL_L2","Behavioral Health Plan Assignment Detail","CDE_BH_ENROLL_L2","Low","-","NONE","NONE"]
[1,{"$f":"IF('Legal Approval Form'!$B$26=\"Y\",\"Yes\",\"No\")","v":"No"},"Budget Group","CDE_BUDGET_GROUP","APCD Lookup reference table: TLKP_MHEE_REFERENCE","CDE_BUDGET_GROUP","cde_budget_group",null,"CHAR",32,null,"nw_state_eligibility",null,"Y","N",null,null,"CDE_BUDGET_GROUP","Budget Group","CDE_BUDGET_GROUP","Low","-","NONE","NONE"]
[1,{"$f":"IF('Legal Approval Form'!$B$26=\"Y\",\"Yes\",\"No\")","v":"No"},"Disability Code","CDE_DISABILITY","APCD Lookup reference table: TLKP_MHEE_REFERENCE","CDE_DISABILITY","cde_disability","lookup case sensitive issue: eg) cde_disability - several others below too!","CHAR",32,null,"nw_state_eligibility",null,"Y","N",null,null,"CDE_DISABILITY","Disability Code","CDE_DISABILITY","Low","-","NONE","NONE"]
[1,{"$f":"IF('Legal Approval Form'!$B$26=\"Y\",\"Yes\",\"No\")","v":"No"},"Home and Community Based Waiver Code","CDE_HCB_WAIVER","APCD Lookup reference table: TLKP_MHEE_REFERENCE","CDE_HCB_WAIVER","cde_hcb_waiver",null,"CHAR",32,null,"nw_state_eligibility",null,"Y","N",null,null,"CDE_HCB_WAIVER","Home and Community Based Waiver Code","CDE_HCB_WAIVER","Low","-","NONE","NONE"]
[1,{"$f":"IF('Legal Approval Form'!$B$26=\"Y\",\"Yes\",\"No\")","v":"No"},"Member Homeless Indicator Code","CDE_HOMELESS",null,"CDE_HOMELESS","cde_homeless",null,"CHAR",1,"Values Y,  , N","nw_member",null,"Y","N",null,null,"CDE_HOMELESS","Member Homeless Indicator Code","CDE_HOMELESS","Low","-","NONE","NONE"]
[1,{"$f":"IF('Legal Approval Form'!$B$26=\"Y\",\"Yes\",\"No\")","v":"No"},"Managed Care Plan Code","CDE_MANAGED_CARE_PLAN","APCD Lookup reference table: TLKP_MHEE_REFERENCE","CDE_MANAGED_CARE_PLAN","cde_managed_care_plan",null,"CHAR",32,null,"nw_state_eligibility",null,"Y","N",null,null,"CDE_MANAGED_CARE_PLAN","Managed Care Plan Code","CDE_MANAGED_CARE_PLAN","Low","-","NONE","NONE"]
[1,{"$f":"IF('Legal Approval Form'!$B$26=\"Y\",\"Yes\",\"No\")","v":"No"},"Managed Care Plan Code Detail","CDE_MANAGED_CARE_PLAN_L2","APCD Lookup reference table: TLKP_MHEE_REFERENCE","CDE_MANAGED_CARE_PLAN_L2","cde_managed_care_plan_l2",null,"CHAR",32,null,"nw_state_eligibility",null,"Y","N",null,null,"CDE_MANAGED_CARE_PLAN_L2","Managed Care Plan Code Detail","CDE_MANAGED_CARE_PLAN_L2","Low","-","NONE","NONE"]
[1,{"$f":"IF('Legal Approval Form'!$B$26=\"Y\",\"Yes\",\"No\")","v":"No"},"Federal Poverty Level Group","CDE_PCT_INCOME_FPL","APCD Lookup reference table: TLKP_MHEE_REFERENCE","CDE_PCT_INCOME_FPL","cde_pct_income_fpl",null,"CHAR",32,null,"nw_state_eligibility",null,"Y","N",null,null,"CDE_PCT_INCOME_FPL","Federal Poverty Level Group","CDE_PCT_INCOME_FPL","Low","-","NONE","NONE"]
[1,{"$f":"IF('Legal Approval Form'!$B$26=\"Y\",\"Yes\",\"No\")","v":"No"},"Benefit Plan","CDE_PGM_HEALTH","APCD Lookup reference table: TLKP_MHEE_REFERENCE","CDE_PGM_HEALTH","cde_pgm_health",null,"CHAR",32,null,"nw_state_eligibility",null,"Y","N",null,null,"CDE_PGM_HEALTH","Benefit Plan","CDE_PGM_HEALTH","Low","-","NONE","NONE"]
[1,{"$f":"IF('Legal Approval Form'!$B$26=\"Y\",\"Yes\",\"No\")","v":"No"},"Accountable Care Organization B Assignment Plan","CDE_PGM_HEALTH_ACOB","New R8 - ","CDE_PGM_HEALTH_ACOB","cde_pgm_health_acob","add to APCD_LOOKUP.DBO.TLKP_MHEE_REFERENCE","CHAR",32,"ACOB",null,null,"Y","N",null,null,"CDE_PGM_HEALTH_ACOB","Accountable Care Organization B Assignment Plan","CDE_PGM_HEALTH_ACOB","Low","-","NONE","NONE"]
[1,{"$f":"IF('Legal Approval Form'!$B$26=\"Y\",\"Yes\",\"No\")","v":"No"},"Behavioral Health Assignment Plan","CDE_PGM_HEALTH_BH","APCD Lookup reference table: TLKP_MHEE_REFERENCE","CDE_PGM_HEALTH_BH","cde_pgm_health_bh",null,"CHAR",32,null,"nw_state_eligibility",null,"Y","N",null,null,"CDE_PGM_HEALTH_BH","Behavioral Health Assignment Plan","CDE_PGM_HEALTH_BH","Low","-","NONE","NONE"]
[1,{"$f":"IF('Legal Approval Form'!$B$26=\"Y\",\"Yes\",\"No\")","v":"No"},"Community Partners Assignment Plan","CDE_PGM_HEALTH_CP","New R8 - Program values are: BHCP, CSA, LTSS, ELTSS, ACSS1, ACSS2, PACC1, PACC2","CDE_PGM_HEALTH_CP","cde_pgm_health_cp","add to APCD_LOOKUP.DBO.TLKP_MHEE_REFERENCE","CHAR",32,"various",null,null,"Y","N",null,null,"CDE_PGM_HEALTH_CP","Community Partners Assignment Plan","CDE_PGM_HEALTH_CP","Low","-","NONE","NONE"]
[1,{"$f":"IF('Legal Approval Form'!$B$26=\"Y\",\"Yes\",\"No\")","v":"No"},"Managed Care Assignment Plan","CDE_PGM_HEALTH_MC","APCD Lookup reference table: TLKP_MHEE_REFERENCE","CDE_PGM_HEALTH_MC","cde_pgm_health_mc","this one is mixed case! (CDE_PGM_HEALTH_mc)","CHAR",32,null,"nw_state_eligibility",null,"Y","N",null,null,"CDE_PGM_HEALTH_MC","Managed Care Assignment Plan","CDE_PGM_HEALTH_MC","Low","-","NONE","NONE"]
[1,{"$f":"IF(AND('Legal Approval Form'!$B$26=\"Y\",'Legal Approval Form'!$B$33=\"N\"),\"Yes\",\"No\")","v":"No"},"Member Primary Language Code","CDE_PRIMARY_LANG","APCD Lookup reference table: TLKP_MHEE_REFERENCE","CDE_PRIMARY_LANGDE","cde_primary_lang",null,"CHAR",32,null,"nw_member",null,"N","Y","Create CDE_PRIMARY_LANGDE (English, Spanish, Other) - everything else set to Other. ","create new DE column","CDE_PRIMARY_LANG","Member Primary Language Code","CDE_PRIMARY_LANG","Moderate","Language","Field will be updated in CHIA's Submission Guide to only allow entries of codes for English, Spanish, Other, Unknown/Not Specified (Transformed in See Section 6.2.4)","Field will be updated in CHIA's Submission Guide to only allow entries of codes for English, Spanish, Other, Unknown/Not Specified (Transformed in See Section 6.2.4)"]
[1,{"$f":"IF('Legal Approval Form'!$B$26=\"Y\",\"Yes\",\"No\")","v":"No"},"Behavioral Health Provider Type","CDE_PROV_TYPE_BH","APCD Lookup reference table: TLKP_MHEE_REFERENCE","CDE_PROV_TYPE_BH","cde_prov_type_bh",null,"CHAR",32,null,"nw_state_eligibility",null,"Y","N",null,null,"CDE_PROV_TYPE_BH","Behavioral Health Provider Type","CDE_PROV_TYPE_BH","Low","-","NONE","NONE"]
[1,{"$f":"IF('Legal Approval Form'!$B$26=\"Y\",\"Yes\",\"No\")","v":"No"},"Community Partners Provider Type","CDE_PROV_TYPE_CP","New R8 - Provider Types are: A5 – CP CSA, A6 – CP LTSS, A7 – CP BH","CDE_PROV_TYPE_CP","cde_prov_type_cp","add to APCD_LOOKUP.DBO.TLKP_MHEE_REFERENCE","CHAR",32,null,null,null,"Y","N",null,null,"CDE_PROV_TYPE_CP","Community Partners Provider Type","CDE_PROV_TYPE_CP","Low","-","NONE","NONE"]
[1,{"$f":"IF('Legal Approval Form'!$B$26=\"Y\",\"Yes\",\"No\")","v":"No"},"Long Term Care Provider Type","CDE_PROV_TYPE_LTC","APCD Lookup reference table: TLKP_MHEE_REFERENCE","CDE_PROV_TYPE_LTC","cde_prov_type_ltc",null,"CHAR",32,null,"nw_state_eligibility",null,"Y","N",null,null,"CDE_PROV_TYPE_LTC","Long Term Care Provider Type","CDE_PROV_TYPE_LTC","Low","-","NONE","NONE"]
[1,{"$f":"IF('Legal Approval Form'!$B$26=\"Y\",\"Yes\",\"No\")","v":"No"},"Managed Care Provider Type","CDE_PROV_TYPE_MCO","APCD Lookup reference table: TLKP_MHEE_REFERENCE","CDE_PROV_TYPE_MCO","cde_prov_type_mco",null,"CHAR",32,null,"nw_state_eligibility",null,"Y","N",null,null,"CDE_PROV_TYPE_MCO","Managed Care Provider Type","CDE_PROV_TYPE_MCO","Low","-","NONE","NONE"]
[1,{"$f":"IF('Legal Approval Form'!$B$26=\"Y\",\"Yes\",\"No\")","v":"No"},"Primary Care Clinician Provider Type","CDE_PROV_TYPE_PCC","APCD Lookup reference table: TLKP_MHEE_REFERENCE","CDE_PROV_TYPE_PCC","cde_prov_type_pcc",null,"CHAR",32,null,"nw_state_eligibility",null,"Y","N",null,null,"CDE_PROV_TYPE_PCC","Primary Care Clinician Provider Type","CDE_PROV_TYPE_PCC","Low","-","NONE","NONE"]
[1,{"$f":"IF('Legal Approval Form'!$B$26=\"Y\",\"Yes\",\"No\")","v":"No"},"Behavioral Health Enrollment Rate Cell","CDE_RATE_CELL_BH","APCD Lookup reference table: TLKP_MHEE_REFERENCE","CDE_RATE_CELL_BH","cde_rate_cell_bh",null,"CHAR",32,null,"nw_state_eligibility",null,"Y","N",null,null,"CDE_RATE_CELL_BH","Behavioral Health Enrollment Rate Cell","CDE_RATE_CELL_BH","Low",null,"NONE","NONE"]
[1,{"$f":"IF('Legal Approval Form'!$B$26=\"Y\",\"Yes\",\"No\")","v":"No"},"Community Partners Rate Cell","CDE_RATE_CELL_CP","New R8 - Not active yet but should have same value as CDE_PGM_HEALTH_CP","CDE_RATE_CELL_CP","cde_rate_cell_cp","add to APCD_LOOKUP.DBO.TLKP_MHEE_REFERENCE","CHAR",32,null,null,null,"Y","N",null,null,"CDE_RATE_CELL_CP","Community Partners Rate Cell","CDE_RATE_CELL_CP","Low","-","NONE","NONE"]
[1,{"$f":"IF('Legal Approval Form'!$B$26=\"Y\",\"Yes\",\"No\")","v":"No"},"Managed Care Enrollment Rate Cell","CDE_RATE_CELL_MCO","APCD Lookup reference table: TLKP_MHEE_REFERENCE","CDE_RATE_CELL_MCO","cde_rate_cell_mco",null,"CHAR",32,null,"nw_state_eligibility",null,"Y","N",null,null,"CDE_RATE_CELL_MCO","Managed Care Enrollment Rate Cell","CDE_RATE_CELL_MCO","Low","-","NONE","NONE"]
[1,{"$f":"IF('Legal Approval Form'!$B$26=\"Y\",\"Yes\",\"No\")","v":"No"},"Primary Care Clinician Enrollment Rate Cell","CDE_RATE_CELL_PCC","New R8 - ","CDE_RATE_CELL_PCC","cde_rate_cell_pcc","add to APCD_LOOKUP.DBO.TLKP_MHEE_REFERENCE","CHAR",32,"PCR",null,null,"Y","N",null,null,"CDE_RATE_CELL_PCC","Primary Care Clinician Enrollment Rate Cell","CDE_RATE_CELL_PCC","Low","-","NONE","NONE"]
[1,{"$f":"IF('Legal Approval Form'!$B$26=\"Y\",\"Yes\",\"No\")","v":"No"},"State Children's Health Insurance Program Code","CDE_SCHIP_TYPE","APCD Lookup reference table: TLKP_MHEE_REFERENCE","CDE_SCHIP_TYPE","cde_schip_type",null,"CHAR",32,null,"nw_state_eligibility",null,"Y","N",null,"No action","CDE_SCHIP_TYPE","State Children's Health Insurance Program Code","CDE_SCHIP_TYPE","Moderate","Age","NONE","NONE"]
[1,{"$f":"IF('Legal Approval Form'!$B$26=\"Y\",\"Yes\",\"No\")","v":"No"},"Member Gender Code","CDE_SEX","APCD Lookup reference table: TLKP_MHEE_REFERENCE","CDE_SEX","cde_sex",null,"CHAR",1,null,"nw_member",null,"Y","N","Only M, F values found in MHEE data","No action","CDE_SEX","Member Gender Code","CDE_SEX","Moderate","Gender","NONE","NONE"]
[1,{"$f":"IF('Legal Approval Form'!$B$26=\"Y\",\"Yes\",\"No\")","v":"No"},"Member Third Party Liability Status","CDE_TPL_STATUS","APCD Lookup reference table: TLKP_MHEE_REFERENCE","CDE_TPL_STATUS","cde_tpl_status",null,"CHAR",32,null,"nw_state_eligibility",null,"Y","N",null,null,"CDE_TPL_STATUS","Member Third Party Liability Status","CDE_TPL_STATUS","Low","-","NONE","NONE"]
[1,{"$f":"IF('Legal Approval Form'!$B$26=\"Y\",\"Yes\",\"No\")","v":"No"},"Derived Carrier Specific Unique Member ID","ID_MEDICAID","This is a Surrogate key for Medicaid ID","CHIACARRIERSPECIFICUNIQUEMEMBERID","chiacarrierspecificuniquememberid","CHIA Surrogate Key","Integer",20,null,"N/A","Y","Y","N",null,"No action"]
[1,{"$f":"IF('Legal Approval Form'!$B$26=\"Y\",\"Yes\",\"No\")","v":"No"},"Third Party Liability Coverage Category","COVERAGE_CATEGORY","APCD Lookup reference table: TLKP_MHEE_REFERENCE","COVERAGE_CATEGORY","coverage_category",null,"CHAR",32,null,"nw_state_eligibility",null,"Y","N",null,null,"COVERAGE_CATEGORY","Third Party Liability Coverage Category","COVERAGE_CATEGORY","Low","-","NONE","NONE"]
[1,{"$f":"IF(AND('Legal Approval Form'!$B$26=\"Y\",'Legal Approval Form'!$B$33=\"N\"),\"Yes\",\"No\")","v":"No"},"Member Date of Birth","DTE_BIRTH","full DOB","DTE_BIRTHDE","dte_birth","Consider encryption for this column. ","CHAR",6,"YYYYMMDD","nw_member",null,"N","Y","String to YYYYMM, Set DOB = 999 when age >89, consistent with APCD ","create new DE column","DTE_BIRTH","Member Year and Month of Birth","DTE_BIRTH","Moderate","Age","Recode as year of birth. Bottom recode to ensure a 90+ age group","Recode as year of birth. Bottom recode to ensure a 90+ age group"]
[1,{"$f":"IF('Legal Approval Form'!$B$26=\"Y\",\"Yes\",\"No\")","v":"No"},"MH Record source Effective date","DTE_EFFECTIVE","applies to source span, not derived monthly segments","DTE_EFFECTIVE","dte_effective",null,"Date",8,"YYYYMMDD",null,null,"Y","N",null,"No action","DTE_EFFECTIVE","Derived Effective Begin date","DTE_EFFECTIVE","Moderate","Date","NONE","NONE"]
[1,{"$f":"IF('Legal Approval Form'!$B$26=\"Y\",\"Yes\",\"No\")","v":"No"},"Derived Effective Begin date (Monthly Segment begin)","DTE_EFFECTIVE","Effective date enrollment (of segment) - Monthly bounded YYYYMMDD","DTE_EFFECTIVE_MONTH","dte_effective_month",null,"Date",8,"YYYYMMDD","N/A",null,"Y","N"]
[1,{"$f":"IF('Legal Approval Form'!$B$26=\"Y\",\"Yes\",\"No\")","v":"No"},"MH Record source End date","DTE_END","applies to source span, not derived monthly segments","DTE_END","dte_end",null,"Date",8,"YYYYMMDD",null,null,"Y","N",null,"No action","DTE_END","Derived Effective End date","DTE_END","Moderate","Date","NONE","NONE"]
[1,{"$f":"IF('Legal Approval Form'!$B$26=\"Y\",\"Yes\",\"No\")","v":"No"},"Derived Effective End date (Monthly segment end)","DTE_END","End date enrollment (of segment) - Monthly bounded YYYYMMDD","DTE_END_MONTH","dte_end_month",null,"Date",8,"YYYYMMDD","N/A",null,"Y","N"]
[1,{"$f":"IF('Legal Approval Form'!$B$26=\"Y\",\"Yes\",\"No\")","v":"No"},"Derived MHEE Release Record ID ","N/A","Unique record identity element","ID","id","Max value in R8:  1,162,160,505","Integer",12,null,"N/A",null,"Y","N",null,null,"ID"]
[1,{"$f":"IF('Legal Approval Form'!$B$26=\"Y\",\"Yes\",\"No\")","v":"No"},"Derived Behavioral Health Provider ID","ID_PROVIDER_LOCATION_BH","Record linkage to APCD Provider (PV) File","ID_PROVIDER_LOCATION_BH_LINKAGE_ID","id_provider_location_bh_linkage_id",null,"Integer",20,null,"N/A","Y","Y","N"]
[1,{"$f":"IF('Legal Approval Form'!$B$26=\"Y\",\"Yes\",\"No\")","v":"No"},"Derived Community Partner Provider ID","ID_PROVIDER_LOCATION_CP","New R8 - Record linkage to APCD Provider (PV) File. There are 27 Community Partners and 36 Community Service Agencies","ID_PROVIDER_LOCATION_CP_LINKAGE_ID","(not on source table -created in view )","Derive for Provider Location just like the other \"_LINKAGE_ID\" columns to enable linking to PV file. ","Integer",20,null,"N/A","Y","Y","N"]
[1,{"$f":"IF('Legal Approval Form'!$B$26=\"Y\",\"Yes\",\"No\")","v":"No"},"Derived Long Term Care Provider ID","ID_PROVIDER_LOCATION_LTC","Record linkage to APCD Provider (PV) File","ID_PROVIDER_LOCATION_LTC_LINKAGE_ID","id_provider_location_ltc_linkage_id",null,"Integer",20,null,"N/A","Y","Y","N"]
[1,{"$f":"IF('Legal Approval Form'!$B$26=\"Y\",\"Yes\",\"No\")","v":"No"},"Derived Managed Care Entity Provider ID","ID_PROVIDER_LOCATION_MCO","Record linkage to APCD Provider (PV) File","ID_PROVIDER_LOCATION_MCO_LINKAGE_ID","id_provider_location_mco_linkage_id",null,"Integer",20,null,"N/A","Y","Y","N"]
[1,{"$f":"IF('Legal Approval Form'!$B$26=\"Y\",\"Yes\",\"No\")","v":"No"},"Derived Primary Care Clinician Provider ID","ID_PROVIDER_LOCATION_PCC","Record linkage to APCD Provider (PV) File","ID_PROVIDER_LOCATION_PCC_LINKAGE_ID","id_provider_location_pcc_linkage_id",null,"Integer",20,null,"N/A","Y","Y","N"]
[1,{"$f":"IF('Legal Approval Form'!$B$26=\"Y\",\"Yes\",\"No\")","v":"No"},"Member Active Flag","IND_ACTIVE","Values Y/N","IND_ACTIVE","ind_active",null,"CHAR",1,"Values Y, N","nw_state_eligibility",null,"Y","N",null,null,"IND_ACTIVE","Member Active Flag","IND_ACTIVE","Low","-","NONE","NONE"]
[1,{"$f":"IF('Legal Approval Form'!$B$26=\"Y\",\"Yes\",\"No\")","v":"No"},"Disability Aid Category Flag","IND_AID_DISABLED","Values Y/N","IND_AID_DISABLED","ind_aid_disabled",null,"CHAR",1,"Values Y, N","nw_state_eligibility",null,"Y","N",null,null,"IND_AID_DISABLED","Disability Aid Category Flag","IND_AID_DISABLED","Low","-","NONE","NONE"]
[1,{"$f":"IF('Legal Approval Form'!$B$26=\"Y\",\"Yes\",\"No\")","v":"No"},"SSI (Aged and Disabled) Aid Category Flag","IND_AID_SSI","Values Y/N","IND_AID_SSI","ind_aid_ssi",null,"CHAR",1,"Values Y, N","nw_state_eligibility",null,"Y","N",null,"No action","IND_AID_SSI","SSI (Aged and Disabled) Aid Category Flag","IND_AID_SSI","Moderate","Age","NONE","NONE"]
[1,{"$f":"IF('Legal Approval Form'!$B$26=\"Y\",\"Yes\",\"No\")","v":"No"},"CommonHealth Non-Working Aid Category Flag","IND_COMMONHLTH_NON_WORKING","Values Y/N","IND_COMMONHLTH_NON_WORKING","ind_commonhlth_non_working",null,"CHAR",1,"Values Y, N","nw_state_eligibility",null,"Y","N",null,null,"IND_COMMONHLTH_NON_WORKING","CommonHealth Non-Working Aid Category Flag","IND_COMMONHLTH_NON_WORKING","Low","-","NONE","NONE"]
[1,{"$f":"IF('Legal Approval Form'!$B$26=\"Y\",\"Yes\",\"No\")","v":"No"},"CommonHealth Working Aid Category Flag","IND_COMMONHLTH_WORKING","Values Y/N","IND_COMMONHLTH_WORKING","ind_commonhlth_working",null,"CHAR",1,"Values Y, N","nw_state_eligibility",null,"Y","N",null,null,"IND_COMMONHLTH_WORKING","CommonHealth Working Aid Category Flag","IND_COMMONHLTH_WORKING","Low","-","NONE","NONE"]
[1,{"$f":"IF('Legal Approval Form'!$B$26=\"Y\",\"Yes\",\"No\")","v":"No"},"Commonwealth Care Aid Category Flag","IND_COMMONWEALTH_CARE","Values Y/N","IND_COMMONWEALTH_CARE","ind_commonwealth_care",null,"CHAR",1,"Values Y, N","nw_state_eligibility",null,"Y","N",null,null,"IND_COMMONWEALTH_CARE","Commonwealth Care Aid Category Flag","IND_COMMONWEALTH_CARE","Low","-","NONE","NONE"]
[1,{"$f":"IF('Legal Approval Form'!$B$26=\"Y\",\"Yes\",\"No\")","v":"No"},"Behavioral Health Community Partner Flag","IND_CP_BH","New R8 - Y/N, null","IND_CP_BH","ind_cp_bh",null,"CHAR",1,"Values Y, N",null,null,"Y","N",null,null,"IND_CP_BH","Behavioral Health Community Partner Flag","IND_CP_BH","Low","-","NONE","NONE"]
[1,{"$f":"IF('Legal Approval Form'!$B$26=\"Y\",\"Yes\",\"No\")","v":"No"},"Community Service Agency Flag","IND_CP_CSA","New R8 - Y/N, null","IND_CP_CSA","ind_cp_csa",null,"CHAR",1,"Values Y, N",null,null,"Y","N",null,null,"IND_CP_CSA","Community Service Agency Flag","IND_CP_CSA","Low","-","NONE","NONE"]
[1,{"$f":"IF('Legal Approval Form'!$B$26=\"Y\",\"Yes\",\"No\")","v":"No"},"Long Term Services and Support Community Partners Flag","IND_CP_LTSS","New R8 - Y/N, null","IND_CP_LTSS","ind_cp_ltss",null,"CHAR",1,"Values Y, N",null,null,"Y","N",null,null,"IND_CP_LTSS","Long Term Services and Support Community Partners Flag","IND_CP_LTSS","Low","-","NONE","NONE"]
[1,{"$f":"IF('Legal Approval Form'!$B$26=\"Y\",\"Yes\",\"No\")","v":"No"},"Health Safety Net Flag","IND_HEALTH_SAFETY_NET","Values Y/N","IND_HEALTH_SAFETY_NET","ind_health_safety_net",null,"CHAR",1,"Values Y, N","nw_state_eligibility",null,"Y","N",null,null,"IND_HEALTH_SAFETY_NET","Health Safety Net Flag","IND_HEALTH_SAFETY_NET","Low","-","NONE","NONE"]
[1,{"$f":"IF('Legal Approval Form'!$B$26=\"Y\",\"Yes\",\"No\")","v":"No"},"Kaleigh Mulligan Based Aid Category Flag","IND_KALEIGH_DISABLED","Values Y/N","IND_KALEIGH_DISABLED","ind_kaleigh_disabled",null,"CHAR",1,"Values Y, N","nw_state_eligibility",null,"Y","N",null,null,"IND_KALEIGH_DISABLED","Kaleigh Mulligan Based Aid Category Flag","IND_KALEIGH_DISABLED","Low","-","NONE","NONE"]
[1,{"$f":"IF('Legal Approval Form'!$B$26=\"Y\",\"Yes\",\"No\")","v":"No"},"Long Term Care Eligibility Flag","IND_LTC_FACILITY","Values Y/N","IND_LTC_FACILITY","ind_ltc_facility",null,"CHAR",1,"Values Y, N","nw_state_eligibility",null,"Y","N",null,null,"IND_LTC_FACILITY","Long Term Care Eligibility Flag","IND_LTC_FACILITY","Low","-","NONE","NONE"]
[1,{"$f":"IF('Legal Approval Form'!$B$26=\"Y\",\"Yes\",\"No\")","v":"No"},"Managed Care Eligibility Flag","IND_MANAGED_CARE_ELIGIBLE","Values Y/N","IND_MANAGED_CARE_ELIGIBLE","ind_managed_care_eligible",null,"CHAR",1,"Values Y, N","nw_state_eligibility",null,"Y","N",null,null,"IND_MANAGED_CARE_ELIGIBLE","Managed Care Eligibility Flag","IND_MANAGED_CARE_ELIGIBLE","Low","-","NONE","NONE"]
[1,{"$f":"IF('Legal Approval Form'!$B$26=\"Y\",\"Yes\",\"No\")","v":"No"},"Managed Care Eligibility/Aid Category Flag","IND_MCE_AID_CATEGORY","Values Y/N","IND_MCE_AID_CATEGORY","ind_mce_aid_category",null,"CHAR",1,"Values Y, N","nw_state_eligibility",null,"Y","N",null,null,"IND_MCE_AID_CATEGORY","Managed Care Eligibility/Aid Category Flag","IND_MCE_AID_CATEGORY","Low","-","NONE","NONE"]
[1,{"$f":"IF('Legal Approval Form'!$B$26=\"Y\",\"Yes\",\"No\")","v":"No"},"Medicare Part A Coverage Flag","IND_MEDICARE_A","Values Y/N","IND_MEDICARE_A","ind_medicare_a",null,"CHAR",1,"Values Y, N","nw_state_eligibility",null,"Y","N",null,null,"IND_MEDICARE_A","Medicare Part A Coverage Flag","IND_MEDICARE_A","Low","-","NONE","NONE"]
[1,{"$f":"IF('Legal Approval Form'!$B$26=\"Y\",\"Yes\",\"No\")","v":"No"},"Medicare Part B Coverage Flag","IND_MEDICARE_B","Values Y/N","IND_MEDICARE_B","ind_medicare_b",null,"CHAR",1,"Values Y, N","nw_state_eligibility",null,"Y","N",null,null,"IND_MEDICARE_B","Medicare Part B Coverage Flag","IND_MEDICARE_B","Low","-","NONE","NONE"]
[1,{"$f":"IF('Legal Approval Form'!$B$26=\"Y\",\"Yes\",\"No\")","v":"No"},"Medicare Advantage Coverage Flag","IND_MEDICARE_C","Values Y/N","IND_MEDICARE_C","ind_medicare_c",null,"CHAR",1,"Values Y, N","nw_state_eligibility",null,"Y","N",null,null,"IND_MEDICARE_C","Medicare Advantage Coverage Flag","IND_MEDICARE_C","Low","-","NONE","NONE"]
[1,{"$f":"IF('Legal Approval Form'!$B$26=\"Y\",\"Yes\",\"No\")","v":"No"},"Medicare Part D Coverage Flag","IND_MEDICARE_D","Values Y/N","IND_MEDICARE_D","ind_medicare_d",null,"CHAR",1,"Values Y, N","nw_state_eligibility",null,"Y","N",null,null,"IND_MEDICARE_D","Medicare Part D Coverage Flag","IND_MEDICARE_D","Low","-","NONE","NONE"]
[1,{"$f":"IF('Legal Approval Form'!$B$26=\"Y\",\"Yes\",\"No\")","v":"No"},"Medicare Home Health Coverage Flag","IND_MEDICARE_H","Values Y/N","IND_MEDICARE_H","ind_medicare_h",null,"CHAR",1,"Values Y, N","nw_state_eligibility",null,"Y","N",null,null,"IND_MEDICARE_H","Medicare Home Health Coverage Flag","IND_MEDICARE_H","Low","-","NONE","NONE"]
[1,{"$f":"IF('Legal Approval Form'!$B$26=\"Y\",\"Yes\",\"No\")","v":"No"},"‘Money Follows the Person’ Program Flag","IND_MFP","Values Y/N","IND_MFP","ind_mfp",null,"CHAR",1,"Values Y, N","nw_state_eligibility",null,"Y","N",null,null,"IND_MFP","‘Money Follows the Person’ Program Flag","IND_MFP","Low","-","NONE","NONE"]
[1,{"$f":"IF('Legal Approval Form'!$B$26=\"Y\",\"Yes\",\"No\")","v":"No"},"Program All-Inclusive Care for the Elderly  Enrollment Flag","IND_PACE_ENROLLED","Values Y/N","IND_PACE_ENROLLED","ind_pace_enrolled",null,"CHAR",1,"Values Y, N","nw_state_eligibility",null,"Y","N",null,"No action","IND_PACE_ENROLLED","Program All-Inclusive Care for the Elderly  Enrollment Flag","IND_PACE_ENROLLED","Moderate","Age","NONE","NONE"]
[1,{"$f":"IF('Legal Approval Form'!$B$26=\"Y\",\"Yes\",\"No\")","v":"No"},"Pharmacy Third Party Liability Coverage Flag","IND_PHARMACY_COVERAGE","Values Y/N","IND_PHARMACY_COVERAGE","ind_pharmacy_coverage",null,"CHAR",1,"Values Y, N","nw_state_eligibility",null,"Y","N",null,null,"IND_PHARMACY_COVERAGE","Pharmacy Third Party Liability Coverage Flag","IND_PHARMACY_COVERAGE","Low","-","NONE","NONE"]
[1,{"$f":"IF('Legal Approval Form'!$B$26=\"Y\",\"Yes\",\"No\")","v":"No"},"Pregnancy Indicator Flag","IND_PREGNANCY","Values Y/N","IND_PREGNANCY","ind_pregnancy",null,"CHAR",1,"Values Y, N","nw_state_eligibility",null,"Y","N",null,null,"IND_PREGNANCY","Pregnancy Indicator Flag","IND_PREGNANCY","Low","-","NONE","NONE"]
[1,{"$f":"IF('Legal Approval Form'!$B$26=\"Y\",\"Yes\",\"No\")","v":"No"},"Senior Care Option Enrollment Flag","IND_SCO","Values Y/N","IND_SCO","ind_sco",null,"CHAR",1,"Values Y, N","nw_state_eligibility",null,"Y","N",null,"No action","IND_SCO","Senior Care Option Enrollment Flag","IND_SCO","Moderate","Age","NONE","NONE"]
[1,{"$f":"IF('Legal Approval Form'!$B$26=\"Y\",\"Yes\",\"No\")","v":"No"},"MH Days per eligibility segment record","NUM_DAYS_ELIGIBLE","applies to source span, not derived monthly segments, no value to users","NUM_DAYS_ELIGIBLE","num_days_eligible","max value 366","Integer",3,null,null,null,"Y","N",null,null,"NUM_DAYS_ELIGIBLE","Derived Eligible Days in Month","NUM_DAYS_ELIGIBLE","Low","-","NONE","NONE"]
[1,{"$f":"IF('Legal Approval Form'!$B$26=\"Y\",\"Yes\",\"No\")","v":"No"},"Derived Eligible Days in Month","NUM_DAYS_ELIGIBLE","Integer values 1 to 31 represents days pertaining to the referenced month","NUM_DAYS_ELIGIBLE_MONTH","num_days_eligible_month",null,"Integer",2,"Values 1 to 31","N/A",null,"Y","N","No action needed"]
[1,{"$f":"IF('Legal Approval Form'!$B$26=\"Y\",\"Yes\",\"No\")","v":"No"},"Submitter ID (ORGID)","Derived column added by CHIA ","New - CHIA assigned Organization ID (always 3156 = MassHealth)","ORGID","(created in view)","Integer, set value = 3156","Integer",6,null,"N/A",null,"Y","N","No action needed",null,"ORGID"]
[1,{"$f":"IF('Legal Approval Form'!$B$26=\"Y\",\"Yes\",\"No\")","v":"No"},"Federal Poverty Level Income Percent","PCT_INCOME_FPL",null,"PCT_INCOME_FPL","pct_income_fpl","cast as 6.2 in Release for privacy concerns (Really?)","NUMERIC",6.2,9999.99,"nw_state_eligibility",null,"Y","N",null,null,"PCT_INCOME_FPL","Federal Poverty Level Income Percent","PCT_INCOME_FPL","Low","-","NONE","NONE"]
[1,{"$f":"IF('Legal Approval Form'!$B$26=\"Y\",\"Yes\",\"No\")","v":"No"},"Submission Month","SUBMISSIONMONTH",null,"SUBMISSIONMONTH","submissionmonth",null,"Integer",2,"MM",null,null,"Y","N",null,"No action","SUBMISSIONMONTH","Submission Month","SUBMISSIONMONTH","Moderate","Date","NONE","NONE"]
[1,{"$f":"IF('Legal Approval Form'!$B$26=\"Y\",\"Yes\",\"No\")","v":"No"},"Submission Year","SUBMISSIONYEAR",null,"SUBMISSIONYEAR","submissionyear",null,"Integer",4,"YYYY",null,null,"Y","N",null,"No action","SUBMISSIONYEAR","Submission Year","SUBMISSIONYEAR","Moderate","Date","NONE","NONE"]
[]
["ID -  MassHealth Enhanced Eligibility  (MHEE) - Identifiable (L2) Elements"]
["Release Level","Included   (this request)","Functional Name   ","Data Elements (MassHealth Source Fields)","Comments","Release Column Name",null,"Dev Requirement Notes","Data Type","Field Length","Format","MH Warehouse Reference","CHIA Code",null,"OnPoint Mitigation"," 2025 UVR Release Comments ","Action"]
[2,{"$f":"IF(AND('Legal Approval Form'!$B$26=\"Y\",'Legal Approval Form'!$B$33=\"Y\"),\"Yes\",\"No\")","v":"No"},"Member mailing zip code","ADR_MAIL_ZIP","Note '+' value = missing, '#' value = 'N/A'","ADR_MAIL_ZIP","adr_mail_zip","trim to 5 char","CHAR",5,null,"nw_state_eligibility",null,"N",null,"no suppression - see DE Level 1 version",null,"ADR_MAIL_ZIP","Member mailing zip code","ADR_MAIL_ZIP"]
[2,{"$f":"IF(AND('Legal Approval Form'!$B$26=\"Y\",'Legal Approval Form'!$B$33=\"Y\"),\"Yes\",\"No\")","v":"No"},"Richest Aid Category - MassHealth","CDE_AID_CATEGORY","Identifiable release only. See 5 derived release elts.","CDE_AID_CATEGORY","cde_aid_category",null,"CHAR",2,null,"nw_state_eligibility",null,"N",null,"no suppression - see DE Level 1 version","no action","CDE_AID_CATEGORY","Aid Category","CDE_AID_CATEGORY","Moderate","Public event, Age","Transform according to MHEEE Aid Categories","Transform according to MHEEE Aid Categories"]
[2,{"$f":"IF(AND('Legal Approval Form'!$B$26=\"Y\",'Legal Approval Form'!$B$33=\"Y\"),\"Yes\",\"No\")","v":"No"},"Aid Category - Coverage type","CDE_AID_CATEGORY",null,"AIDCATCOVERAGETYPE","aidcatcoveragetype","Derivation see: Aid Category Derivation of New Data Elements - ME and MHEE.xlsx","CHAR",50,null,"nw_state_eligibility",null,"N",null,"no mitigation - See DE Level 1 version",null,"AIDCATCOVERAGETYPE","Aid Category Coverage Type","CDE_AID_CATEGORY","Low","-","NONE","NONE"]
[2,{"$f":"IF(AND('Legal Approval Form'!$B$26=\"Y\",'Legal Approval Form'!$B$33=\"Y\"),\"Yes\",\"No\")","v":"No"},"Aid Category - Disability Indicator","CDE_AID_CATEGORY",null,"AIDCATDISABILITYINDICATOR","aidcatdisabilityindicator","Derivation see: Aid Category Derivation of New Data Elements - ME and MHEE.xlsx","CHAR",1,null,"nw_state_eligibility",null,"N",null,"no mitigation - See DE Level 1 version",null,"AIDCATDISABILITYINDICATOR","Aid Category Disability Indicator","CDE_AID_CATEGORY","Low","-","NONE","NONE"]
[2,{"$f":"IF(AND('Legal Approval Form'!$B$26=\"Y\",'Legal Approval Form'!$B$33=\"Y\"),\"Yes\",\"No\")","v":"No"},"Aid Category - Population","CDE_AID_CATEGORY",null,"AIDCATPOPULATION","aidcatpopulation","Derivation see: Aid Category Derivation of New Data Elements - ME and MHEE.xlsx","CHAR",50,null,"nw_state_eligibility",null,"N",null,"no mitigation - See DE Level 1 version",null,"AIDCATPOPULATION","Aid Category Population","CDE_AID_CATEGORY","Low","-","NONE","NONE"]
[2,{"$f":"IF(AND('Legal Approval Form'!$B$26=\"Y\",'Legal Approval Form'!$B$33=\"Y\"),\"Yes\",\"No\")","v":"No"},"Aid Category - Premium assistance indicator","CDE_AID_CATEGORY",null,"AIDCATPREMIUMASSISTANCEINDICATOR","aidcatpremiumassistanceindicator","Derivation see: Aid Category Derivation of New Data Elements - ME and MHEE.xlsx","CHAR",1,null,"nw_state_eligibility",null,"N",null,"no mitigation - See DE Level 1 version",null,"AIDCATPREMIUMASSISTANCEINDICATOR","Aid Category Premium assistance indicator","CDE_AID_CATEGORY","Low","-","NONE","NONE"]
[2,{"$f":"IF(AND('Legal Approval Form'!$B$26=\"Y\",'Legal Approval Form'!$B$33=\"Y\"),\"Yes\",\"No\")","v":"No"},"Aid Category - Temporary Coverage Type","CDE_AID_CATEGORY",null,"AIDCATTEMPORARYCOVERAGETYPE","aidcattemporarycoveragetype","Derivation see: Aid Category Derivation of New Data Elements - ME and MHEE.xlsx","CHAR",1,null,"nw_state_eligibility",null,"N",null,"no mitigation - See DE Level 1 version",null,"AIDCATTEMPORARYCOVERAGETYPE","Aid Category Temporary Coverage Type","CDE_AID_CATEGORY","Low","-","NONE","NONE"]
[2,{"$f":"IF(AND('Legal Approval Form'!$B$26=\"Y\",'Legal Approval Form'!$B$33=\"Y\"),\"Yes\",\"No\")","v":"No"},"Member Year and Month of Birth","DTE_BIRTH","Year redacted for Age > 89","DTE_BIRTH_YYYYMM","(derived - not on source table - OK )","If Age >89<=115 set to '92', Invalid age set to null {Calculate Age in Years using difference between [DTE_EFFECTIVE_MONTH] and [dte_birth]}","CHAR",6,"YYYYMM","nw_member",null,"N",null,"String to YYYYMM unmitigated - see also DE version (L1)","YYYYMM only, unmitigated"]
[2,{"$f":"IF(AND('Legal Approval Form'!$B$26=\"Y\",'Legal Approval Form'!$B$33=\"Y\"),\"Yes\",\"No\")","v":"No"},"Behavioral Health (MBHP) Enrollment Aid Category","CDE_AID_CATEGORY_BH","Identifiable release only. See 5 derived release elts.","CDE_AID_CATEGORY_BH","cde_aid_category_bh",null,"CHAR",2,null,"nw_state_eligibility",null,"N",null,"Domain contains Aid Cat values","unmitigated OK for ID (L2) release"]
[2,{"$f":"IF(AND('Legal Approval Form'!$B$26=\"Y\",'Legal Approval Form'!$B$33=\"Y\"),\"Yes\",\"No\")","v":"No"},"Managed Care (MCO) Enrollment Aid Category","CDE_AID_CATEGORY_MC","Identifiable release only. See 5 derived release elts.","CDE_AID_CATEGORY_MC","cde_aid_category_mc",null,"CHAR",2,null,"nw_state_eligibility",null,"N",null,"Domain contains Aid Cat values","unmitigated OK for ID (L2) release"]
[2,{"$f":"IF(AND('Legal Approval Form'!$B$26=\"Y\",'Legal Approval Form'!$B$33=\"Y\"),\"Yes\",\"No\")","v":"No"},"Accountable Care Organization B Aid Category","CDE_AID_CATEGORY_ACOB","New R8 - See ref table for CDE_AID_CATEGORY","CDE_AID_CATEGORY_ACOB","cde_aid_category_acob",null,"CHAR",2,null,null,null,"N",null,"Domain contains Aid Cat values","unmitigated OK for ID (L2) release","CDE_AID_CATEGORY_ACOB","Accountable Care Organization B Aid Category","CDE_AID_CATEGORY_ACOB","Low","-","NONE","NONE"]
[2,{"$f":"IF(AND('Legal Approval Form'!$B$26=\"Y\",'Legal Approval Form'!$B$33=\"Y\"),\"Yes\",\"No\")","v":"No"},"Community Partners Aid Category","CDE_AID_CATEGORY_CP","New R8 - See ref table for CDE_AID_CATEGORY","CDE_AID_CATEGORY_CP","cde_aid_category_cp",null,"CHAR",2,null,null,null,"N",null,"Domain contains Aid Cat values","unmitigated OK for ID (L2) release","CDE_AID_CATEGORY_CP","Community Partners Aid Category","CDE_AID_CATEGORY_CP","Low","-","NONE","NONE"]
[2,{"$f":"IF(AND('Legal Approval Form'!$B$26=\"Y\",'Legal Approval Form'!$B$33=\"Y\"),\"Yes\",\"No\")","v":"No"},"Managed Care Plan/Provider Type Code","CDE_MH_PLAN","Identifiable release only. ","CDE_MH_PLAN","cde_mh_plan",null,"CHAR",4,null,"nw_state_eligibility",null,"N",null,"Not reviewed (OnPoint)"]
[2,{"$f":"IF(AND('Legal Approval Form'!$B$26=\"Y\",'Legal Approval Form'!$B$33=\"Y\"),\"Yes\",\"No\")","v":"No"},"Waiver Category","CDE_WAIVER_CATEGORY","Available for internal use only.","CDE_WAIVER_CATEGORY","cde_waiver_category",null,"CHAR",20,null,"nw_state_eligibility",null,"N",null,"Not reviewed (OnPoint)"]
[2,{"$f":"IF(AND('Legal Approval Form'!$B$26=\"Y\",'Legal Approval Form'!$B$33=\"Y\"),\"Yes\",\"No\")","v":"No"},"Waiver Eligibility Flag","CDE_WAIVER_FLG","Identifiable release only","CDE_WAIVER_FLG","cde_waiver_flg",null,"CHAR",1,null,"nw_state_eligibility",null,"N",null,"Not reviewed (OnPoint)"]
[2,{"$f":"IF(AND('Legal Approval Form'!$B$26=\"Y\",'Legal Approval Form'!$B$33=\"Y\"),\"Yes\",\"No\")","v":"No"},"Indicates Adoption Subsidy","IND_ADOPTION_SUBSIDY","Identifiable release only","IND_ADOPTION_SUBSIDY","ind_adoption_subsidy",null,"CHAR",1,"Values Y, N",null,null,"N",null,"Not reviewed (OnPoint)"]
[2,{"$f":"IF(AND('Legal Approval Form'!$B$26=\"Y\",'Legal Approval Form'!$B$33=\"Y\"),\"Yes\",\"No\")","v":"No"},"Waiver Eligibility Flag","IND_WAIVER_ELIG","Available for internal use only. ","IND_WAIVER_ELIG","ind_waiver_elig","Values Y/N","CHAR",1,null,"nw_state_eligibility",null,"N",null,"Not reviewed (OnPoint)"]
[2,{"$f":"IF(AND('Legal Approval Form'!$B$26=\"Y\",'Legal Approval Form'!$B$33=\"Y\"),\"Yes\",\"No\")","v":"No"},"Member Ethnicity Code","CDE_ETHNIC","APCD Lookup reference table: TLKP_MHEE_REFERENCE","CDE_ETHNIC","cde_ethnic",null,"CHAR",32,null,"nw_member",null,"N",null,null,null,"CDE_ETHNIC","Member Ethnicity Code","CDE_ETHNIC","Moderate","Ethnicity","-","Remove"]
[2,{"$f":"IF(AND('Legal Approval Form'!$B$26=\"Y\",'Legal Approval Form'!$B$33=\"Y\"),\"Yes\",\"No\")","v":"No"},"Member Primary Language Code","CDE_PRIMARY_LANG","APCD Lookup reference table: TLKP_MHEE_REFERENCE","CDE_PRIMARY_LANG","cde_primary_lang",null,"CHAR",32,null,"nw_member",null,"N",null,"no suppression - see DE Level 1 version",null,"CDE_PRIMARY_LANG","Member Primary Language Code","CDE_PRIMARY_LANG","Moderate","Language","Field will be updated in CHIA's Submission Guide to only allow entries of codes for English, Spanish, Other, Unknown/Not Specified (Transformed in See Section 6.2.4)","Field will be updated in CHIA's Submission Guide to only allow entries of codes for English, Spanish, Other, Unknown/Not Specified (Transformed in See Section 6.2.4)"]
["SR - Patient Identifiable, Special Release"]
["Release Level","Included   (this request)","Functional Name   ","Data Elements (MassHealth Source Fields)","Comments","Release Column Name",null,"Dev Requirement Notes","Data Type","Field Length","Format","MH Warehouse Reference","CHIA Code",null,"OnPoint Mitigation"," 2025 UVR Release Comments ","Action"]
[3,"SR Only","Member mailing zip code formatted","ADR_MAIL_ZIP_DSP","Formatted zip - little additional value for users - see ADR_MAIL_ZIP instead. ","ADR_MAIL_ZIP_CODE_DSP","adr_mail_zip_dsp","trim to 5 char","CHAR",5,null,null,null,"N",null,"No Release"]
[3,"SR Only","Internal Use ETL Batch ID","RELEASEETLBATCHID","internal manufacturing use only","RELEASEETLBATCHID","releaseetlbatchid",null,"Integer",6,null,null,null,"N"]
[3,"SR Only","Submission Control ID","SUBMISSIONCONTROLID",null,"SUBMISSIONCONTROLID","submissioncontrolid",null,"Integer",8,null,null,null,"Y"]
[3,"SR Only","Internal Use ETL Batch date","CREATEDATE","internal manufacturing use only","CREATEDATE","createdate",null,"Date:Time",23,null,null,null,"N"]
[3,"SR Only","Internal Use ETL Batch ID","ETLBATCHID","internal manufacturing use only","ETLBATCHID","etlbatchid",null,"Integer",6,null,null,null,"N"]
[3,"SR Only","New MMIS ID","ID_MEDICAID","As reported MH value - do not disclose","ID_MEDICAID","id_medicaid","Consider encryption for this column. ","CHAR",12,null,"nw_member",null,"N",null,"OnPoint thought this was hashed…No, this is the unhashed Medicaid ID! ",null,"ID_MEDICAID","MassHealth Medicaid ID",null,"Moderate","Unique ID",null,"NONE (already pseudonymized)"]
[3,"SR Only","Member Date of Birth","DTE_BIRTH","full DOB","DTE_BIRTH","dte_birth","Consider encryption for this column. ","Date",8,"YYYYMMDD","nw_member",null,"N",null,"full DOB YYYYMMDD - No supression","see also DE column","DTE_BIRTH","Member Year and Month of Birth","DTE_BIRTH","Moderate","Age","Recode as year of birth. Bottom recode to ensure a 90+ age group","Recode as year of birth. Bottom recode to ensure a 90+ age group"]
[3,"SR Only","Member Date of Death","DTE_DEATH","Note: 1900-01-01 default","DTE_DEATH","dte_death","Formerly was Level 3","Integer",8,"YYYYMMDD","nw_member",null,"N",null,"Not reviewed (OnPoint)"]
[3,"SR Only","Behavioral Health Provider ID","ID_PROVIDER_LOCATION_BH","As reported MH value - Identifiable release only","ID_PROVIDER_LOCATION_BH","id_provider_location_bh",null,"CHAR",10,null,null,null,"N",null,"See surrogate (linkage_ID)",null,"ID_PROVIDER_LOCATION_BH","Derived Behavioral Health Provider ID","ID_PROVIDER_LOCATION_BH","Moderate","Geography","NONE","NONE"]
[3,"SR Only","Community Partner Provider ID","ID_PROVIDER_LOCATION_CP","New R8 - As reported MH value - Identifiable release only","ID_PROVIDER_LOCATION_CP","id_provider_location_cp",null,"CHAR",10,null,null,null,"N",null,"See surrogate (linkage_ID)",null,"ID_PROVIDER_LOCATION_CP","Derived Community Partner Provider ID","ID_PROVIDER_LOCATION_CP","Moderate","Geography","NONE","NONE"]
[3,"SR Only","Long Term Care Provider ID","ID_PROVIDER_LOCATION_LTC","As reported MH value - Identifiable release only","ID_PROVIDER_LOCATION_LTC","id_provider_location_ltc",null,"CHAR",10,null,null,null,"N",null,"See surrogate (linkage_ID)",null,"ID_PROVIDER_LOCATION_LTC","Derived Long Term Care Provider ID","ID_PROVIDER_LOCATION_LTC","Moderate","Geography","NONE","NONE"]
[3,"SR Only","Managed Care Entity Provider ID","ID_PROVIDER_LOCATION_MCO","As reported MH value - Identifiable release only","ID_PROVIDER_LOCATION_MCO","id_provider_location_mco",null,"CHAR",10,null,null,null,"N",null,"See surrogate (linkage_ID)",null,"ID_PROVIDER_LOCATION_MCO","Derived Managed Care Entity Provider ID","ID_PROVIDER_LOCATION_MCO","Moderate","Geography","NONE","NONE"]
[3,"SR Only","Primary Care Clinician Provider ID","ID_PROVIDER_LOCATION_PCC","As reported MH value - Identifiable release only","ID_PROVIDER_LOCATION_PCC","id_provider_location_pcc",null,"CHAR",10,null,null,null,"N",null,"See surrogate (linkage_ID)",null,"ID_PROVIDER_LOCATION_PCC","Derived Primary Care Clinician Provider ID","ID_PROVIDER_LOCATION_PCC","Moderate","Geography","NONE","NONE"]
[3,"SR Only","Member Marital Status Code","CDE_MARITAL","no data available","CDE_MARITAL","cde_marital","no data for this? Suggest we drop the column. ","CHAR",1,null,"nw_member",null,"Y",null,"Remove per OnPoint","remove","CDE_MARITAL","Member Marital Status Code","CDE_MARITAL","Moderate","Marital Status","Remove","Remove"]
[]
["Drop - Columns no longer on, or to be dropped from table/view."]
[4,"Drop","Carrier Specific Member ID - Old surrogate hash",null,null,"hashcarrierspecificuniquememberid","hashcarrierspecificuniquememberid"]
[4,"Drop","Member Link EID","Derived column added by CHIA ","New - CHIA assignedMaster Member ID","MEMBERLINKEID","(not on source table - no longer in Release view)","MEMBERLINKEID is an alias for MEMBERMDMID, which is sourced from tbl_MDM_Member","Integer",10,null,"N/A"]

{"sheet":"GEO","index":11,"n_rows":23,"n_cols":14,"rows_kept":23,"cut":false,"hidden":false,"merged":[]}
["Release Level","Data Element Source","Included   (this request)","Member Eligibility (ME) - Data Element Name","CHIA Notes","Release Column Name","Data Type","Length","CHIA Code","De-Identified Set","OnPoint Mitigation","Onpoint De-Identification Requirement - Amended"," 2025 UVR Release Comments ","Action"]
[1,"HD005","Yes","Submission Year and Month",null,"SUBMISSIONYEARMONTH","Integer",6,null,"Y","N","None"]
[1,"ME001","Yes","Submitter (OrgId)","Carrier Organization ID","ORGID","Integer",6,null,"Y","N","None"]
[1,"ME107","Yes","Carrier Specific Unique Member ID",null,"CHIACARRIERSPECIFICUNIQUEMEMBERID","Integer",20,"CHIA","Y","N","None"]
[1,"ME117","Yes","Carrier Specific Unique Subscriber ID",null,"CHIACARRIERSPECIFICUNIQUESUBSCRIBERID","Integer",20,"CHIA","Y","N","None"]
[1,"Derived",{"$f":"IF('Legal Approval Form'!$B$33=\"N\",\"Yes\", \"No\")","v":"Yes"},"Member Zip Code","some aggregation of small zip codes","memberzipcodeDE","Text",5,null,"Y","Y","FileSecure  (mostly)  remaps ZIP codes per Onpoint spec (see Table 4, CHIA Remapped Geocodes, Section 6.2.2)","New column: memberzipcodeDE        (replaces the LDS column, source MEMBERZIPCODECLEANED)","Derive memberzipcodeDE   1. Must be a valid MA zip code 2. Remap MA validated Zip code.  See document: Universal Release - Deidentify Zip Code.docx"]
[1,"ME016",{"$f":"IF('Legal Approval Form'!$B$33=\"N\",\"Yes\", \"No\")","v":"Yes"},"Member State or Province",null,"MEMBERSTATEORPROVINCEDE","Char",2,null,"Y","Y","CHIA will map codes as prescribed. States would be reported as CT, MA, ME, NH, NY, RI, VT, or Other (Transformed according to Section 6.2.2)","Domain release values for LDS are congruent with Onpoint: LDS State transformation (NE + NY else XX).","Rename MEMBERSTATEORPROVINCELDS: MEMBERSTATEORPROVINCEDE   Or see specifications here: UVR - Deidentify State or Province.docx"]
[1,"Derived",{"$f":"IF('Legal Approval Form'!$B$33=\"N\",\"Yes\", \"No\")","v":"Yes"},"Member County",null,"MEMBERCOUNTYDE","Char",24,null,"Y","Y","CHIA will update Member County to reflect assignment from mapped ZIP codes (Transformed according to Section 6.2.2)","New work - County remap after zip rollup . Create MEMBERCOUNTYDE","Create MEMBERCOUNTYDE     See specifications here: UVR - Deidentify State or Province.docx"]
[1,"Derived",{"$f":"IF('Legal Approval Form'!$B$33=\"N\",\"Yes\", \"No\")","v":"Yes"},"Subscriber Zip Code","some aggregation of small zip codes","subscriberzipcodeDE","Text",5,null,"Y","Y","Remap small population zip codes. ","New column: subscriberzipcodeDE   (replaces the LDS column, source SUBSCRIBERZIPCODECLEANED)","Derive subscriberzipcodeDE     1. Must be a valid MA zip code 2. Remap MA validated Zip code.  See document: Universal Release - Deidentify Zip Code.docx"]
[1,"ME109",{"$f":"IF('Legal Approval Form'!$B$33=\"N\",\"Yes\", \"No\")","v":"Yes"},"Subscriber State or Province",null,"SUBSCRIBERSTATEORPROVINCEDE","Char",2,null,"Y","Y","CHIA will map codes as prescribed. States would be reported as CT, MA, ME, NH, NY, RI, VT, or Other (Transformed according to Section 6.2.2)","Domain release values for LDS are congruent with Onpoint: LDS State transformation (NE + NY else XX).","Rename SUBSCRIBERSTATEORPROVINCELDS: SUBSCRIBERSTATEORPROVINCEDE     Or see specifications here: UVR - Deidentify State or Province.docx"]
[1,"Derived",{"$f":"IF('Legal Approval Form'!$B$33=\"N\",\"Yes\", \"No\")","v":"Yes"},"Subscriber County",null,"SUBSCRIBERCOUNTYDE","Char",24,null,"Y","Y","CHIA will update Member County to reflect assignment from mapped ZIP codes (Transformed according to Section 6.2.2)","New work - County remap after zip rollup.  Create SUBSCRIBERCOUNTYDE","Create SUBSCRIBERCOUNTYDE   See specifications here: UVR - Deidentify State or Province.docx"]
[1,"Derived","Yes","Derived Last Activity Date","ME056 unless missing, then derived.","derivedlastactivitydate","Integer",8,null,"Y","N","None","Usually as reported - except when missing is derived. ","Derived column:  When LASTACTIVITYDATE is missing assign column = SUBMISSIONYEARMONTH + \"01\", otherwise assign column = LASTACTIVITYDATE "]
[1,"Derived","Yes","GEO Effective Begin Date","YYYYMMDD","geobegindate","Integer",8,null,"Y","N","None (N/A)","EffectiveDateBeg = Minimum release date when first record for Member, Else LASTACTIVITYDATE","Derived column: EffectiveDateBeg = Minimum release date when first record for Member, Else LASTACTIVITYDATE"]
[1,"Derived","Yes","GEO Effective End Date","YYYYMMDD","geoenddate","Integer",8,null,"Y","N","None (N/A)","EffectiveDateEnd: See derivation. When this is the last record for the member then = MaxDate.","Derived column:  When this is the last (or only) record = Max date (based on the Release period date range - 6Mo run out), otherwise = 1 day before the subsequent record EffectiveDateBeg "]
[]
["ID - Member Eligibility (ME) - Identifiable (L2) Elements"]
["Release Level","Data Element Source","Included   (this request)","Data Element Name","CHIA Notes","Release Column Name","Data Type","Length","CHIA Code","De-Identified Set","OnPoint Mitigation","Onpoint De-Identification Requirement"," 2025 UVR Release Comments ","Action"]
[2,"ME017",{"$f":"IF('Legal Approval Form'!$B$33=\"Y\",\"Yes\", \"No\")","v":"No"},"Member ZIP Code","No supression","MEMBERZIPCODECLEANED","Char",5,"Cleaned","N",null,null,"Currently remapped on Intake for small zips but in the future will be as reported","No action"]
[2,"ME016",{"$f":"IF('Legal Approval Form'!$B$33=\"Y\",\"Yes\", \"No\")","v":"No"},"Member State or Province","No supression","MEMBERSTATEORPROVINCE","Char",2,null,"N",null,null,"no suppression"]
[2,"Derived",{"$f":"IF('Legal Approval Form'!$B$33=\"Y\",\"Yes\", \"No\")","v":"No"},"Member County","No supression","MEMBERCOUNTY","Char",24,null,"N",null,"See also deidentified version",null,"No action"]
[2,"ME110",{"$f":"IF('Legal Approval Form'!$B$33=\"Y\",\"Yes\", \"No\")","v":"No"},"Subscriber ZIP Code","No supression","SUBSCRIBERZIPCODECLEANED","Char",5,"Cleaned","N",null,null,"Currently remapped on Intake for small zips but in the future will be as reported","No action"]
[2,"ME109",{"$f":"IF('Legal Approval Form'!$B$33=\"Y\",\"Yes\", \"No\")","v":"No"},"Subscriber State or Province","No supression","SUBSCRIBERSTATEORPROVINCE","Char",2,null,"N",null,null,"no suppression"]
[2,"Derived",{"$f":"IF('Legal Approval Form'!$B$33=\"Y\",\"Yes\", \"No\")","v":"No"},"Subscriber County","No supression","SUBSCRIBERCOUNTY","Char",24,null,"N",null,"See also deidentified version",null,"No action"]

{"sheet":"MEID","index":12,"n_rows":11,"n_cols":13,"rows_kept":11,"cut":false,"hidden":false,"merged":[]}
["Release Level","Data Element Source","Included   (this request)","Member Eligibility (ME) - Data Element Name","CHIA Notes","Release Column Name","Data Type","Length","CHIA Code","De-Identified Set","OnPoint Mitigation","Onpoint De-Identification Requirement - Amended"," 2025 UVR Release Comments "]
[1,"ME001","Yes","Submitter","Carrier Organization ID","ORGID","Integer",6,null,"Y","N","None"]
[1,"ME107","Yes","Carrier Specific Unique Member ID",null,"CHIACARRIERSPECIFICUNIQUEMEMBERID","Integer",20,"CHIA","Y","N","None"]
[1,"Derived","Yes","Member Link EID",null,"MEMBERLINKEID","Integer",10,null,"Y","N","None","MEMBERLINKEID is an alias for MEMBERMDMID, which is sourced from tbl_MDM_Member"]
[]
["ID - MEID Identifiable (L2) Elements"]
["Release Level","Data Element Source","Included   (this request)","Data Element Name","CHIA Notes","Release Column Name","Data Type","Length","CHIA Code","De-Identified Set","OnPoint Mitigation","Onpoint De-Identification Requirement"," 2025 UVR Release Comments "]
[2,null,"No","N/A (None)"]
["SR - Special Release Only, Internal Use"]
["Release Level","Data Element Source","Included   (this request)","Data Element Name","CHIA Notes","Column Name","Data Type","Length","CHIA Code","De-Identified Set","OnPoint Mitigation","Onpoint De-Identification Requirement"," 2025 UVR Release Comments "]
[3,"ME107","SR Only","Carrier Specific Unique Member ID","Reported - decrypted","CARRIERSPECIFICUNIQUEMEMBERID","Char",50,null,null,"Encryp","Not reviewed","Moved from L3  for UR - Rarely requested. We can decrypt and release as Identifiable if approved. "]

{"sheet":"Document Versions","index":13,"n_rows":43,"n_cols":4,"rows_kept":43,"cut":false,"hidden":true,"merged":[]}
["Version","Date","Updated by","Description"]
["1.0","2025-09-25","C. Kane","Initial draft - started with copy of \"UVR Request Template - APCD CY2022 V6.2 DOT unpro\" - a WIP development Release template.  This CY2024 will be the first production release. "]
[null,null,null,"Updated \"Legal Approval Form\" tab: for relevant data reference years, updated ICON. (Gold color)"]
[null,null,null,"Update CY2024 View names, and Release column headers in tabs: DC, MC, ME, PC, PR, PV, BP, MHEE  "]
[null,null,null,"Update Years available on Legal Approval Form Checkboxes .  "]
[null,null,null,"IMP! See tab \"UVR Filename Lkup\" - Update Row 1 - columns E, F, G, H, I - for Years available (Hard reference to filenaming derivation)"]
[null,null,null,"Update Row 1 cols A,B,C,D,E - in tab \"Data Fulfillment\" - with current years available. "]
["1.1","2025-09-29","C. Kane","Updated Age columns in DC, MC, PC and ME to conform to OCDW specs (Set to 90 when Age > 89)"]
[null,null,null,"Also created Level 4 designation for No Release (NR). Moved Audit columns to the end as Level 4. "]
["2.0","2025-10-03","C. Kane","Created new tab \"GEO\" for zip code and related geographic columns. Removed zip code and related geo columns from the ME Tab to the new Release File Tab \"GEO\".     Remove (deprecate to L4) Aid Cat column and derived related on the ME tab."]
["2.1","2025-10-07","C. Kane","Added conditional \"GEO\" file  (apcd_2020_GEO_DE.txt, apcd_2020_GEO_ID.txt) to Data Fulfillment tab. Column G is a complete list of files on the shelf to be exported for a given request."]
["2.2","2025-10-08","C. Kane","Fix column name typo on DC tab: DIAGNOSISDDE to DIAGNOSISDE"]
["2.3","2025-10-09","C. Kane","Put Employer Zip columns back on ME tab. Added MEMBERELIGIBILITYID and SUBMISSIONCONTROLID to GEO tab for audit trail purposes."]
["2.4","2025-10-09","C. Kane","PC012(membergendercleaned) deidentified name correction: membergenderDE, ME014(MEMBERDATEOFBIRTHMONTH) deidentified name correction: memberbirthmonthde , Added back IncurredYearMonth to Claims while keeping IncurredFullDate.    "]
["2.5","2025-10-20","C. Kane","Correction to PC Column name - was MEMBERAGEATSERVICEINYEARSREDACTED, should be MEMBERAGEATSERVICEINYEARSDE"]
["2.51","2025-10-21","C. Kane","Changed Data Element Name on GEO tab to Submitter for ME001 (column name is still ORGID)"]
[2.52,"2025-10-30","C. Kane","Corrected typo in formula spec for MEMBERBIRTHMONTHDE on MC tab. "]
["2.53","2025-11-03","C. Kane","Corrected typo in formula spec for MEMBERLANGUAGEPREFERENCEDE on ME tab. "]
["3.0","2025-11-05","C. Kane","Added MEID Tab to reflect the fact that the MEID data will be on a separate file (and therfore removed MemberLinkID column from ME, DC, MC, PC). "]
["3.1","2025-11-07","C. Kane","Set Included  flag to NR for MemberLinkID column  - ME, DC, MC, PC tabs. "]
["3.2","2025-11-20","C. Kane","Modified UVR Filename Lkup tab (table) - Removed apcd from the filename string. "]
["3.3","2025-11-21","C. Kane","V3.2 change messed up a lot of code that was scanning columns expecting to find filenames starting with \"apcd\".  Consequently - put the naming back to \"apcd_*\".  In the meantime several other formatting and changes to metadata columns data type and length columns had also been added, so needed to make this a new version, and fix rather than revert back to previous version.    "]
["3.4","2025-12-03","C. Kane","Added note for MEMBERLINKEID - now No Release (L4) on DC, PC, MC, ME - moved to MEID File."]
["4.0","2025-12-04","C. Kane","Rework of MHEE Tab for UVR Release - per OnPoint specs"]
["4.1","2025-12-12","C. Kane","Modified specs and placement of DTE_BIRTH permutations (3) on the MHEE tab, and moved DTE_DEATH to Special Release."]
["4.2","2025-12-17","C. Kane","Slight modification to ME, MHEE language columns for mitigation (MEMBERLANGUAGEPREFERENCEDE, CDE_PRIMARY_LANGDE)"]
[4.3,"2024-12-18","S. Curley","Slight modification to CHIA Notes colomn on MC, PC, DC for geography fields in SR to clarify no longer collected on SG and user should use GEO table. Slight modification to make CHIA note section on Carrier Specific Unique Member/Subscriber ID and NewMMISID fields in SR section consistent"]
[4.5,"2026-01-02","C. Kane","Move PR column ProductName to SR (direct PI concerns).  Update MHEE tab with multiple Aid Category related DE columns to complete deidentification requirements (expansion of OnPoint specs to cover unaddressed issues - see documentation). "]
[4.7,"2026-01-15","C. Kane","Corrected Column lengths for the following on MHEE: aidcatdisabilityindicator, aidcatpremiumassistanceindicator, aidcattemporarycoveragetype = CHAR 1 (and also the 3 DE versions of these columns)\naidcatcoveragetype, AIDCATCOVERAGETYPEDE, aidcatpopulation, AIDCATPOPULATIONDE = CHAR 50"]
[4.9000000000000004,"2026-01-19","C. Kane","Corrected code in the MHEE column \"Included (this request)\" - so that DE versions of columns would not be included in the ID release (since they would be redundant).  Also updated Data Element Source column for submissionyearmonth to HD005 for DC, MC, PC, PR, ME, PV, GEO - and HD003 for BP."]
["5.0","2026-02-13","C. Kane","Changes to GEO Tab columns - Replace lastactivitydate with EffectiveDateBeg, add EffectiveDateEnd "]
["5.1","2026-02-25","C. Kane","Modified element name and comment on MC Template - for MC040. From \"Ecode\" to \"External Cause Code\" since ICD10 codes begin w/ V, W, X, or Y. "]
["5.2","2026-04-08","C. Kane","Changes to GEO Tab columns - Keeping lastactivitydate, new columns added to table are EffectiveDateBeg, add EffectiveDateEnd. Also modified the derivation description which has evolved with the GEO Build.  (waiting for table creation to confirm finalized column names)… "]
["5.3","2026-04-09","C. Kane","Final changes to GEO Tab columns - New columns renamed GeoBeginDate, and GeoEndDate, in accord with created GEO Table. Also rearranged columns on the template to match the order on the actual Postgres created GEO table. Finally - modified Element names to better align with actual release column names.  Note that indexes will be added for this table later (should not affect Template)."]
["5.3.1","2026-04-09","C. Kane","Fixed a fat fingered value on the GEO tab for Release Level (') - to 1"]
["5.4.1","2026-04-14","C. Kane","Reordered File Type Tabs to align with the order on the Legal Approval Form. Added new row on approval form to highlight the TYPE of release request (Standard ID, Standard DE, Special) ."]
["5.4.2","2026-04-15","C. Kane","Changed MEID and GEO text file names - derived on the Data Fulfillment tab."]
["5.4.3","2026-04-24","C. Kane","Modified GEO source description of LastActivitydate to \"Derived\", added reference to ME056 in comment column."]
["5.4.4","2026-05-05","C. Kane","Modified GEO Element column  description: GEO Effective Begin Date, GEO Effective End Date.  Did not change the actual column names. "]
["5.7","2026-05-11","C. Kane","After testing revealed errors in the Template data type and length columns (due to data exceptions in reported data) these columns were corrected in in MC, PC, ME and PV. The MC ValueCodeAmount columns 1 to 10 were incorrect on the Template (but the Release View was correct).   "]
["5.7.1","2026-05-11","C. Kane","Some additional data typing and lengthmodifications across several filing type tabs - to increase consistency.  "]
["5.7.2","2026-05-14","C. Kane","2 changes to \"Legal Approval Form\": renamed Request # to \"Application ID#\", and added Applicant Name to Requesting Entity."]
["5.7.3","2026-05-19","C. Kane","Modified naming on Export file on the Data Fulfillment tab per Joe C, and removed spaces. Added button to execute VB code which exports the file list to whatever directory the template is in. "]

{"sheet":"APCD Header Def","index":14,"n_rows":21,"n_cols":3,"rows_kept":21,"cut":false,"hidden":true,"merged":[]}
["DC-MC-ME-PC-PR-PV-BP  Column Headers","MHEE Column Headers","External Template Columns"]
["OnPoint Mitigation",null,"Only has relevance to Level 2 (Deidentified Release) data elements. \"N\" means No mitigation needed, and this column can be included in both L2 and L3 Release. \"Y\" means either mitigation is needed, or is already mitigated by definition - such that this column would not be included in a L3 (Identifiable Release) since the identifiable/unitigated version of the column would already be included in the L3 Universal Release.   "]
["Release Level","Release Level","Restriction Level based on data sensitivity (PHI). Level 3 is more restrictive and requires justification and approval by CHIA Legal authority."]
["Data Element Source",null,"Submission Guide element reference if applicable - or designated as derived if created by CHIA, and not directly tied to the submission guide."]
[null,"Functional Name   ","MHEE only - English like field description (since there is no submission guide reference for MHEE at this time)"]
["Data Element Name","Data Elements (MassHealth Source Fields)","Submission Guide element name reference if applicable - or description of derived element if created by CHIA."]
["Include Y/N","Include Y/N","User selects elements requested by entering a \"Y\" in this column. Note that some columns have been preselected since they are designated as necessary for all  applicants."]
["Reason for Requesting Data Element","Reason for Requesting Data Element","Per HIPPA minimum requirement laws it is necessary to provide justification for elements to the target study - these will help with CHIA review and approval of the data request."]
["CHIA Notes","Comments","Additional descriptions provided by CHIA IT where deemed applicable. "]
[null,null,"Internal Only - Template Columns"]
["COLUMN NAME NETEZZA Source","Column Name from NETEZZA  ","Actual Column name in the source database - This value will be reflected in the header row of the delimited file data extract."]
["Notes","Notes","Internal notes - IT specific"]
["SG\nData Type",null,"Submission Guide data type - Helps identify expec tations for contents"]
["SG\nLength",null,"Submission Guide data element length - Helps identify expec tations for contents"]
["FLAG Carrier Specific TLKP",null,"If applicable - identifies which lookup/reference table should be used to decode a reference value. "]
["Field Type",null,"Designates fields that have been altered - \"Derived\" means either CHIA calculated or result of a standardization, \"Cleaned\" means data was corrected - see cleaning rules. "]
["CHIA Code","CHIA Code","Indicates field is replaced with a surrogate key value in the output extract file. "]
["Redaction",null,"Indicates field is redacted - suspected or possible SSN values have been scanned for and the field set to null if it contains 9 numbers. "]
[null,"MH Warehouse Reference","MHEE only - Reference table name in MassHealth Warehouse (may be useful for some users)"]
[null,"Data Type","Data types as defined in Netezza provides general data typing guidance"]
[null,"Field Length","Where applicable for character (numeric and data lengths are software dependant). "]

{"sheet":"Hide Internal Use Notes","index":15,"n_rows":27,"n_cols":5,"rows_kept":27,"cut":false,"hidden":true,"merged":[]}
["Purpose of this new 2022 template: "]
[null,"1- The template contains a Legal approval form, which will be the official authorization sent to DOT to request fulfillment.  "]
[null,"2- For reference only - The template contains a comprehensive list of data elements in the release, by file type.  "]
[]
[null,null,"Level","Description","Comment"]
["Entity Drop down List:",null,1,"Public","N/A currently"]
[null,null,2,"Deidentified","Any approved Entity"]
[null,null,3,"Identifiable","Gov only"]
[null,null,"NR*","Direct Identifiers, sensitive or Internal derived use"]
[]
[null,null,"*NR - No Release columns may be released for exceptions (Gov only)"]
[]
[null,"Logic for Selection restrictions enforced by code - These Rows to be hidden:"]
[null,"This form will be coded to restrict appropriate selections based on based on B25 and B27 values selected."]
[]
[null,"(B25) Requesting Entity Type must be selected (See Entity drop down list)"]
[null,"(B27) Substance Abuse drop down – To be defaulted to “N”, but may be approved for any request by selecting \"Y\""]
[]
[null,"Enable Identifiable data drop down (B29)  to be selectable only in the following cases:"]
[]
[null,"Case 1 - Requesting Entity Type (B25)  = \"Internal or CHIA Contractor\""]
[]
[null,"Case 2 - Requesting Entity Type (B25)  = \"Government Agency\" AND Substance Abuse drop down (B25) = “N”"]
[]
[null,"Case 3 - Requesting Entity Type (B25)  = \"Payer/Provider TCC\" AND Substance Abuse drop down (B25) = “N”"]
[]
[null,"Case 4 - Requesting Entity Type (B25)  = \"Researcher\" AND Substance Abuse drop down (B25) = “N”"]

{"sheet":"Data Fulfillment","index":16,"n_rows":7,"n_cols":10,"rows_kept":7,"cut":false,"hidden":false,"merged":[[0,7,0,8]]}
["2020Files","2021 Files","2022 Files","2023 Files","2024 Files","Other Misc","All Selected Years + Misc","Requestor Information (from Legal Approval Form tab)"]
[{"$f":"IFERROR(_xlfn._xlws.FILTER('Legal Approval Form'!G11:G42, ISNUMBER(SEARCH(\"apcd\", 'Legal Approval Form'!G11:G42))), {\"No Matches\"})","v":"No Matches"},{"$f":"IFERROR(_xlfn._xlws.FILTER('Legal Approval Form'!H11:H42, ISNUMBER(SEARCH(\"apcd\", 'Legal Approval Form'!H11:H42))), {\"No Matches\"})","v":"No Matches"},{"$f":"IFERROR(_xlfn._xlws.FILTER('Legal Approval Form'!I11:I42, ISNUMBER(SEARCH(\"apcd\", 'Legal Approval Form'!I11:I42))), {\"No Matches\"})","v":"No Matches"},{"$f":"IFERROR(_xlfn._xlws.FILTER('Legal Approval Form'!J11:J42, ISNUMBER(SEARCH(\"apcd\", 'Legal Approval Form'!J11:J42))), {\"No Matches\"})","v":"No Matches"},{"$f":"IFERROR(_xlfn._xlws.FILTER('Legal Approval Form'!K11:K42, ISNUMBER(SEARCH(\"apcd\", 'Legal Approval Form'!K11:K42))), {\"No Matches\"})","v":"No Matches"},"apcd_2024_MEID_ALL_ID.txt",{"$f":"_xlfn._xlws.FILTER(_xlfn.VSTACK(A2:A100, B2:B100, C2:C100, D2:D100,E2:E100,F2:F100), LEFT(_xlfn.VSTACK(A2:A100, B2:B100, C2:C100, D2:D100,E2:E100,F2:F100), 4)=\"apcd\")","v":"apcd_2024_MEID_ALL_ID.txt"},"Entity/Applicant Name:",{"$f":"'Legal Approval Form'!B6:C6","v":" "},0]
[null,null,null,null,null,{"$f":"IF('Legal Approval Form'!$B$33=\"N\",\"apcd_2024_GEO_ALL_DE.txt\", \"apcd_2024_GEO_ALL_ID.txt\")","v":"apcd_2024_GEO_ALL_DE.txt"},"apcd_2024_GEO_ALL_DE.txt","Project Name:",{"$f":"'Legal Approval Form'!B7:C7","v":" "},0]
[null,null,null,null,null,null,null,"Extract Request#:",{"$f":"'Legal Approval Form'!B4","v":"#000"}]
[null,null,null,null,null,null,null,"Release ID:",{"$f":"'Legal Approval Form'!D1","v":"CY2024"}]
[null,null,null,null,null,null,null,"File Components:",{"$f":"CONCATENATE(I4,\"_\",I2,\"_ExtractList\")","v":"#000_ _ExtractList"}]
[null,null,null,null,null,null,null,"Export File Name:",{"$f":"SUBSTITUTE(TRIM(I6), \" \", \"_\")","v":"#000___ExtractList"},"(Spaces Removed)"]

{"sheet":"UVR Filename Lkup","index":17,"n_rows":52,"n_cols":9,"rows_kept":52,"cut":false,"hidden":true,"merged":[]}
["UVR View Description","FT","ET","SL","2020","2021","2022","2023","2024"]
["Dental DE-Identifed","DC","CM","DE",{"$f":"CONCATENATE(\"apcd_\",E$1,\"_\",$B2,\"_\",$C2,\"_\",$D2,\".txt\")","v":"apcd_2020_DC_CM_DE.txt"},"apcd_2021_DC_CM_DE.txt","apcd_2022_DC_CM_DE.txt","apcd_2023_DC_CM_DE.txt","apcd_2024_DC_CM_DE.txt"]
["Dental Identifiable","DC","CM","ID","apcd_2020_DC_CM_ID.txt","apcd_2021_DC_CM_ID.txt","apcd_2022_DC_CM_ID.txt","apcd_2023_DC_CM_ID.txt","apcd_2024_DC_CM_ID.txt"]
["Dental MH DE-Identified","DC","MH","DE","apcd_2020_DC_MH_DE.txt","apcd_2021_DC_MH_DE.txt","apcd_2022_DC_MH_DE.txt","apcd_2023_DC_MH_DE.txt","apcd_2024_DC_MH_DE.txt"]
["Dental MH Identifiable","DC","MH","ID","apcd_2020_DC_MH_ID.txt","apcd_2021_DC_MH_ID.txt","apcd_2022_DC_MH_ID.txt","apcd_2023_DC_MH_ID.txt","apcd_2024_DC_MH_ID.txt"]
["Medical Claims DE-Identifed","MC","CM","DE","apcd_2020_MC_CM_DE.txt","apcd_2021_MC_CM_DE.txt","apcd_2022_MC_CM_DE.txt","apcd_2023_MC_CM_DE.txt","apcd_2024_MC_CM_DE.txt"]
["Medical Claims Identifiable","MC","CM","ID","apcd_2020_MC_CM_ID.txt","apcd_2021_MC_CM_ID.txt","apcd_2022_MC_CM_ID.txt","apcd_2023_MC_CM_ID.txt","apcd_2024_MC_CM_ID.txt"]
["Medical Claims MH DE-Identified","MC","MH","DE","apcd_2020_MC_MH_DE.txt","apcd_2021_MC_MH_DE.txt","apcd_2022_MC_MH_DE.txt","apcd_2023_MC_MH_DE.txt","apcd_2024_MC_MH_DE.txt"]
["Medical Claims MH Identifiable","MC","MH","ID","apcd_2020_MC_MH_ID.txt","apcd_2021_MC_MH_ID.txt","apcd_2022_MC_MH_ID.txt","apcd_2023_MC_MH_ID.txt","apcd_2024_MC_MH_ID.txt"]
["MC Commercial SUD DE-Identified","MC","CS","DE","apcd_2020_MC_CS_DE.txt","apcd_2021_MC_CS_DE.txt","apcd_2022_MC_CS_DE.txt","apcd_2023_MC_CS_DE.txt","apcd_2024_MC_CS_DE.txt"]
["MC Commercial SUD Identifiable","MC","CS","ID","apcd_2020_MC_CS_ID.txt","apcd_2021_MC_CS_ID.txt","apcd_2022_MC_CS_ID.txt","apcd_2023_MC_CS_ID.txt","apcd_2024_MC_CS_ID.txt"]
["MC MassHealth SUD DE-Identified","MC","MS","DE",{"$f":"CONCATENATE(\"apcd_\",E$1,\"_\",$B12,\"_\",$C12,\"_\",$D12,\".txt\")","v":"apcd_2020_MC_MS_DE.txt"},"apcd_2021_MC_MS_DE.txt","apcd_2022_MC_MS_DE.txt","apcd_2023_MC_MS_DE.txt","apcd_2024_MC_MS_DE.txt"]
["MC MassHealth SUD Identifiable","MC","MS","ID","apcd_2020_MC_MS_ID.txt","apcd_2021_MC_MS_ID.txt","apcd_2022_MC_MS_ID.txt","apcd_2023_MC_MS_ID.txt","apcd_2024_MC_MS_ID.txt"]
["Member Eligibility DE-Identified","ME","CM","DE","apcd_2020_ME_CM_DE.txt","apcd_2021_ME_CM_DE.txt","apcd_2022_ME_CM_DE.txt","apcd_2023_ME_CM_DE.txt","apcd_2024_ME_CM_DE.txt"]
["Member Eligibility Identifiable","ME","CM","ID","apcd_2020_ME_CM_ID.txt","apcd_2021_ME_CM_ID.txt","apcd_2022_ME_CM_ID.txt","apcd_2023_ME_CM_ID.txt","apcd_2024_ME_CM_ID.txt"]
["Member Eligibility MH DE-Identified","ME","MH","DE","apcd_2020_ME_MH_DE.txt","apcd_2021_ME_MH_DE.txt","apcd_2022_ME_MH_DE.txt","apcd_2023_ME_MH_DE.txt","apcd_2024_ME_MH_DE.txt"]
["Member Eligibility MH Identifiable","ME","MH","ID","apcd_2020_ME_MH_ID.txt","apcd_2021_ME_MH_ID.txt","apcd_2022_ME_MH_ID.txt","apcd_2023_ME_MH_ID.txt","apcd_2024_ME_MH_ID.txt"]
["Pharmacy DE-Identified","PC","CM","DE","apcd_2020_PC_CM_DE.txt","apcd_2021_PC_CM_DE.txt","apcd_2022_PC_CM_DE.txt","apcd_2023_PC_CM_DE.txt","apcd_2024_PC_CM_DE.txt"]
["Pharmacy Identifiable","PC","CM","ID","apcd_2020_PC_CM_ID.txt","apcd_2021_PC_CM_ID.txt","apcd_2022_PC_CM_ID.txt","apcd_2023_PC_CM_ID.txt","apcd_2024_PC_CM_ID.txt"]
["Pharmacy MH DE-Identified","PC","MH","DE","apcd_2020_PC_MH_DE.txt","apcd_2021_PC_MH_DE.txt","apcd_2022_PC_MH_DE.txt","apcd_2023_PC_MH_DE.txt","apcd_2024_PC_MH_DE.txt"]
["Pharmacy MH Identifiable","PC","MH","ID","apcd_2020_PC_MH_ID.txt","apcd_2021_PC_MH_ID.txt","apcd_2022_PC_MH_ID.txt","apcd_2023_PC_MH_ID.txt","apcd_2024_PC_MH_ID.txt"]
["Product DE-Identiied","PR","CM","DE",{"$f":"CONCATENATE(\"apcd_\",E$1,\"_\",$B22,\"_\",$C22,\"_\",$D22,\".txt\")","v":"apcd_2020_PR_CM_DE.txt"},"apcd_2021_PR_CM_DE.txt","apcd_2022_PR_CM_DE.txt","apcd_2023_PR_CM_DE.txt","apcd_2024_PR_CM_DE.txt"]
["Product Identifiable","PR","CM","ID","apcd_2020_PR_CM_ID.txt","apcd_2021_PR_CM_ID.txt","apcd_2022_PR_CM_ID.txt","apcd_2023_PR_CM_ID.txt","apcd_2024_PR_CM_ID.txt"]
["Product MH DE-Identified","PR","MH","DE","apcd_2020_PR_MH_DE.txt","apcd_2021_PR_MH_DE.txt","apcd_2022_PR_MH_DE.txt","apcd_2023_PR_MH_DE.txt","apcd_2024_PR_MH_DE.txt"]
["Product MH Identifiable","PR","MH","ID","apcd_2020_PR_MH_ID.txt","apcd_2021_PR_MH_ID.txt","apcd_2022_PR_MH_ID.txt","apcd_2023_PR_MH_ID.txt","apcd_2024_PR_MH_ID.txt"]
["Provider DE-Identified","PV","CM","DE","apcd_2020_PV_CM_DE.txt","apcd_2021_PV_CM_DE.txt","apcd_2022_PV_CM_DE.txt","apcd_2023_PV_CM_DE.txt","apcd_2024_PV_CM_DE.txt"]
["Provider Identifiable","PV","CM","ID","apcd_2020_PV_CM_ID.txt","apcd_2021_PV_CM_ID.txt","apcd_2022_PV_CM_ID.txt","apcd_2023_PV_CM_ID.txt","apcd_2024_PV_CM_ID.txt"]
["Provider MH DE-Identified","PV","MH","DE","apcd_2020_PV_MH_DE.txt","apcd_2021_PV_MH_DE.txt","apcd_2022_PV_MH_DE.txt","apcd_2023_PV_MH_DE.txt","apcd_2024_PV_MH_DE.txt"]
["Provider MH Identifiable","PV","MH","ID","apcd_2020_PV_MH_ID.txt","apcd_2021_PV_MH_ID.txt","apcd_2022_PV_MH_ID.txt","apcd_2023_PV_MH_ID.txt","apcd_2024_PV_MH_ID.txt"]
["Benefit Plan DE-Identified","BP","CM","DE","apcd_2020_BP_CM_DE.txt","apcd_2021_BP_CM_DE.txt","apcd_2022_BP_CM_DE.txt","apcd_2023_BP_CM_DE.txt","apcd_2024_BP_CM_DE.txt"]
["Benefit Plan Identifiable","BP","CM","ID","apcd_2020_BP_CM_ID.txt","apcd_2021_BP_CM_ID.txt","apcd_2022_BP_CM_ID.txt","apcd_2023_BP_CM_ID.txt","apcd_2024_BP_CM_ID.txt"]
["MH Enhanced Eligibility DE-identified","EE","MH","DE","apcd_2020_EE_MH_DE.txt","apcd_2021_EE_MH_DE.txt","apcd_2022_EE_MH_DE.txt","apcd_2023_EE_MH_DE.txt","apcd_2024_EE_MH_DE.txt"]
["MH Enhanced Eligibility Identifiable","EE","MH","ID","apcd_2020_EE_MH_ID.txt","apcd_2021_EE_MH_ID.txt","apcd_2022_EE_MH_ID.txt","apcd_2023_EE_MH_ID.txt","apcd_2024_EE_MH_ID.txt"]
[]
["Naming Conventions:",null,null,null,"Attribute Type Code","Attribute Code","Attribute Description"]
["File Extract name:",null,null,null,"FT","MC","Medical Claim"]
[" &yyyy + &FT + &ET + &SL",null,null,null,"FT","DC","Dental Claim"]
["(separate by \"_\" - underscores)",null,null,null,"FT","PC","Pharmacy Claim"]
[null,null,null,null,"FT","ME","Member Eligibility"]
[null,null,null,null,"FT","EE","MassHealth Enhanced Eligibility"]
[null,null,null,null,"FT","PV","Provider"]
[null,null,null,null,"FT","PR","Product"]
[null,null,null,null,"FT","BP","Benefit Plan"]
[]
[null,null,null,null,"ET","CM","Commercial"]
[null,null,null,null,"ET","CS","Commercial SUD* only"]
[null,null,null,null,"ET","MH","MassHealth only"]
[null,null,null,null,"ET","MS","MassHealth SUD* only"]
[]
[null,null,null,null,"SL","DE","De-Identified"]
[null,null,null,null,"SL","ID"," Identifiable"]
[null,null,null,null,"SL","SR"," Special Release"]

{"sheet":"Hide Look up tables","index":18,"n_rows":19,"n_cols":6,"rows_kept":19,"cut":false,"hidden":true,"merged":[[0,4,0,5]]}
["Default","Include","Message - Reason","Request Form Reference","Table 1: Universal Release Levels and CHIA naming.  "]
["N",null,"Restrictions apply with Substance Use data*","Dental Claims","UVR Release Level ID","UVR Level Description"]
[null,"Y","This entity type is not allowed identifiable!","Medical Claims",1,"L1 - Deidentified Only"]
[null,null,"Attention - Entity Type Required!","Member Eligibility",2,"L2 - Identifiable Data"]
[null,null,"Attention!","Pharmacy Claims",3,"L3 - Special Request"]
[null,null,"Are you sure?","Product File"]
[null,null,"\"N\" means De-identified data only","Provider File"]
[null,null,"Include Identifiable data*","Benefit Plan Control Totals"]
[]
[]
[null,null,null,"Include MassHealth Data","$B$26 MH data"]
[null,null,null,"MassHealth Enhanced Eligibility"]
[]
[null,null,null,"Requesting Entity Type:"]
[]
[null,null,null,"Include Substance Abuse Claims","$B$31 SUD"]
[]
[null,null,null,"Include Identifiable Data ","$B$33 ID data"]
[null,null,null,"Custom Filter Requested"]

{"sheet":"MHEE - Verify Columns","index":19,"n_rows":102,"n_cols":13,"rows_kept":102,"cut":false,"hidden":true,"merged":[]}
["Release Level","Functional Name   ","Data Elements (related MH Source Fields)","Comments","Dev Requirement Notes","Release Column R8","Columns Found in Release 8","DATA_TYPE","CHARACTER_MAXIMUM_LENGTH","Field Length","R8 Comment","MH Warehouse Reference","CHIA Code"]
[3,"Member mailing zip code","ADR_MAIL_ZIP",null,"New - Encryption recommended - Set to null if not numeric","ADR_MAIL_ZIP5","ADR_MAIL_ZIP","CHARACTER VARYING(5)",5,5,null,"nw_state_eligibility"]
[3,"Aid Category Coverage type","CDE_AID_CATEGORY",null,"New - Derivation see: Aid Category Derivation of New Data Elements - ME and MHEE.xlsx","AIDCATCOVERAGETYPE","AIDCATCOVERAGETYPE","CHARACTER VARYING(50)",50,50,null,"nw_state_eligibility"]
[3,"Aid Category Disability Indicator","CDE_AID_CATEGORY",null,"New - Derivation see: Aid Category Derivation of New Data Elements - ME and MHEE.xlsx","AIDCATDISABILITYINDICATOR","AIDCATDISABILITYINDICATOR","CHARACTER VARYING(1)",1,1,null,"nw_state_eligibility"]
[3,"Aid Category Population","CDE_AID_CATEGORY",null,"New - Derivation see: Aid Category Derivation of New Data Elements - ME and MHEE.xlsx","AIDCATPOPULATION","AIDCATPOPULATION","CHARACTER VARYING(50)",50,50,null,"nw_state_eligibility"]
[3,"Aid Category Premium assistance indicator","CDE_AID_CATEGORY",null,"New - Derivation see: Aid Category Derivation of New Data Elements - ME and MHEE.xlsx","AIDCATPREMIUMASSISTANCEINDICATOR","AIDCATPREMIUMASSISTANCEINDICATOR","CHARACTER VARYING(1)",1,1,null,"nw_state_eligibility"]
[3,"Aid Category Temporary Coverage Type","CDE_AID_CATEGORY",null,"New - Derivation see: Aid Category Derivation of New Data Elements - ME and MHEE.xlsx","AIDCATTEMPORARYCOVERAGETYPE","AIDCATTEMPORARYCOVERAGETYPE","CHARACTER VARYING(1)",1,1,null,"nw_state_eligibility"]
[3,"Age Group","CDE_AGE_GROUP",null,null,"CDE_AGE_GROUP","CDE_AGE_GROUP","CHARACTER VARYING(30)",30,30,null,"nw_state_eligibility"]
[3,"Behavioral Health Plan Assignment","CDE_BH_ENROLL",null,null,"CDE_BH_ENROLL","CDE_BH_ENROLL","CHARACTER VARYING(14)",14,14,null,"nw_state_eligibility"]
[3,"Behavioral Health Plan Assignment Detail","CDE_BH_ENROLL_L2",null,null,"CDE_BH_ENROLL_L2","CDE_BH_ENROLL_L2","CHARACTER VARYING(23)",23,23,null,"nw_state_eligibility"]
[3,"Budget Group","CDE_BUDGET_GROUP",null,null,"CDE_BUDGET_GROUP","CDE_BUDGET_GROUP","CHARACTER VARYING(2)",2,2,null,"nw_state_eligibility"]
[3,"Disability Code","CDE_DISABILITY",null,null,"CDE_DISABILITY","CDE_DISABILITY","CHARACTER VARYING(7)",7,7,null,"nw_state_eligibility"]
[3,"Member Ethnicity Code","CDE_ETHNIC",null,null,"CDE_ETHNIC","CDE_ETHNIC","CHARACTER VARYING(6)",6,6,null,"nw_member"]
[3,"Home and Community Based Waiver Code","CDE_HCB_WAIVER",null,null,"CDE_HCB_WAIVER","CDE_HCB_WAIVER","CHARACTER VARYING(30)",30,30,null,"nw_state_eligibility"]
[3,"Member Homeless Indicator Code","CDE_HOMELESS",null,null,"CDE_HOMELESS","CDE_HOMELESS","CHARACTER VARYING(1)",1,1,null,"nw_member"]
[3,"Managed Care Plan Code","CDE_MANAGED_CARE_PLAN",null,null,"CDE_MANAGED_CARE_PLAN","CDE_MANAGED_CARE_PLAN","CHARACTER VARYING(14)",14,14,null,"nw_state_eligibility"]
[3,"Managed Care Plan Code Detail","CDE_MANAGED_CARE_PLAN_L2",null,null,"CDE_MANAGED_CARE_PLAN_L2","CDE_MANAGED_CARE_PLAN_L2","CHARACTER VARYING(23)",23,23,null,"nw_state_eligibility"]
[3,"Member Marital Status Code","CDE_MARITAL",null,null,"CDE_MARITAL","CDE_MARITAL","CHARACTER VARYING(1)",1,1,null,"nw_member"]
[3,"Federal Poverty Level Group","CDE_PCT_INCOME_FPL",null,null,"CDE_PCT_INCOME_FPL","CDE_PCT_INCOME_FPL","CHARACTER VARYING(30)",30,30,null,"nw_state_eligibility"]
[3,"Benefit Plan","CDE_PGM_HEALTH",null,null,"CDE_PGM_HEALTH","CDE_PGM_HEALTH","CHARACTER VARYING(5)",5,5,null,"nw_state_eligibility"]
[3,"Behavioral Health Assignment Plan","CDE_PGM_HEALTH_BH",null,null,"CDE_PGM_HEALTH_BH","CDE_PGM_HEALTH_BH","CHARACTER VARYING(5)",5,5,null,"nw_state_eligibility"]
[3,"Managed Care Assignment Plan","CDE_PGM_HEALTH_MC",null,null,"CDE_PGM_HEALTH_MC","CDE_PGM_HEALTH_MC","CHARACTER VARYING(5)",5,5,null,"nw_state_eligibility"]
[3,"Member Primary Language Code","CDE_PRIMARY_LANG",null,null,"CDE_PRIMARY_LANG","CDE_PRIMARY_LANG","CHARACTER VARYING(6)",6,6,null,"nw_member"]
[3,"Behavioral Health Provider Type","CDE_PROV_TYPE_BH",null,null,"CDE_PROV_TYPE_BH","CDE_PROV_TYPE_BH","CHARACTER VARYING(2)",2,2,null,"nw_state_eligibility"]
[3,"Long Term Care Provider Type","CDE_PROV_TYPE_LTC",null,null,"CDE_PROV_TYPE_LTC","CDE_PROV_TYPE_LTC","CHARACTER VARYING(2)",2,2,null,"nw_state_eligibility"]
[3,"Managed Care Provider Type","CDE_PROV_TYPE_MCO",null,null,"CDE_PROV_TYPE_MCO","CDE_PROV_TYPE_MCO","CHARACTER VARYING(2)",2,2,null,"nw_state_eligibility"]
[3,"Primary Care Clinician Provider Type","CDE_PROV_TYPE_PCC",null,null,"CDE_PROV_TYPE_PCC","CDE_PROV_TYPE_PCC","CHARACTER VARYING(2)",2,2,null,"nw_state_eligibility"]
[3,"Member Race Code","CDE_RACE",null,null,"CDE_RACE","CDE_RACE","CHARACTER VARYING(6)",6,6,null,"nw_member"]
[3,"Behavioral Health Enrollment Rate Cell","CDE_RATE_CELL_BH",null,null,"CDE_RATE_CELL_BH","CDE_RATE_CELL_BH","CHARACTER VARYING(5)",5,5,null,"nw_state_eligibility"]
[3,"Managed Care Enrollment Rate Cell","CDE_RATE_CELL_MCO",null,null,"CDE_RATE_CELL_MCO","CDE_RATE_CELL_MCO","CHARACTER VARYING(5)",5,5,null,"nw_state_eligibility"]
[3,"State Children's Health Insurance Program Code","CDE_SCHIP_TYPE",null,null,"CDE_SCHIP_TYPE","CDE_SCHIP_TYPE","CHARACTER VARYING(20)",20,20,null,"nw_state_eligibility"]
[3,"Member Gender Code","CDE_SEX",null,null,"CDE_SEX","CDE_SEX","CHARACTER VARYING(1)",1,1,null,"nw_member"]
[3,"Member Third Party Liability Status","CDE_TPL_STATUS",null,null,"CDE_TPL_STATUS","CDE_TPL_STATUS","CHARACTER VARYING(7)",7,7,null,"nw_state_eligibility"]
[3,"Derived Carrier Specific Unique Member ID","ID_MEDICAID",null,"New - Surrogate Key recommended","CHIACARRIERSPECIFICUNIQUEMEMBERID","CHIACARRIERSPECIFICUNIQUEMEMBERID","BIGINT","NULL",30,null,"N/A","Y"]
[3,"Third Party Liability Coverage Category","COVERAGE_CATEGORY",null,null,"COVERAGE_CATEGORY","COVERAGE_CATEGORY","CHARACTER VARYING(20)",20,20,null,"nw_state_eligibility"]
[3,"Member Date of Birth","DTE_BIRTH",null,"New - Encryption and Renaming recommended","DTE_BIRTH","DTE_BIRTH","DATE","NULL",null,null,"nw_member"]
[3,"Member Date of Death","DTE_DEATH",null,null,"DTE_DEATH","DTE_DEATH","DATE","NULL",null,null,"nw_member"]
[3,"Derived Effective Begin date","DTE_EFFECTIVE","Effective date enrollment (of segment) - Monthly bounded YYYYMMDD",null,"DTE_EFFECTIVE_MONTH","DTE_EFFECTIVE_MONTH","DATE","NULL",null,null,"N/A"]
[3,"Derived Effective End date","DTE_END","End date enrollment (of segment) - Monthly bounded YYYYMMDD",null,"DTE_END_MONTH","DTE_END_MONTH","DATE","NULL",null,null,"N/A"]
[3,"Derived MHEE Release Record ID ","N/A","Unique record identity element",null,"ID","ID","BIGINT","NULL",null,null,"N/A"]
[3,"Derived Behavioral Health Provider ID","ID_PROVIDER_LOCATION_BH","Record linkage to APCD Provider (PV) File",null,"ID_PROVIDER_LOCATION_BH_LINKAGE_ID","ID_PROVIDER_LOCATION_BH_LINKAGE_ID","BIGINT","NULL",null,null,"N/A","Y"]
[3,"Derived Long Term Care Provider ID","ID_PROVIDER_LOCATION_LTC","Record linkage to APCD Provider (PV) File",null,"ID_PROVIDER_LOCATION_LTC_LINKAGE_ID","ID_PROVIDER_LOCATION_LTC_LINKAGE_ID","BIGINT","NULL",null,null,"N/A","Y"]
[3,"Derived Managed Care Entity Provider ID","ID_PROVIDER_LOCATION_MCO","Record linkage to APCD Provider (PV) File",null,"ID_PROVIDER_LOCATION_MCO_LINKAGE_ID","ID_PROVIDER_LOCATION_MCO_LINKAGE_ID","BIGINT","NULL",null,null,"N/A","Y"]
[3,"Derived Primary Care Clinician Provider ID","ID_PROVIDER_LOCATION_PCC","Record linkage to APCD Provider (PV) File",null,"ID_PROVIDER_LOCATION_PCC_LINKAGE_ID","ID_PROVIDER_LOCATION_PCC_LINKAGE_ID","BIGINT","NULL",null,null,"N/A","Y"]
[3,"Member Active Flag","IND_ACTIVE","Values Y/N",null,"IND_ACTIVE","IND_ACTIVE","CHARACTER VARYING(1)",1,1,null,"nw_state_eligibility"]
[3,"Disability Aid Category Flag","IND_AID_DISABLED","Values Y/N",null,"IND_AID_DISABLED","IND_AID_DISABLED","CHARACTER VARYING(1)",1,1,null,"nw_state_eligibility"]
[3,"SSI (Aged and Disabled) Aid Category Flag","IND_AID_SSI","Values Y/N",null,"IND_AID_SSI","IND_AID_SSI","CHARACTER VARYING(1)",1,1,null,"nw_state_eligibility"]
[3,"CommonHealth Non-Working Aid Category Flag","IND_COMMONHLTH_NON_WORKING","Values Y/N",null,"IND_COMMONHLTH_NON_WORKING","IND_COMMONHLTH_NON_WORKING","CHARACTER VARYING(1)",1,1,null,"nw_state_eligibility"]
[3,"CommonHealth Working Aid Category Flag","IND_COMMONHLTH_WORKING","Values Y/N",null,"IND_COMMONHLTH_WORKING","IND_COMMONHLTH_WORKING","CHARACTER VARYING(1)",1,1,null,"nw_state_eligibility"]
[3,"Commonwealth Care Aid Category Flag","IND_COMMONWEALTH_CARE","Values Y/N",null,"IND_COMMONWEALTH_CARE","IND_COMMONWEALTH_CARE","CHARACTER VARYING(1)",1,1,null,"nw_state_eligibility"]
[3,"Health Safety Net Flag","IND_HEALTH_SAFETY_NET","Values Y/N",null,"IND_HEALTH_SAFETY_NET","IND_HEALTH_SAFETY_NET","CHARACTER VARYING(1)",1,1,null,"nw_state_eligibility"]
[3,"Kaleigh Mulligan Based Aid Category Flag","IND_KALEIGH_DISABLED","Values Y/N",null,"IND_KALEIGH_DISABLED","IND_KALEIGH_DISABLED","CHARACTER VARYING(1)",1,1,null,"nw_state_eligibility"]
[3,"Long Term Care Eligibility Flag","IND_LTC_FACILITY","Values Y/N",null,"IND_LTC_FACILITY","IND_LTC_FACILITY","CHARACTER VARYING(1)",1,1,null,"nw_state_eligibility"]
[3,"Managed Care Eligibility Flag","IND_MANAGED_CARE_ELIGIBLE","Values Y/N",null,"IND_MANAGED_CARE_ELIGIBLE","IND_MANAGED_CARE_ELIGIBLE","CHARACTER VARYING(1)",1,1,null,"nw_state_eligibility"]
[3,"Managed Care Eligibility/Aid Category Flag","IND_MCE_AID_CATEGORY","Values Y/N",null,"IND_MCE_AID_CATEGORY","IND_MCE_AID_CATEGORY","CHARACTER VARYING(1)",1,1,null,"nw_state_eligibility"]
[3,"Medicare Part A Coverage Flag","IND_MEDICARE_A","Values Y/N",null,"IND_MEDICARE_A","IND_MEDICARE_A","CHARACTER VARYING(1)",1,1,null,"nw_state_eligibility"]
[3,"Medicare Part B Coverage Flag","IND_MEDICARE_B","Values Y/N",null,"IND_MEDICARE_B","IND_MEDICARE_B","CHARACTER VARYING(1)",1,1,null,"nw_state_eligibility"]
[3,"Medicare Advantage Coverage Flag","IND_MEDICARE_C","Values Y/N",null,"IND_MEDICARE_C","IND_MEDICARE_C","CHARACTER VARYING(1)",1,1,null,"nw_state_eligibility"]
[3,"Medicare Part D Coverage Flag","IND_MEDICARE_D","Values Y/N",null,"IND_MEDICARE_D","IND_MEDICARE_D","CHARACTER VARYING(1)",1,1,null,"nw_state_eligibility"]
[3,"Medicare Home Health Coverage Flag","IND_MEDICARE_H","Values Y/N",null,"IND_MEDICARE_H","IND_MEDICARE_H","CHARACTER VARYING(1)",1,1,null,"nw_state_eligibility"]
[3,"‘Money Follows the Person’ Program Flag","IND_MFP","Values Y/N",null,"IND_MFP","IND_MFP","CHARACTER VARYING(1)",1,1,null,"nw_state_eligibility"]
[3,"Program All-Inclusive Care for the Elderly  Enrollment Flag","IND_PACE_ENROLLED","Values Y/N",null,"IND_PACE_ENROLLED","IND_PACE_ENROLLED","CHARACTER VARYING(1)",1,1,null,"nw_state_eligibility"]
[3,"Pharmacy Third Party Liability Coverage Flag","IND_PHARMACY_COVERAGE","Values Y/N",null,"IND_PHARMACY_COVERAGE","IND_PHARMACY_COVERAGE","CHARACTER VARYING(1)",1,1,null,"nw_state_eligibility"]
[3,"Pregnancy Indicator Flag","IND_PREGNANCY","Values Y/N",null,"IND_PREGNANCY","IND_PREGNANCY","CHARACTER VARYING(1)",1,1,null,"nw_state_eligibility"]
[3,"Senior Care Option Enrollment Flag","IND_SCO","Values Y/N",null,"IND_SCO","IND_SCO","CHARACTER VARYING(1)",1,1,null,"nw_state_eligibility"]
[3,"Derived Eligible Days in Month","NUM_DAYS_ELIGIBLE","Integer values 1 to 31 represents days pertaining to the referenced month",null,"NUM_DAYS_ELIGIBLE_MONTH","NUM_DAYS_ELIGIBLE_MONTH","NUMERIC(18,2)","NULL",null,null,"N/A"]
[3,"Federal Poverty Level Income Percent","PCT_INCOME_FPL",null,"cast as 6.2 in Release core for privacy concerns","PCT_INCOME_FPL","PCT_INCOME_FPL","NUMERIC(18,2)","NULL",null,null,"nw_state_eligibility"]
[3,"Submission Control ID","SUBMISSIONCONTROLID","Required by IT for internal linkage","New for R6","SUBMISSIONCONTROLID","SUBMISSIONCONTROLID","INTEGER","NULL"]
[3,"Submission Month","SUBMISSIONMONTH","Required by IT for internal linkage","New for R6","SUBMISSIONMONTH","SUBMISSIONMONTH","INTEGER","NULL",2]
[3,"Submission Year","SUBMISSIONYEAR","Required by IT for internal linkage","New for R6","SUBMISSIONYEAR","SUBMISSIONYEAR","INTEGER","NULL",4]
["NR","Member mailing zip code formatted","ADR_MAIL_ZIP_DSP","Formatted zip - no additiona value for users - see ADR_MAIL_ZIP instead. Drop this from MHEE Release","New - Encryption recommended - or drop from release","ADR_MAIL_ZIP_DSP5","ADR_MAIL_ZIP_DSP","CHARACTER VARYING(7)",7,7,null,"nw_state_eligibility"]
["NR","Richest MassHealth Aid Category","CDE_AID_CATEGORY","Available for internal use only. See 5 derived release elts.",null,"CDE_AID_CATEGORY","CDE_AID_CATEGORY","CHARACTER VARYING(2)",2,2]
["NR","Behavioral Health (MBHP) Enrollment Aid Category","CDE_AID_CATEGORY_BH","Available for internal use only. See 5 derived release elts.",null,"CDE_AID_CATEGORY_BH","CDE_AID_CATEGORY_BH","CHARACTER VARYING(2)",2,2,null,"nw_state_eligibility"]
["NR","Managed Care (MCO) Enrollment Aid Category","CDE_AID_CATEGORY_MC","Available for internal use only. See 5 derived release elts.",null,"CDE_AID_CATEGORY_MC","CDE_AID_CATEGORY_MC","CHARACTER VARYING(2)",2,2,null,"nw_state_eligibility"]
["NR","Managed Care Plan/Provider Type Code","CDE_MH_PLAN","Available for internal use only. ",null,"CDE_MH_PLAN","CDE_MH_PLAN","CHARACTER VARYING(4)",4,4,null,"nw_state_eligibility"]
["NR","Waiver Category","CDE_WAIVER_CATEGORY","Available for internal use only.",null,"CDE_WAIVER_CATEGORY","CDE_WAIVER_CATEGORY","CHARACTER VARYING(20)",20,20,null,"nw_state_eligibility"]
["NR","Waiver Eligibility Flag","CDE_WAIVER_FLG","Available for internal use only. ",null,"CDE_WAIVER_FLG","CDE_WAIVER_FLG","CHARACTER VARYING(1)",1,1,null,"nw_state_eligibility"]
["NR","Internal Use ETL Batch ID","CREATEDATE","internal manufacturing use only",null,"CREATEDATE","CREATEDATE","TIMESTAMP","NULL"]
["NR","MH Record source Effective date","DTE_EFFECTIVE","applies to source span, not derived monthly segments",null,"DTE_EFFECTIVE","DTE_EFFECTIVE","DATE","NULL"]
["NR","MH Record source End date","DTE_END","applies to source span, not derived monthly segments",null,"DTE_END","DTE_END","DATE","NULL"]
["NR","Internal Use ETL Batch ID","ETLBATCHID","internal manufacturing use only",null,"ETLBATCHID","ETLBATCHID","INTEGER","NULL"]
["NR","Hashed Carrier Specific Unique Member ID","HASHCARRIERSPECIFICUNIQUEMEMBERID","Hashed carrier specific unique member ID",null,"HASHCARRIERSPECIFICUNIQUEMEMBERID","HASHCARRIERSPECIFICUNIQUEMEMBERID","CHARACTER VARYING(256)",256,256]
["NR","New MMIS ID","ID_MEDICAID","As reported MH value - do not disclose","New - Encryption and Renaming recommended","ID_MEDICAID","ID_MEDICAID","CHARACTER VARYING(12)",12,12]
["NR","Behavioral Health Provider ID","ID_PROVIDER_LOCATION_BH","As reported MH value - do not disclose",null,"ID_PROVIDER_LOCATION_BH","ID_PROVIDER_LOCATION_BH","CHARACTER VARYING(10)",10,10]
["NR","Long Term Care Provider ID","ID_PROVIDER_LOCATION_LTC","As reported MH value - do not disclose",null,"ID_PROVIDER_LOCATION_LTC","ID_PROVIDER_LOCATION_LTC","CHARACTER VARYING(10)",10,10]
["NR","Managed Care Entity Provider ID","ID_PROVIDER_LOCATION_MCO","As reported MH value - do not disclose",null,"ID_PROVIDER_LOCATION_MCO","ID_PROVIDER_LOCATION_MCO","CHARACTER VARYING(10)",10,10]
["NR","Primary Care Clinician Provider ID","ID_PROVIDER_LOCATION_PCC","As reported MH value - do not disclose",null,"ID_PROVIDER_LOCATION_PCC","ID_PROVIDER_LOCATION_PCC","CHARACTER VARYING(10)",10,10]
["NR","Indicates Adoption Subsidy","IND_ADOPTION_SUBSIDY","No Data available from MH, nor required - Drop from release schema",null,"IND_ADOPTION_SUBSIDY","IND_ADOPTION_SUBSIDY","CHARACTER VARYING(1)",1]
["NR","Waiver Eligibility Flag","IND_WAIVER_ELIG","Available for internal use only. ","Values Y/N","IND_WAIVER_ELIG","IND_WAIVER_ELIG","CHARACTER VARYING(1)",1,1,null,"nw_state_eligibility"]
["NR","MH Days per eligibility segment record","NUM_DAYS_ELIGIBLE","applies to source span, not derived monthly segments, no value to users",null,"NUM_DAYS_ELIGIBLE","NUM_DAYS_ELIGIBLE","NUMERIC(18,2)","NULL"]
["NR","Internal Use ETL Batch ID","RELEASEETLBATCHID","internal manufacturing use only",null,"RELEASEETLBATCHID","RELEASEETLBATCHID","INTEGER","NULL"]
["tbd8A",null,"CDE_AID_CATEGORY_ACOB",null,"New - Release 8A","CDE_AID_CATEGORY_ACOB","CDE_AID_CATEGORY_ACOB","CHARACTER VARYING(2)",2,2]
["tbd8A",null,"CDE_PGM_HEALTH_ACOB",null,"New - Release 8A","CDE_PGM_HEALTH_ACOB","CDE_PGM_HEALTH_ACOB","CHARACTER VARYING(5)",5,5]
["tbd8A",null,"CDE_RATE_CELL_PCC",null,"New - Release 8A","CDE_RATE_CELL_PCC","CDE_RATE_CELL_PCC","CHARACTER VARYING(5)",5,5]
["tbd8B","CDE_AID_CATEGORY_CP","CDE_AID_CATEGORY_CP","Note - no new aid categories","New - Release 8","CDE_AID_CATEGORY_CP","CDE_AID_CATEGORY_CP","CHARACTER VARYING(2)",2,2]
["tbd8B","CDE_PGM_HEALTH_CP","CDE_PGM_HEALTH_CP","Program values are:","New - Release 8","CDE_PGM_HEALTH_CP","CDE_PGM_HEALTH_CP","CHARACTER VARYING(5)",5,5]
["tbd8B","CDE_PROV_TYPE_CP","CDE_PROV_TYPE_CP","A5 – CP CSA","New - Release 8","CDE_PROV_TYPE_CP","CDE_PROV_TYPE_CP","CHARACTER VARYING(2)",2,2]
["tbd8B","CDE_RATE_CELL_CP","CDE_RATE_CELL_CP","Not active yet but should have same value as CDE_PGM_HEALTH_CP","New - Release 8","CDE_RATE_CELL_CP","CDE_RATE_CELL_CP","CHARACTER VARYING(5)",5,5]
["tbd8B","ID_PROVIDER_LOCATION_CP","ID_PROVIDER_LOCATION_CP","There are 27 Community Partners and 36 Community Service Agencies","New - Release 8","ID_PROVIDER_LOCATION_CP","ID_PROVIDER_LOCATION_CP","CHARACTER VARYING(10)",10,10]
["tbd8B","IND_CP_BH","IND_CP_BH","Y/N","New - Release 8","IND_CP_BH","IND_CP_BH","CHARACTER VARYING(1)",1,1]
["tbd8B","IND_CP_CSA","IND_CP_CSA","Y/N","New - Release 8","IND_CP_CSA","IND_CP_CSA","CHARACTER VARYING(1)",1,1]
["tbd8B","IND_CP_LTSS","IND_CP_LTSS","Y/N","New - Release 8","IND_CP_LTSS","IND_CP_LTSS","CHARACTER VARYING(1)",1,1]

{"sheet":"Diagnosis Columns","index":20,"n_rows":28,"n_cols":3,"rows_kept":28,"cut":false,"hidden":true,"merged":[]}
["SG Ref","Column"]
["DC061","Diagnosis Code","N/A - Only applies to MC where Substance Abuse suppression applies"]
["MC039","ADMITTINGDIAGNOSISCLEANED"]
["MC041","PRINCIPALDIAGNOSISCLEANED"]
["MC042","OTHERDIAGNOSIS1CLEANED"]
["MC043","OTHERDIAGNOSIS2CLEANED"]
["MC044","OTHERDIAGNOSIS3CLEANED"]
["MC045","OTHERDIAGNOSIS4CLEANED"]
["MC046","OTHERDIAGNOSIS5CLEANED"]
["MC047","OTHERDIAGNOSIS6CLEANED"]
["MC048","OTHERDIAGNOSIS7CLEANED"]
["MC049","OTHERDIAGNOSIS8CLEANED"]
["MC050","OTHERDIAGNOSIS9CLEANED"]
["MC051","OTHERDIAGNOSIS10CLEANED"]
["MC052","OTHERDIAGNOSIS11CLEANED"]
["MC053","OTHERDIAGNOSIS12CLEANED"]
["MC142","OTHERDIAGNOSIS13CLEANED"]
["MC143","OTHERDIAGNOSIS14CLEANED"]
["MC144","OTHERDIAGNOSIS15CLEANED"]
["MC145","OTHERDIAGNOSIS16CLEANED"]
["MC146","OTHERDIAGNOSIS17CLEANED"]
["MC147","OTHERDIAGNOSIS18CLEANED"]
["MC148","OTHERDIAGNOSIS19CLEANED"]
["MC149","OTHERDIAGNOSIS20CLEANED"]
["MC150","OTHERDIAGNOSIS21CLEANED"]
["MC151","OTHERDIAGNOSIS22CLEANED"]
["MC152","OTHERDIAGNOSIS23CLEANED"]
["MC153","OTHERDIAGNOSIS24CLEANED"]