Resolution Date Date the Appeal/Expedited Appeal/State Date/Time No REQUIRED IF AND ONLY IF: “Type of Issue” is Fair Hearing was resolved “Appeal”, “Expedited Appeal”, or “State Fair Hearing” Resolution Outcome CHOOSE: Short Text No REQUIRED IF AND ONLY IF: “Type of Issue” is Upheld “Appeal”, “Expedited Appeal”, or “State Fair Overturned Hearing” Withdrawn Partially Overturned Dismissed Unresolved Denial Type CHOOSE: Short Text No REQUIRED IF AND ONLY IF: “Resolution Durable Medical Equipment Outcome” is “Upheld” Therapy Services Procedure in Physician Office Outpatient Procedures Inpatient Procedures Home Health Services Radiology Pharmacy Vision Benefits Other Denial Reasoning Description of the rationale given for Long Text No REQUIRED IF AND ONLY IF: “Resolution upholding denial Outcome” is “Upheld” Other Denial Type Description Short description of the type of “other” Short Text No REQUIRED IF AND ONLY IF: “Denial Reasoning” denial is "Other" Reason Unresolved Short description of the reason the Short Text No REQUIRED IF AND ONLY IF: “Resolution appeal/expedited appeal/state fair hearing Outcome” is "Unresolved" is unresolved Provider First Name First name of the provider on the grievance Short Text Yes N/A Provider Last Name Last name of the provider on the grievance Short Text Yes N/A NE Medicaid Provider ID Provider’s NE Medicaid ID number Short Text Yes N/A Provider NPI Provider’s NPI ID number Short Text Yes N/A Procedure Code If a procedure is a part of the grievance, list Short Text No N/A the code of the procedure
Resolution Date Date the Appeal/Expedited Appeal/State Fair Hearing was resolved Date/Time No REQUIRED IF AND ONLY IF: “Type of Issue” is “Appeal”, “Expedited Appeal”, or “State Fair Hearing” Resolution Outcome CHOOSE: Upheld Overturned Withdrawn Partially Overturned Dismissed Unresolved Short Text No REQUIRED IF AND ONLY IF: “Type of Issue” is “Appeal”, “Expedited Appeal”, or “State Fair Hearing” Denial Type CHOOSE: Durable Medical Equipment Therapy Services Procedure in Physician Office Outpatient Procedures Inpatient Procedures Home Health Services Radiology Pharmacy Vision Benefits Other Short Text No REQUIRED IF AND ONLY IF: “Resolution Outcome” is “Upheld” Denial Reasoning Description of the rationale given for upholding denial Long Text No REQUIRED IF AND ONLY IF: “Resolution Outcome” is “Upheld” Other Denial Type Description Short description of the type of “other” denial Short Text No REQUIRED IF AND ONLY IF: “Denial Reasoning” is "Other" Reason Unresolved Short description of the reason the appeal/expedited appeal/state fair hearing is unresolved Short Text No REQUIRED IF AND ONLY IF: “Resolution Outcome” is "Unresolved" Provider First Name First name of the provider on the grievance Short Text Yes N/A Provider Last Name Last name of the provider on the grievance Short Text Yes N/A NE Medicaid Provider ID Provider’s NE Medicaid ID number Short Text Yes N/A Provider NPI Provider’s NPI ID number Short Text Yes N/A Procedure Code If a procedure is a part of the grievance, list the code of the procedure Short Text No N/A
HH%20Data%20Dictionary.docx