Data Record Date Active Col Element Type Format Length Required Element Submission Guideline Element Type (version) Name ZR 4 ZR004 Insurance 01/17/18 Integer ID 1 Yes Indicates the insurance category that is Category reported : Code 1 = Medicare & Medicare Advantage 2 = Medicaid & Medicaid MCOs 3 = Commercial: Full-Claim 4 = Commercial: Partial-Claim 6 = Medicare and Medicaid Dual- Eligibles, 65 and over (e.g., SCO) 7 = Medicare and Medicaid Dual- Eligibles, 21-64 (e.g., OneCare) 8 = Value must be an integer between ‘1’ and or and ‘4’ ‘6’ ‘8’. ZR 5 ZR005 Member 12/10/10 Integer ######### 9 Yes The number of members participating in a plan over a specified period of Months time expressed in months of membership ZR 6 ZR006 Health 12/10/10 Number ##.## 6 Yes A value that measures a patient’s illness Status burden and predicted resource use based on differences in patient Adjustment characteristics or other risk factors. No negative values. Number must be between and ‘.2’ ‘10’. ZR 7 ZR007 Normalized 12/10/10 Number ##.## 6 Yes The health status adjustment score Health divided by the Payer’s weighted Status average health status adjustment Adjustment score within each insurance category Score No negative values. Number must be between and ‘.2’ ‘10’. ZR 8 ZR008 Claims: 12/10/10 Money #######.## 12 Yes Total allowed claims for hospital Hospital inpatient medical expenses Inpatient No negative values.
Record Type Col Element Data Element Name Date Active (version) Type Format Length Required Element Submission Guideline ZR 4 ZR004 Insurance Category Code 01/17/18 Integer ID 1 Yes Indicates the insurance category that is reported : 1 = Medicare & Medicare Advantage 2 = Medicaid & Medicaid MCOs 3 = Commercial: Full-Claim 4 = Commercial: Partial-Claim 6 = Medicare and Medicaid Dual- Eligibles, 65 and over (e.g., SCO) 7 = Medicare and Medicaid Dual- Eligibles, 21-64 (e.g., OneCare) 8 = Value must be an integer between ‘1’ and ‘4’ or ‘6’ and ‘8’. ZR 5 ZR005 Member Months 12/10/10 Integer ######### 9 Yes The number of members participating in a plan over a specified period of time expressed in months of membership ZR 6 ZR006 Health Status Adjustment 12/10/10 Number ##.## 6 Yes A value that measures a patient’s illness burden and predicted resource use based on differences in patient characteristics or other risk factors. No negative values. Number must be between ‘.2’ and ‘10’. ZR 7 ZR007 Normalized Health Status Adjustment Score 12/10/10 Number ##.## 6 Yes The health status adjustment score divided by the Payer’s weighted average health status adjustment score within each insurance category No negative values. Number must be between ‘.2’ and ‘10’. ZR 8 ZR008 Claims: Hospital Inpatient 12/10/10 Money #######.## 12 Yes Total allowed claims for hospital inpatient medical expenses No negative values.
data-spec-manual-tme.docx