2021 CCLF File Data Elements Resource - V2 - 508

Medicare Shared Savings Program
CLAIM AND CLAIM LINE FEED

FILE DATA ELEMENTS
Resource
April 2021
Version #2
Disclaimer: This communication material was prepared as a service to the public and is
not intended to grant rights or impose obligations. It may contain references or links to
statutes, regulations, or other policy materials. The information provided is only intended
to be a general summary. It is not intended to take the place of either the written law or
regulations. We encourage readers to review the specific statutes, regulations, and other
interpretive materials for a full and accurate statement of its contents. This document is
published, produced, and disseminated at U.S. taxpayer expense.
Revision History (From Version 1 to Version 2)
VERSION DATE REVISION/CHANGE DESCRIPTION AFFECTED AREA
2 April 2021 Updated the Part A and Part B Claims Benefit Table 10, Table 11
Enhancement and Demonstration Codes Files with
Care Management Home Visits benefit enhancement.
2 April 2021 Updated the description of Claim Outpatient Service All
Type Code.
2 April 2021 Added filename convention for Shared Savings All
Program run-out CCLFs.
2 April 2021 Updated the NGACO Suppression process from All
Quarterly to Monthly.
2 April 2021 Updated NGACO and VTAPM run-out file names. All
2 April 2021 Added Note to Executive Summary: “To comply with All
the Medicare Access and CHIP Reauthorization Act
(MACRA) of 2015, after the end of the New Medicare
Card Transition Period in December 2019, only the
MBI will be accepted on claims, and the Health
Information Claim Number (HICN) value will no longer
be displayed. CMS will include blanks for the HICN,
Beneficiary Equitable Beneficiary Identification Code
(BIC) HICN, and Beneficiary Railroad Board Number
(RRB) fields in CCLFs generated effective January 1,
2020 onwards.”
Disclaimer: This communication material was prepared as a service to the public and is not intended to grant rights or
impose obligations. It may contain references or links to statutes, regulations, or other policy materials. The information
provided is only intended to be a general summary. It is not intended to take the place of either the written law or
regulations. We encourage readers to review the specific statutes, regulations, and other interpretive materials for a full
and accurate statement of its contents. This document is published, produced, and disseminated at U.S. taxpayer
expense.
Medicare Shared Savings Program | Claim and Claim Line Feed File Data Elements Resource i
Table of Contents
1 Executive Summary ........................................................................................... 1
2 CCLF File Layouts .............................................................................................. 2
Table 1. Part A Claims Header File (CCLF1)........................................................ 2
Table 2. Part A Claims Revenue Center Detail File (CCLF2) ............................. 12
Table 3. Part A Procedure Code File (CCLF3) ................................................... 17
Table 4. Part A Diagnosis Code File (CCLF4) .................................................... 20
Table 5. Part B Physicians File (CCLF5) ............................................................ 24
Table 6. Part B DME File (CCLF6) ..................................................................... 35
Table 7. Part D File (CCLF7) .............................................................................. 41
Table 8. Beneficiary Demographics File (CCLF8) .............................................. 47
Table 9. Beneficiary XREF File (CCLF9) ............................................................ 52
Table 10. Part A Claims Benefit Enhancement and Demonstration Code File
(CCLFA) ............................................................................................................. 54
Table 11. Part B Claims Benefit Enhancement and Demonstration Code File
(CCLFB) ............................................................................................................. 59
Table 12. Summary Statistics Header Record (CCLF0) ..................................... 64
Table 13. Summary Statistics Detail Records..................................................... 65
expense.
Medicare Shared Savings Program | Claim and Claim Line Feed File Data Elements Resource ii
1 Executive Summary
Purpose:
The following is the list of data elements present on the Claim and Claim Line Feed
(CCLF) files as referred to in 42 CFR § 425 Subpart H. Please note that these are
subject to change. These tables are maintained as part of an appendix in the CCLF
Information Packet (IP) that can be found in the Program Resources section of the
Knowledge Library tab in the ACO Management System (ACO-MS).
Notes:
Where applicable in the file layouts, a minus “-” in the beginning of the format
description indicates that if the value is negative, the first character will display as “-”.
For all other values, a blank will display as the first character.
Fields where data are not available from the data source will be left blank.
Data Fields marked with an I contain Personally Identifiable Information (PII). Data
Fields marked with an H contain Protected Health Information (PHI).
To comply with the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015,
after the end of the New Medicare Card Transition Period in December 2019, only the
MBI will be accepted on claims, and the Health Information Claim Number (HICN) value
will no longer be displayed. CMS will include blanks for the HICN, Beneficiary Equitable
Beneficiary Identification Code (BIC) HICN, and Beneficiary Railroad Board Number
(RRB) fields in CCLFs generated effective January 1, 2020 onwards.
expense.
Medicare Shared Savings Program | Claim and Claim Line Feed File Data Elements Resource 1
2 CCLF File Layouts
The filename convention for the Medicare Shared Savings Program in Table 1 is:
 For regular CCLFs: P.A****.ACO.ZC1Y**.Dyymmdd.Thhmmsst.
 For run-out CCLFs: P.A****.ACO.ZC1R**.Dyymmdd.Thhmmsst, “R” instead of “Y” indicating run-out.
Table 1. Part A Claims Header File (CCLF1)

ELEMENT CLAIM FIELD LABEL CLAIM FIELD START END DATA FORMAT CLAIM FIELD DESCRIPTION
# NAME POSITION POSITION LENGTH
1 CUR_CLM_UNIQ_ID Current Claim 1 13 13 9(13) A unique identification number assigned
Unique Identifier to the claim. I H
2 PRVDR_OSCAR_NUM Provider OSCAR 14 19 6 X(06) A facility’s Medicare/Medicaid
Number identification number. It is also known as a
Medicare/Medicaid Provider Number, or
CCN. This number verifies that a provider
has been Medicare certified for a
particular type of service. H
3 BENE_MBI_ID Medicare 20 30 11 X(11) A Medicare Beneficiary Identifier assigned
Beneficiary to a beneficiary. I H
Identifier
4 BENE_HIC_NUM Beneficiary HIC 31 41 11 X(11) Legacy Beneficiary HICN field.
I
Number
Note: To comply with MACRA of 2015,
after the end of the New Medicare Card
Transition Period in December 2019, only
the MBI will be accepted on claims, and
the HICN value will no longer be
displayed. The Beneficiary HIC Number
will be blank in CCLFs generated effective
January 1, 2020 onwards.
Disclaimer: This communication material was prepared as a service to the public and is not intended to grant rights or impose obligations. It may contain references or links to
statutes, regulations, or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of either the written law or
regulations. We encourage readers to review the specific statutes, regulations, and other interpretive materials for a full and accurate statement of its contents. This document is
5 CLM_TYPE_CD Claim Type Code 42 43 2 9(02) Signifies the type of claim being submitted
through the Medicare or Medicaid
programs. H
Claim type code include:
10 = HHA claim
20 = Non swing bed SNF claim
30 = Swing bed SNF claim
40 = Outpatient claim
50 = Hospice claim
60 = Inpatient claim
61 = Inpatient “Full-Encounter” claim
6 CLM_FROM_DT Claim From Date 44 53 10 YYYY- The first day on the billing statement that
MM-DD covers services rendered to the
beneficiary. H
Also known as “Statement Covers From
Date.”
7 CLM_THRU_DT Claim Thru Date 54 63 10 YYYY- The last day on the billing statement that
beneficiary. H
Also known as the “Statement Covers
Through Date.”
8 CLM_BILL_FAC_TYPE_CD Claim Bill Facility 64 64 1 X(01) The first digit of the type of bill (TOB1) is
Type Code used to identify the type of facility that
provided care to the beneficiary (e.g.,
hospital or SNF). H
Claim Facility Type Code include:
1 = Hospital
2 = SNF
3 = HHA
4 = Religious non-medical (hospital)
5 = Religious non-medical (extended
care)
6 = Intermediate care
7 = Clinic or hospital-based renal dialysis
facility
8 = Specialty facility or Ambulatory
Surgical Center (ASC) surgery
9 = Reserved
9 CLM_BILL_CLSFCTN_CD Claim Bill 65 65 1 X(01) The second digit of the type of bill (TOB2)
Classification is used to indicate with greater specificity
Code where the service was provided (e.g., a
department within a hospital).H
Find Claim Service Classification Code at
the ResDAC website.
10 PRNCPL_DGNS_CD Principal 66 72 7 X(07) The ICD-9/10 diagnosis code identifies
Diagnosis Code the beneficiary’s principal illness or
disability. H
11 ADMTG_DGNS_CD Admitting 73 79 7 X(07) The ICD-9/10 diagnosis code identifies
Diagnosis Code the illness or disability for which the
beneficiary was admitted. H
12 CLM_MDCR_NPMT_RSN_ Claim Medicare 80 81 2 X(02) Indicates the reason payment on an
CD Non-Payment institutional claim is denied.
Reason Code
Find Medicare Non-Payment Reason
Code at the ResDAC website.
13 CLM_PMT_AMT Claim Payment 82 98 17 -9(13).99 Amount that Medicare paid on the claim. H
Amount
14 CLM_NCH_PRMRY_PYR_ Claim NCH 99 99 1 X(01) If a payer other than Medicare has
CD Primary Payer primary responsibility for payment of the
Code beneficiary’s health insurance bills, this
code indicates the responsible primary
payer. H
If this field is blank, Medicare is the
primary payer for the beneficiary.
Find NCH Primary Payer Code at the
ResDAC website.
15 PRVDR_FAC_FIPS_ST_C Federal 100 101 2 X(02) Identifies the state where the facility
D Information providing services is located.
Processing
Standards (FIPS)
State Code
16 BENE_PTNT_STUS_CD Beneficiary 102 103 2 X(02) Indicates the patient’s discharge status as
Patient Status of the Claim Through Date. For example,
Code it may indicate where a patient was
discharged to (e.g., home, another
facility) or the circumstances of a
discharge (e.g., against medical advice,
or patient death). I H
Find Patient Discharge Status Code at
the ResDAC website.
17 DGNS_DRG_CD Diagnosis Related 104 107 4 X(04) Indicates the diagnostic related group to
Group Code which a hospital claim belongs for
prospective payment purposes. I H
18 CLM_OP_SRVC_TYPE_CD Claim Outpatient 108 108 1 X(01) A code reported by the provider that
Service Type indicates the specific type of claim
Code (Inpatient, Outpatient, etc.). I H
Claim Outpatient Service Type Code
include:
0 = Blank
1 = Emergency (The patient required
immediate medical intervention because
of severe life threatening or potentially
disabling conditions. Generally, the patient
was admitted through the emergency
room)
2 = Urgent (The patient required
immediate attention for the care and
treatment of a physical or mental disorder.
Generally, the patient was admitted to the
available and suitable accommodation)
3 = Elective (The patient’s condition
permitted adequate time to schedule the
availability of suitable accommodations)
5 = Reserved
6 = Reserved
7 = Reserved
8 = Reserved
9 = Unknown (Information not available)
19 FAC_PRVDR_NPI_NUM Facility Provider 109 118 10 X(10) Identifies the facility associated with the
NPI Number claim. Each facility is assigned its own
unique NPI.
20 OPRTG_PRVDR_NPI_NU Operating 119 128 10 X(10) Identifies the operating provider
M Provider NPI associated with the claim. Each provider
Number is assigned its own unique NPI.
21 ATNDG_PRVDR_NPI_NUM Attending 129 138 10 X(10) Identifies the attending provider
Provider NPI associated with the claim. Each provider
Number is assigned its own unique NPI.
22 OTHR_PRVDR_NPI_NUM Other Provider 139 148 10 X(10) Identifies the other providers associated
NPI Number with the claim. Each provider is assigned
its own unique NPI.
23 CLM_ADJSMT_TYPE_CD Claim Adjustment 149 150 2 X(02) Indicates whether the claim is an original,
Type Code cancellation, or adjustment claim.
Claim Adjustment Type Code include:
0 = Original Claim
1 = Cancellation Claim
2 = Adjustment Claim
24 CLM_EFCTV_DT Claim Effective 151 160 10 YYYY- Date the claim was processed and added
Date MM-DD to the NCH. Also referred to as the NCH
Weekly Processing Date. H
25 CLM_IDR_LD_DT Claim IDR Load 161 170 10 YYYY- When the claim was loaded into the IDR.
Date MM-DD
26 BENE_EQTBL_BIC_HICN_ Beneficiary 171 181 11 X(11) Legacy Beneficiary Equitable BIC HICN
NUM Equitable BIC Number.
HICN Number
Transition Period in December 2019, MBI
will be accepted on claims, and the HICN
value/ Beneficiary Equitable BIC HICN
Number will no longer be displayed. The
Beneficiary Equitable BIC HICN Number
27 CLM_ADMSN_TYPE_CD Claim Admission 182 183 2 X(2) Indicates the type and priority of inpatient
Type Code services. I H
Claim Admission Type Code include:
0 = Blank
1 = Emergency
2 = Urgent
3 = Elective
4 = Newborn
5 = Trauma Center
6-8 = Reserved
9 = Unknown
28 CLM_ADMSN_SRC_CD Claim Admission 184 185 2 X(2) Indicates the source of the beneficiary’s
Source Code referral for admission or visit (e.g., a
physician or another facility).
Find Admission Source Code at the
ResDAC website.
29 CLM_BILL_FREQ_CD Claim Bill 186 186 1 X(1) The third digit of the type of bill (TOB3)
Frequency Code code. It indicates the sequence of the
claim in the beneficiary's current episode
of care (e.g., interim or voided).
Find Claim Frequency Code at the
ResDAC website.
30 CLM_QUERY_CD Claim Query 187 187 1 X(1) Indicates the type of claim record being
Code processed with respect to payment (e.g.,
debit/credit indicator or interim/final
indicator).
Claim Query Code include:
0 = Credit adjustment
1 = Interim bill
2 = HHA benefits exhausted
3 = Final bill
4 = Discharge notice
5 = Debit adjustment
31 DGNS_PRCDR_ICD_IND ICD Version 188 188 1 X(1) 9 = ICD-9
Indicator
0 = ICD-10
U = any value other than “9” or “0” in the
source data.
32 CLM_MDCR_INSTNL_TOT Total Claim 189 203 15 -9(11).99 Effective with NCH Version G, the total
_CHRG_AMT Charge Amount charges for all services included on the
institutional claim. This field is redundant
with revenue center code 0001/total
charges.
33 CLM_MDCR_IP_PPS_CPT Claim Capital 204 218 15 -9(11).99 The amount of the indirect medical
L_IME_AMT Indirect Medical education (IME) (reimbursable amount for
Education teaching hospitals only; an added amount
Amount passed by Congress to augment normal
Prospective Payment System [PPS]
payments for teaching hospitals to
compensate them for higher patient costs
resulting from medical education
programs for interns and residents)
portion of the PPS payment for capital.
Note: Applicable for claim type = 60 and
total calculated based on debit credit
methodology.
34 CLM_OPRTNL_IME_AMT Claim Operational 219 240 22 -9(18).99 The indirect medical education amount
Indirect Medical applicable to the bill. (Do not include PPS
Education capital IME adjustment in this entry).
Amount
methodology.
35 CLM_MDCR_IP_PPS_DSP Claim Capital 241 255 15 -9(11).99 Effective 3/2/92, the amount of
RPRTNT_AMT Disproportionate disproportionate share (rate reflecting
Amount indigent population served) portion of the
PPS payment for capital. [NCH]
methodology.
36 CLM_HIPPS_UNCOMPD_ Claim Health 256 270 15 -9(11).99 This is a payment for DSH hospitals as
CARE_AMT Insurance part of Section 3133 of ACA. It represents
Prospective the uncompensated care amount of the
Payment System payment.
Uncompensated
Note: Applicable for claim types = (10, 20,
Care Amount
30, 40, 50, 60) and total calculated based
on debit credit methodology.
37 CLM_OPRTNL_DSPRPRT Claim Operational 271 292 22 -9(18).99 The disproportionate share amount
NT_AMT Disproportionate applicable to the bill. Use the amount
Amount provided by the disproportionate share
field in PRICER. (Do not include any PPS
capital DSH adjustment in this entry).
methodology.
Table 2. Part A Claims Revenue Center Detail File (CCLF2)

2 CLM_LINE_NUM Claim Line 14 23 10 9(10) A sequential number that identifies a
Number specific claim line.
Identifier
Number
the MBI will be accepted on claims and
programs. H
10 = HHA claim
50 = Hospice claim
6 CLM_LINE_FROM_DT Claim Line From 48 57 10 YYYY-MM- The date the service associated with the
Date DD line item began. H
7 CLM_LINE_THRU_DT Claim Line Thru 58 67 10 YYYY-MM- The date the service associated with the
Date DD line item ended. H
8 CLM_LINE_PROD_REV_C Product Revenue 68 71 4 X(04) The number a provider assigns to the cost
TR_CD Center Code center to which a particular charge is
billed (e.g., accommodations or supplies).
A cost center is a division or unit within a
hospital (e.g., radiology, emergency room,
pathology).
Find Revenue Center Code at the
ResDAC website.
Revenue center code 0001 represents the
total of all revenue centers included on the
claim.
9 CLM_LINE_INSTNL_REV_ Claim Line 72 81 10 YYYY-MM- The date that applies to the service
CTR_DT Institutional DD associated with the Revenue Center code.
Revenue Center
Date
10 CLM_LINE_HCPCS_CD HCPCS Code 82 86 5 X(05) The HCPCS code representing the
procedure, supply, product, and/or service
provided to the beneficiary.
Note: Health Insurance Prospective
Payment System (HIPPS) code may be
available when the Product Revenue
Center Code is “0022” (SNF Prospective
Payment System).
HICN Number
the HICN value/ Beneficiary Equitable BIC
HICN Number will no longer be displayed.
The Beneficiary Equitable BIC HICN
Number will be blank in CCLFs generated
effective January 1, 2020 onwards.
Number identification number, also known as a
particular type of services. H
13 CLM_FROM_DT Claim From Date 104 113 10 YYYY-MM- The first day on the billing statement that
DD covers services rendered to the
beneficiary. H
From Date.”
14 CLM_THRU_DT Claim Thru Date 114 123 10 YYYY-MM- The last day on the billing statement that
beneficiary. H
Through Date.”
15 CLM_LINE_SRVC_UNIT_Q Claim Line 124 147 24 -9(18).9999 Count of total units, at the line-item level,
TY Service Unit associated with services needing unit
Quantity reporting (e.g., anesthesia time units and
blood units). H
16 CLM_LINE_CVRD_PD_AM Claim Line 148 164 17 -9(13).99 The amount Medicare reimbursed the
T Covered Paid provider for covered services associated
Amount with the claim-line. H
17 HCPCS_1_MDFR_CD HCPCS First 165 166 2 X(2) The first code to modify the HCPCS
Modifier Code procedure code associated with the claim-
line. This provides more specific
procedure identification for the line item
service. H
18 HCPCS_2_MDFR_CD HCPCS Second 167 168 2 X(2) The second code to modify the HCPCS
service. H
19 HCPCS_3_MDFR_CD HCPCS Third 169 170 2 X(2) The third code to modify the HCPCS
service. H
20 HCPCS_4_MDFR_CD HCPCS Fourth 171 172 2 X(2) The fourth code to modify the HCPCS
service. H
21 HCPCS_5_MDFR_CD HCPCS Fifth 173 174 2 X(2) The fifth code to modify the HCPCS
service. H
22 CLM_REV_APC_HIPPS_C Claim Revenue 175 179 5 X(5) APC group for outpatient claim type.
D APC HIPPS Code
Table 3. Part A Procedure Code File (CCLF3)

Identifier
Number
programs. H
Claim type codes are:
10 = HHA claim
50 = Hospice claim
5 CLM_VAL_SQNC_NUM Claim Value 38 39 2 9(2) An arbitrary sequential number that
Sequence uniquely identifies a procedure code
Number record within the claim.
6 CLM_PRCDR_CD Procedure Code 40 46 7 X(07) The ICD-9/10 code that indicates the
procedure performed during the period
covered by the claim. H
7 CLM_PRCDR_PRFRM_DT Procedure 47 56 10 YYYY- The date the indicated procedure was
Performed Date MM-DD performed. H
HICN Number
Number identification number. It is also known as a
particular type of services. H
beneficiary. H
Also known as “Statement Covers From
Date.”
beneficiary. H
Through Date.”
Indicator
0 = ICD-10
source data.
Table 4. Part A Diagnosis Code File (CCLF4)

ELEMENT ELEMENT NAME DATA START END DATA FORMAT COMMENTS
# DESCRIPTION POSITION POSITION LENGTH
Identifier
Number
programs. H
10 = HHA claim
50 = Hospice claim
5 CLM_PROD_TYPE_CD Claim Product 38 38 1 X(01) Code classifying the diagnosis category. H
Type Code
Category code include:
E = Accident diagnosis code
1 = First diagnosis E code
D = Other diagnosis code
6 CLM_VAL_SQNC_NUM Claim Value 39 40 2 9(2) An arbitrary sequential number that
Sequence uniquely identifies a procedure code
Number record within the claim.
7 CLM_DGNS_CD Diagnosis Code 41 47 7 X(07) The ICD-9/10 diagnosis code identifying
the beneficiary’s illness or disability. I H
HICN Number
the MBI will be accepted on claims and
Number will be blank effective January 1,
2020.
9 PRVDR_OSCAR_NUM Provider OSCAR 59 64 6 X(6) The OSCAR is a facility’s
Number Medicare/Medicaid identification number.
It is also known as a Medicare/Medicaid
Provider Number, or CCN. This number
verifies that a provider has been Medicare
certified for a particular type of services. H
beneficiary. H
From Date.”
beneficiary. H
Through Date.”
12 CLM_POA_IND Claim Present-on- 85 91 7 X(7) Indicates whether a patient had the
Admission condition listed on the claim line at the
Indicator time of admission to the facility. I H
Find Present-on-Admission values at the
ResDAC website.
Indicator
0 = ICD-10
source data.
Table 5. Part B Physicians File (CCLF5)

Number specific claim line within a given claim.
Identifier
Number
displayed. The HICN field will be blank
effective January 1, 2020.
programs. H
71 = RIC O local carrier non-DMEPOS
claim
72 = RIC O local carrier DMEPOS claim
6 CLM_FROM_DT Claim From Date 48 57 10 YYYY-MM- The first day on the billing statement that
beneficiary. H
From Date.”
7 CLM_THRU_DT Claim Thru Date 58 67 10 YYYY-MM- The last day on the billing statement that
beneficiary. H
Through Date.”
8 RNDRG_PRVDR_TYPE_C Rendering 68 70 3 X(03) Indicates the type of provider who
D Provider Type provided the service associated with this
Code line item on the claim.
Provider Type Code include:
0=Clinics, groups, associations,
partnerships, or other entities
1 = Physicians or suppliers reporting as
solo practitioners
2 = Suppliers (other than sole
proprietorship)
3 = Institutional provider
4 = Independent laboratories
5 = Clinics (multiple specialties)
6 = Groups (single specialty)
7 = Other entities
8 = Family Practice
UI = UPIN Identification
N2 = National Council for Prescription
Drug Programs
D = National Supplier Clearinghouse
BP = PIN Individual
BG = PIN Group
A = Online Survey, Certification and
Reporting
9 RNDRG_PRVDR_FIPS_ST Rendering 71 72 2 X(02) Identifies the state that the provider
_CD Provider FIPS providing the service is located in.
State Code
10 CLM_PRVDR_SPCLTY_CD Claim-Line 73 74 2 X(02) Indicates the CMS specialty code
Provider Specialty associated with the provider of services.
Code CMS used this number to price the
service on the line-item.
Find Provider Specialty Code at CMS.gov
or the Research Data Assistance Center.
11 CLM_FED_TYPE_SRVC_C Claim Federal 75 75 1 X(01) Indicates the type of service (e.g.,
D Type Service consultation, surgery) provided to the
Code beneficiary. Types of Service Code are
defined in the Medicare Carrier Manual.
Find Types of Service Code at the
ResDAC website.
12 CLM_POS_CD Claim Place of 76 77 2 X(02) Indicates the place where the indicated
Service Code service was provided (e.g., ambulance,
school). Places of service are defined in
the Medicare Carrier Manual.
Find Place of Service Code at the
ResDAC website.
Date DD line item began.
14 CLM_LINE_THRU_DT Claim Line Thru 88 97 10 YYYY-MM- The date the service associated with the
Date DD line item ended.
provided to the beneficiary. I H
16 CLM_LINE_CVRD_PD_AM Claim Line NCH 103 117 15 X(15) The amount of payment made by
T Payment Amount Medicare on behalf of the beneficiary for
the indicated service after deductible and
coinsurance amounts have been paid.
17 CLM_LINE_PRMRY_PYR_ Claim Primary 118 118 1 X(01) If a payer other than Medicare has
CD Payer Code primary responsibility for payment of the
service indicated on the claim line, this
code indicates the primary payer. This
field is also known as the Line Beneficiary
Primary Payer Code. I H
Find Primary Payer Code at the ResDAC
website.
18 CLM_LINE_DGNS_CD Diagnosis Code 119 125 7 X(07) The ICD-9/10 diagnosis code identifying
the beneficiary’s principal illness or
disability. I H
19 CLM_RNDRG_PRVDR_TA Claim Provider 126 135 10 X(10) The SSN or Employee Identification
X_NUM Tax Number Number (EIN) of the provider of the
indicated service. This number identifies
who receives payment for the indicated
service. I
20 RNDRG_PRVDR_NPI_NU Rendering 136 145 10 X(10) A number that identifies the provider
M Provider NPI rendering the indicated service on the
Number claim line. Each provider is assigned its
own unique NPI.
21 CLM_CARR_PMT_DNL_C Claim Carrier 146 147 2 X(02) Indicates to whom payment was made
D Payment Denial (e.g., physician, beneficiary), or if the
Code claim was denied.
Find Carrier Payment Denial Code in the
CMS Manual System, Publication 100-04
Medicare Claims Processing.
Additionally, the following code may be
available:
G = MSP Cost Avoided - Secondary
Claims Investigation
H = MSP Cost Avoided - Self Reports
J = MSP Cost Avoided - 411.25
T = MSP Cost Avoided - IEQ contractor
(eff. 7/96)
X = MSP Cost Avoided - generic
Y = MSP Cost Avoided - IRS/SSA data
match project
22 CLM_PRCSG_IND_CD Claim-Line 148 149 2 X(02) Indicates whether the service indicated on
Processing the claim line was allowed or the reason it
Indicator Code was denied.
Find Processing Indicator Code at the
ResDAC website.
available:
19 = MSP Cost Avoided - Worker's
Compensation Set Aside
41 = MSP Cost Avoided - Next
Generation Desktop
0 = Original Claim
2 = Adjustment claim
24 CLM_EFCTV_DT Claim Effective 152 161 10 YYYY-MM- The date the claim was processed and
Date DD added to the NCH. This is also referred to
as the NCH Weekly Processing Date.
25 CLM_IDR_LD_DT Claim IDR Load 162 171 10 YYYY-MM- When the claim was loaded into the IDR.
Date DD
26 CLM_CNTL_NUM Claim Control 172 211 40 X(40) A unique number assigned to a claim by
Number the Medicare carrier.
This number allows CMS to associate
each line item with its respective claim.
HICN Number
Number will be blank effective January 1,
2020.
28 CLM_LINE_ALOWD_CHRG Claim Line 223 239 17 X(17) The amount Medicare approved for
_AMT Allowed Charges payment to the provider.
Amount
blood units).
30 HCPCS_1_MDFR_CD HCPCS First 264 265 2 X(2) The first code to modify the HCPCS
service. H
31 HCPCS_2_MDFR_CD HCPCS Second 266 267 2 X(2) The second code to modify the HCPCS
service. H
32 HCPCS_3_MDFR_CD HCPCS Third 268 269 2 X(2) The third code to modify the HCPCS
service. H
33 HCPCS_4_MDFR_CD HCPCS Fourth 270 271 2 X(2) The fourth code to modify the HCPCS
service. H
34 HCPCS_5_MDFR_CD HCPCS Fifth 272 273 2 X(2) The fifth code to modify the HCPCS
service. H
35 CLM_DISP_CD Claim Disposition 274 275 2 X(2) Information regarding payment actions on
Code the claim.
Claim Disposition Code include:
01 = Debit accepted
02 = Debit accepted (automatic
adjustment)
03 = Cancel accepted
36 CLM_DGNS_1_CD Claim Diagnosis 276 282 7 X(7) The first of 12 allowable ICD-9/10
First Code diagnosis code identifying the
beneficiary’s illness or disability. I H
37 CLM_DGNS_2_CD Claim Diagnosis 283 289 7 X(7) The second of 12 allowable ICD-9/10
Second Code diagnosis code identifying the
38 CLM_DGNS_3_CD Claim Diagnosis 290 296 7 X(7) The third of 12 allowable ICD-9/10
Third Code diagnosis code identifying the
39 CLM_DGNS_4_CD Claim Diagnosis 297 303 7 X(7) The fourth of 12 allowable ICD-9/10
Fourth Code diagnosis code identifying the
40 CLM_DGNS_5_CD Claim Diagnosis 304 310 7 X(7) The fifth of 12 allowable ICD-9/10
Fifth Code diagnosis code identifying the
41 CLM_DGNS_6_CD Claim Diagnosis 311 317 7 X(7) The sixth of 12 allowable ICD-9/10
Sixth Code diagnosis code identifying the
42 CLM_DGNS_7_CD Claim Diagnosis 318 324 7 X(7) The seventh of 12 allowable ICD-9/10
Seventh Code diagnosis code identifying the
43 CLM_DGNS_8_CD Claim Diagnosis 325 331 7 X(7) The eighth of 12 allowable ICD-9/10
Eighth Code diagnosis code identifying the
Indicator
0 = ICD-10
source data.
45 CLM_DGNS_9_CD Claim Diagnosis 333 339 7 X(7) The ninth of 12 allowable ICD-9/10
Ninth Code diagnosis code identifying the
46 CLM_DGNS_10_CD Claim Diagnosis 340 346 7 X(7) The tenth of 12 allowable ICD-9/10
Tenth Code diagnosis code identifying the
47 CLM_DGNS_11_CD Claim Diagnosis 347 353 7 X(7) The eleventh of 12 allowable ICD-9/10
Eleventh Code diagnosis code identifying the
beneficiary’s illness or
disability. I H
48 CLM_DGNS_12_CD Claim Diagnosis 354 360 7 X(7) The twelfth of 12 allowable ICD-9/10
Twelfth Code diagnosis code identifying the
49 HCPCS_BETOS_CD HCPCS BETOS 361 363 3 X(3) A code representing a clinical category.
Code The Berenson-Eggers Type of Service
(BETOS) code.
Table 6. Part B DME File (CCLF6)

Number specific claim line.
Identifier
Number
programs. H
81 = RIC M DMERC non-DMEPOS claim
82 = RIC M DMERC DMEPOS
claim
beneficiary. H
From Date.”
beneficiary. H
Through Date.”
8 CLM_FED_TYPE_SRVC_C Claim Federal 68 68 1 X(01) Indicates the type of service (e.g.,
D Type Service consultation, surgery), provided to the
Code beneficiary. Types of Service Code are
defined in the Medicare Carrier Manual. H
Find Types of Service Code at the
ResDAC website.
9 CLM_POS_CD Claim Place of 69 70 2 X(02) Indicates place where the indicated
Service Code service was provided (e.g., ambulance,
school). H
Find Place of Service Code at the
ResDAC website.
10 CLM_LINE_FROM_DT Claim Line From 71 80 10 YYYY- The date the service associated with the
Date MM-DD line item began. H
11 CLM_LINE_THRU_DT Claim Line Thru 81 90 10 YYYY- The date the service associated with the
Date MM-DD line item ended. H
provided to the beneficiary. H
13 CLM_LINE_CVRD_PD_AM Claim Line NCH 96 110 15 -9(11).99 The amount of payment made by
T Payment Amount Medicare on behalf of the beneficiary for
the indicated service after deductible and
coinsurance amounts have been paid. H
14 CLM_PRMRY_PYR_CD Claim Primary 111 111 1 X(01) If a payer other than Medicare has
Payer Code primary responsibility for payment of the
service indicated on the claim line, this
code indicates the primary payer. This
field is also known as the Line Beneficiary
Primary Payer Code.
Find Primary Payer Code at the ResDAC
website.
15 PAYTO_PRVDR_NPI_NUM Pay-to Provider 112 121 10 X(10) A number that identifies the provider
NPI Number billing for the indicated service on the
claim line. Each provider is assigned its
own unique NPI.
16 ORDRG_PRVDR_NPI_NU Ordering Provider 122 131 10 X(10) A number that identifies the provider
M NPI Number ordering the indicated service on the claim
line. Each provider is assigned its own
unique NPI.
17 CLM_CARR_PMT_DNL_C Claim Carrier 132 133 2 X(02) Indicates to whom payment was made
D Payment Denial (e.g., physician, beneficiary) or if the claim
Code was denied.
Find Carrier Payment Denial Code at the
ResDAC website.
available:
G = Secondary Claims Investigation
H = Self Reports
J = 411.25
T = MSP Cost Avoided - IEQ contractor
(eff. 7/96)
X = MSP Cost Avoided - generic
Y = MSP Cost Avoided - IRS/SSA data
match project
18 CLM_PRCSG_IND_CD Claim Processing 134 135 2 X(02) Indicates whether the service indicated on
Indicator Code the claim line was allowed or the reason it
was denied.
Find Processing Indicator Code at the
ResDAC website.
available:
19 = MSP Cost Avoided - Worker's
Compensation Set Aside
41 = MSP Cost Avoided - Next
Generation Desktop
19 CLM_ADJSMT_TYPE_CD Claim Adjustment 136 137 2 X(02) Indicates whether the claim an original,
0 = Original Claim
20 CLM_EFCTV_DT Claim Effective 138 147 10 YYYY- The date the claim was processed and
Date MM-DD added to the NCH. This is also referred to
as the NCH Weekly Processing Date. H
21 CLM_IDR_LD_DT Claim IDR Load 148 157 10 YYYY- When the claim was loaded into the IDR.
Date MM-DD
22 CLM_CNTL_NUM Claim Control 158 197 40 X(40) A unique number assigned to a claim by
Number the Medicare carrier.
This number allows CMS to associate
each line item with its respective claim.
HICN Number
24 CLM_LINE_ALOWD_CHR Claim Line 209 225 17 -9(14).99 The amount Medicare approved for
G_AMT Allowed Charges payment to the provider.
Amount
25 CLM_DISP_CD Claim Disposition 226 227 2 X(2) Contains information regarding payment
Code actions on the claim.
Claim Disposition Code include:
01 = Debit accepted
02 = Debit accepted (automatic
adjustment)
03 = Cancel accepted
 For run-out CCLFs: P.A****.ACO.ZC7R**.Dyymmdd.Thhmmsst, “R” instead of “Y” indicating run-out
Table 7. Part D File (CCLF7)

Identifier
Number
4 CLM_LINE_NDC_ CD NDC Code 36 46 11 X(11) A universal unique product identifier for
human drugs. H
programs. H
01 = Part D - Original without resubmitted
PDE
02 = Part D - Adjusted PDE
03 = Part D - Deleted Claims
04 = Part D - Resubmitted PDE
Date DD line item began (i.e., the date upon which
the prescription was filled).
7 PRVDR_SRVC_ID_QLFYR Provider Service 59 60 2 X(02) Indicates the type of number used to
_CD Identifier Qualifier identify the pharmacy providing the
Code services:
01 = NPI Number
06 = Unique Physician Identification
Number (UPIN)
07 = National Council for Prescription
Drug Programs (NCPDP) Number
08 = State License Number
11 = TIN
99 = Other mandatory for Standard Data
Format
8 CLM_SRVC_PRVDR_GNR Claim Service 61 80 20 X(20) The number associated with the indicated
C_ID_NUM Provider Generic code in the Provider Service Identification
ID Number Qualifier Code field.
9 CLM_DSPNSNG_STUS_C Claim Dispensing 81 81 1 X(01) Indicates the status of prescription
D Status Code fulfillment.
Dispensing Code include:
P = Partially filled
C = Completely filled
10 CLM_DAW_PROD_SLCTN Claim Dispense 82 82 1 X(01) Indicates the prescriber's instructions
_CD as Written (DAW) regarding generic substitution or how
Product Selection those instructions were followed.
Code
DAW Product Selection Code include:
0 = No product selection indicated
1 = Substitution not allowed by prescriber
2 = Substitution allowed – Patient
requested that brand be dispensed
3 = Substitution allowed – Pharmacist
selected product dispensed
4 = Substitution allowed – Generic not in
stock
5 = Substitution allowed – Brand drug
dispensed as generic
6 = Override
7 = Substitution not allowed – Brand drug
mandated by law
8 = Substitution allowed – Generic drug
not available in marketplace
9 = Other
blood units).
12 CLM_LINE_DAYS_SUPLY_ Claim Line Days’ 107 115 9 9(09) The number of days the supply of
QTY Supply Quantity medication dispensed by the pharmacy
will cover.
13 PRVDR_PRSBNG_ID_QLF Provider 116 117 2 X(02) Indicates the type of number used to
YR_CD Prescribing ID identify the prescribing provider:
Qualifier Code
01 = NPI Number
06 = UPIN
07 = NCPDP Number
08 = State License Number
11 = TIN
12 = DEA
99 = Other mandatory for Standard Data
Format
14 CLM_PRSBNG_PRVDR_G Claim Prescribing 118 137 20 X(20) The number associated with the indicated
NRC_ID_NUM Provider Generic code in the Provider Prescribing Service
ID Number Identification Qualifier Code field.
15 CLM_LINE_BENE_PMT_A Claim Line 138 150 13 -9(9).99 The dollar amount paid by the beneficiary
MT Beneficiary that is not reimbursed by a third party
Payment Amount (e.g., copayments, coinsurance,
deductible, or other patient pay
amounts). H
0 = Original Claim
17 CLM_EFCTV_DT Claim Effective 153 162 10 YYYY-MM- The date the claim was processed and
Date DD added to the NCH. This is also referred to
as the NCH Weekly Processing Date. H
18 CLM_IDR_LD_DT Claim IDR Load 163 172 10 YYYY-MM- When the claim was loaded into the IDR.
Date DD
19 CLM_LINE_RX_SRVC_RF Claim Line 173 184 12 9(12) Identifies a prescription dispensed by a
RNC_NUM Prescription particular service provider on a particular
Service service date.
Reference
Number
20 CLM_LINE_RX_FILL_NUM Claim Line 185 193 9 X(09) Assigned to the current dispensed supply
Prescription Fill by the pharmacy. It designates the
Number sequential order of the original fill or
subsequent refills of a prescription.
21 CLM_PHRMCY_SRVC_TY Claim Pharmacy 194 195 2 X(02) A unique identifier of a type of service
PE_CD Service Type being performed by a pharmacy when
Code different contractual terms exist between a
payer and the pharmacy or when benefits
are based upon the type of service
performed.
1 = Community/Retail Pharmacy Services
2 = Compounding Pharmacy Services
3 = Home Infusion Therapy Provider
Services
4 = Institutional Pharmacy Services
5 = Long Term Care Pharmacy Services
6 = Mail Order Pharmacy Services
7 = Managed Care Organization
Pharmacy Services
8 = Specialty Care Pharmacy Services
99 = Other
Table 8. Beneficiary Demographics File (CCLF8)

ELEMENT BENEFICIARY FIELD BENEFICIARY START END DATA FORMAT BENEFICIARY FIELD DESCRIPTION
# LABEL FIELD NAME POSITION POSITION LENGTH
Identifier
Number
3 BENE_FIPS_STATE_CD Beneficiary FIPS 23 24 2 9(02) Identifies the state where the beneficiary
State Code receiving services resides. I H
4 BENE_FIPS_CNTY_CD Beneficiary FIPS 25 27 3 9(03) Identifies the county where the beneficiary
County Code receiving services resides. I H
5 BENE_ZIP_CD Beneficiary ZIP 28 32 5 X(05) The beneficiary’s ZIP code as indicated in
Code their Medicare enrollment record. I H
6 BENE_DOB Beneficiary Date of 33 42 10 YYYY- The month, day, and year of the
Birth MM-DD beneficiary’s birth. I H
7 BENE_SEX_CD Beneficiary Sex 43 43 1 X(01) The beneficiary’s sex. I H
Code
Code include:
1 = Male
2 = Female
0 = Unknown
8 BENE_RACE_CD Beneficiary Race 44 44 1 X(01) The beneficiary's race. I H
Code
Code include:
0 = Unknown
1 = White
2 = Black
3 = Other
4 = Asian
5 = Hispanic
6 = North American Native
9 BENE_AGE Beneficiary Age 45 47 3 9(03) The beneficiary’s current age, as
calculated by subtracting the beneficiary’s
date of birth from the current date. I H
10 BENE_MDCR_STUS_CD Beneficiary 48 49 2 X(02) Indicates the reason for a beneficiary's
Medicare Status entitlement to Medicare benefits as of a
Code particular date, broken down by the
following categories: I H
Old Age & Survivors Insurance (OASI),
Disabled, and ESRD, and by appropriate
combinations of these categories:
10 = Aged without ESRD
11 = Aged with ESRD
20 = Disabled without ESRD
21 = Disabled with ESRD
31 = ESRD only
11 BENE_DUAL_STUS_CD Beneficiary Dual 50 51 2 X(02) Identifies the most recent entitlement
Status Code status of beneficiaries eligible for a
program(s) in addition to Medicare (e.g.,
Medicaid). I H
Find Dual Status Code at the ResDAC
website.
12 BENE_DEATH_DT Beneficiary Death 52 61 10 YYYY- The month, day, and year of a
Date MM-DD beneficiary’s death. I H
13 BENE_RNG_BGN_DT Date beneficiary 62 71 10 YYYY- The date the beneficiary enrolled in
enrolled in Hospice MM-DD hospice. I H
14 BENE_RNG_END_DT Date beneficiary 72 81 10 YYYY- The date the beneficiary is enrolled in
ended Hospice MM-DD hospice. I H
15 BENE_1ST_NAME Beneficiary First 82 111 30 X(30) The first name of the beneficiary. I H
Name
16 BENE_MIDL_NAME Beneficiary Middle 112 126 15 X(15) The middle name of the beneficiary. I H
Name
17 BENE_LAST_NAME Beneficiary Last 127 166 40 X(40) The last name of the
Name beneficiary. I H
18 BENE_ORGNL_ENTLMT_ Beneficiary 167 167 1 X(01) The reason for the beneficiary's original
RSN_CD Original entitlement to Medicare benefits. I H
Entitlement
0 = Old Age and Survivors Insurance
Reason Code
(OASI)
1 = Disability Insurance Benefits (DIB)
2 = ESRD
3 = Both DIB and ESRD
4 = Unknown
19 BENE_ENTLMT_ Beneficiary 168 168 1 X(01) Indicates for each month of the
BUYIN_IND Entitlement Buy-in denominator reference year, the
Indicator entitlement of the beneficiary to Medicare
Part A, Medicare Part B, or Medicare
Parts A and B both, as well as whether or
not the beneficiary’s state of residence
was liable and paid for the beneficiary’s
Medicare Part B monthly
premiums. I H
0 = Not Entitled
1 = Part A Only
2 = Part B Only
3 = Part A and Part B
A = Part A, State Buy-In
B = Part B, State Buy-In
C = Parts A and B, State Buy-In
20 BENE_PART_A_ENRLMT_ Bene Entitlement 169 178 10 YYYY- The date that a beneficiary is entitled for
BGN_DT Part A Begin Date MM-DD Medicare Part A benefits.
21 BENE_PART_B_ENRLMT_ Bene Entitlement 179 188 10 YYYY- The date that a beneficiary is entitled for
BGN_DT Part B Begin Date MM-DD Medicare Part B benefits.
22 BENE_LINE_1_ADR Beneficiary 189 233 45 X(45) The first line of the street address. I
Derived Mailing
Line One Address
23 BENE_LINE_2_ADR Beneficiary 234 278 45 X(45) The second line of the street address. I
Derived Mailing
Line Two Address
24 BENE_LINE_3_ADR Beneficiary 279 318 40 X(40) The third line of the street address. I
Derived Mailing
Line Three
Address
25 BENE_LINE_4_ADR Beneficiary 319 358 40 X(40) The fourth line of the street address. I
Derived Mailing
Line Four Address
26 BENE_LINE_5_ADR Beneficiary 359 398 40 X(40) The fifth line of the street address. I
Derived Mailing
Line Five Address
27 BENE_LINE_6_ADR Beneficiary 399 438 40 X(40) The sixth line of the street address. I
Derived Mailing
Line Six Address
28 GEO_ZIP_PLC_NAME Beneficiary City 439 538 100 X(100) The name of the city. I
29 GEO_USPS_STATE_CD Beneficiary State 539 540 2 X(2) State code used by the United States
Postal Service to identify a state. I
30 GEO_ZIP5_CD Beneficiary Zip 541 545 5 X(5) The US Postal Service code that is
Code associated with a geographical area. I
31 GEO_ZIP4_CD Beneficiary Zip 546 549 4 X(4) A four-digit extension to a ZIP Code that
Code Ext. represents a subdivision for mailing
purposes of the ZIP Code. I
Table 9. Beneficiary XREF File (CCLF9)

ELEMENT BENEFICIARY FIELD LABEL BENEFICIARY START END DATA FORMAT BENEFICIARY FIELD
# FIELD NAME POSITION POSITION LENGTH DESCRIPTION
… HICN_MBI_XREF_IND… HICN/MBI … … … X(1)… M = MBI
XREF
Note: To comply with MACRA of
Indicator…
2015, after the end of the New
Medicare Card Transition Period in
December 2019, only the MBI will
be accepted on claims, and the
HICN value will no longer be
displayed. The Beneficiary HIC
Number will be blank in CCLFs
generated effective January 1, 2020
onwards.
2 CRNT_NUM Current 2 12 11 X(11) Current Beneficiary MBI will denote
Beneficiary the MBI.
Identifier
displayed.
The Beneficiary HIC Number will be
blank in CCLFs generated effective
ELEMENT BENEFICIARY FIELD LABEL BENEFICIARY START END DATA FORMAT BENEFICIARY FIELD
# FIELD NAME POSITION POSITION LENGTH DESCRIPTION
3 PRVS_NUM Previous 13 23 11 X(11) Previous Beneficiary MBI.
Beneficiary
Identifier
displayed.
The HICN field will be blank in
CCLFs generated effective January
1, 2020 onwards.
4 PRVS_ID_EFCTV_DT Previous 24 33 10 YYYY- MM- The date the previous identifier
Identifier DD became active.
Effective Date
5 PRVS_ID_OBSLT_DT Previous 34 43 10 YYYY- MM- The date the previous identifier
Identifier DD ceased to be active.
Obsolete Date
6 BENE_RRB_NUM Beneficiary 44 55 12 X(12) Legacy RRB number.
Railroad Board
Number
December 2019, only the Medicare
Beneficiary Identifier (MBI) will be
accepted on claims, and the HICN
and RRB will no longer be
displayed. These fields will be blank
effective January 1, 2020 in CCLF
files.
 For regular CCLFs: P.A****.ACO.ZCAY**.Dyymmdd.Thhmmsst.
 For run-out CCLFs: P.A****.ACO.ZCAR**.Dyymmdd.Thhmmsst, “R” instead of “Y” indicating run-out.
Table 10. Part A Claims Benefit Enhancement and Demonstration Code File (CCLFA)
1 CUR_CLM_UNIQ_ID Current Claim 1 13 13 9(13) A unique identification number
Unique assigned to the claim. I H
Identifier
2 BENE_MBI_ID Medicare 14 24 11 X(11) A Medicare Beneficiary Identifier
Beneficiary assigned to a beneficiary. I H
Identifier
3 BENE_HIC_NUM Beneficiary 25 35 11 X(11) Legacy Beneficiary HICN field.
HIC Number
onwards.
4 CLM_TYPE_CD Claim Type 36 37 2 9(02) Signifies the type of claim being
Code submitted through the Medicare or
Medicaid programs. H
10 = HHA claim
50 = Hospice claim
5 CLM_ACTV_CARE_FROM_DT Claim 38 47 10 YYYY-MM- On an institutional claim, the date
Admission DD the beneficiary was admitted to the
Date hospital, skilled nursing facility, or
Christian science sanatorium. I H
6 CLM_NGACO_PBPMT_SW PBP Benefit 48 48 1 X(1) A single character code of “Y” or “N”
Enhancement that indicates whether a particular
Indicator claim is tied to a PBP benefit
enhancement. Blank if no data are
available.
Note: This field will be used for both
NGACO and VT APM models.
7 CLM_NGACO_PDSCHRG_HCBS Post Discharge 49 49 1 X(1) A single character code of “Y” or “N”
_SW Home Visit that indicates whether a particular
Benefit claim is tied to a Post Discharge
Enhancement Home Visit benefit enhancement.
Indicator Blank if no data are available.
8 CLM_NGACO_SNF_WVR_SW SNF 3-Day 50 50 1 X(1) A single character code of “Y” or “N”
Waiver Benefit that indicates whether a particular
Enhancement claim is tied to a SNF 3-Day Waiver
Indicator benefit enhancement. Blank if no
data are available.
9 CLM_NGACO_TLHLTH_SW Telehealth 51 51 1 X(1) A single character code of “Y” or “N”
Benefit that indicates whether a particular
Enhancement claim is tied to a Telehealth benefit
Indicator enhancement. Blank if no data are
available.
10 CLM_NGACO_CPTATN_SW AIPBP Benefit 52 52 1 X(1) A single character code of “Y” or “N”
Indicator claim is tied to an AIPBP benefit
available.
11 CLM_DEMO_1ST_NUM First Program 53 54 2 X(2) Medicare Demonstration Special
Demonstration Processing Number (SPN).
Number
This is a first demonstration number.
This field will be used to hold the 2-
byte number for future use with the
Bundled Payments for Care
Improvement initiative.
12 CLM_DEMO_2ND_NUM Second 55 56 2 X(2) Medicare Demonstration Special
Program Processing Number (SPN).
Demonstration
This is a second demonstration
Number
number.
13 CLM_DEMO_3RD_NUM Third Program 57 58 2 X(2) Medicare Demonstration Special
Number
This is a third demonstration
number.
14 CLM_DEMO_4TH_NUM Fourth 59 60 2 X(2) Medicare Demonstration Special
Demonstration
This is a fourth demonstration
Number
number.
15 CLM_DEMO_5TH_NUM Fifth Program 61 62 2 X(2) Medicare Demonstration Special
Number
This is a fifth demonstration number.
16 CLM_PBP_INCLSN_AMT PBP/AIPBP 63 81 19 -9(15).99 The amount that would have been
Inclusion paid in the absence of PBP/AIPBP
Amount Reduction.
The value for the PBP/AIPBP
Inclusion Amount is derived from the
table and column called
“CMS_VIEW_CLM_PRD.CLM_VAL
_AMT” when the value code within
the field called “CLM_VAL_CD”
equals “Q0.”
17 CLM_PBP_RDCTN_AMT PBP/AIPBP 82 100 19 -9(15).99 The PBP/AIPBP Reduction Amount
Reduction withheld from payment to the
Amount Provider.
Reduction Amount is derived from
the table and column called
“CMS_VIEW_CLM_PRD.CLM_VAL
_AMT” when the value code within
the field called “CLM_VAL_CD”
equals “Q1.”
18 CLM_NGACO_CMG_WVR_SW Care 101 101 1 X(1) A single character code of “Y” or “N”
Management that indicates whether a particular
Home Visits claim is tied to a Care Management
Home Visits benefit enhancement.
Blank if no data are available.
 For regular CCLFs: P.A****.ACO.ZCBY**.Dyymmdd.Thhmmsst.
 For run-out CCLFs: P.A****.ACO.ZCBR**.Dyymmdd.Thhmmsst, “R” instead of “Y” indicating run-out.
Table 11. Part B Claims Benefit Enhancement and Demonstration Code File (CCLFB)
1 CUR_CLM_UNIQ_ID Current Claim 1 13 13 9(13) A unique identification number
Unique assigned to the claim. I H
Identifier
Number specific claim line within a given
claim.
3 BENE_MBI_ID Medicare 24 34 11 X(11) A Medicare Beneficiary Identifier
Beneficiary assigned to a beneficiary. I H
Identifier
4 BENE_HIC_NUM Beneficiary 35 45 11 X(11) Legacy Beneficiary HICN field.
HIC Number
onwards.
5 CLM_TYPE_CD Claim Type 46 47 2 9(02) Signifies the type of claim being
Code submitted through the Medicare or
Medicaid programs
71 = RIC O local carrier non-
DMEPOS claim
72 = RIC O local carrier DMEPOS
claim
6 CLM_LINE_NGACO_PBPMT_SW PBP Benefit 48 48 1 X(1) A single character code of “Y” or “N”
Indicator claim line is tied to a PBP benefit
available.
7 CLM_LINE_NGACO_PDSCHRG_ Post Discharge 49 49 1 X(1) A single character code of “Y” or “N”
HCBS_SW Home Visit that indicates whether a particular
Benefit claim line is tied to a Post Discharge
Enhancement Home Visit benefit enhancement.
Indicator Blank if no data are available.
8 CLM_LINE_NGACO_SNF_WVR_ SNF 3-Day 50 50 1 X(1) A single character code of “Y” or “N”
SW Waiver Benefit that indicates whether a particular
Enhancement claim line is tied to a SNF 3-Day
Indicator Waiver benefit enhancement. Blank
if no data are available.
9 CLM_LINE_NGACO_TLHLTH_S Telehealth 51 51 1 X(1) A single character code of “Y” or “N”
W Benefit that indicates whether a particular
Enhancement claim line is tied to a Telehealth
Indicator benefit enhancement. Blank if no
data are available.
10 CLM_LINE_NGACO_CPTATN_S AIPBP Benefit 52 52 1 X(1) A single character code of “Y” or “N”

W Enhancement that indicates whether a particular
Indicator claim line is tied to an AIPBP benefit
available.
11 CLM_DEMO_1ST_NUM First Program 53 54 2 X(2) Medicare Demonstration Special
Number
This is a first demonstration number.
12 CLM_DEMO_2ND_NUM Second 55 56 2 X(2) Medicare Demonstration Special
Demonstration
This is a second demonstration
Number
number.
13 CLM_DEMO_3RD_NUM Third Program 57 58 2 X(2) Medicare Demonstration Special
Number
This is a third demonstration
number.
14 CLM_DEMO_4TH_NUM Fourth 59 60 2 X(2) Medicare Demonstration Special
Demonstration
This is a fourth demonstration
Number
number.
15 CLM_DEMO_5TH_NUM Fifth Program 61 62 2 X(2) Medicare Demonstration Special
Number
This is a fifth demonstration number.
16 CLM_PBP_INCLSN_AMT PBP/AIPBP 63 77 15 -9(11).99 The amount that would have been
Inclusion paid in the absence of PBP/AIPBP
Amount Reduction.
Inclusion Amount is derived from the
table and column called
“CMS_VIEW_CLM_PRD.CLM_LINE
_OTHR_APLD_AMT” when the
value code within the field called
“CLM_LINE_OTHR_APLD_CD”
equals “J.”
17 CLM_PBP_RDCTN_AMT PBP/AIPBP 78 92 15 -9(11).99 The PBP/AIPBP Reduction Amount
Reduction withheld from payment to the
Amount Provider.
Reduction Amount is derived from
the table and column called
“CMS_VIEW_CLM_PRD.CLM_LINE
_OTHR_APLD_AMT” when the
value code within the field called
“CLM_LINE_OTHR_APLD_CD”
equals “L.”
18 CLM_NGACO_CMG_WVR_SW Care 93 93 1 X(1) A single character code of “Y” or “N”
Management that indicates whether a particular
Home Visits claim is tied to a Care Management
Home Visits benefit enhancement.
Blank if no data are available.
The filename convention for the Medicare Shared Savings Program in Table 12 and Table 13 is:
 For regular CCLFs: P.A****.ZC0Y**.Dyymmdd.Thhmmsst.
Table 12. Summary Statistics Header Record (CCLF0)

1 File Number Label Title 1 13 13 X(13) “File Number”
This field will be left-justified and
right-padded with spaces.
2 Delimiter Delimiter 14 14 1 X(1) “|”
3 File Description Label Title 15 34 20 X(20) “File Description”
5 Total Records Count Label Title 36 55 20 X(20) “Total Records Count”
7 Record Length Label Title 57 69 13 X(13) “Record Length”
Table 13. Summary Statistics Detail Records
1 File Type Type of CCLF 1 7 7 X(7) Field will contain either “CCLF1”,
file “CCLF2”, “CCLF3”, “CCLF4”,
“CCLF5”, “CCLF6”, “CCLF7”,
“CCLF8”, “CCLF9”, “CCLFA”, or
“CCLFB”.
3 File Name Name of 9 51 43 X(43) For file CCLF1, this field will
CCLF file contain “Part A Claims Header
File”.
For file CCLF2, this field will
contain “Part A Claims Revenue
Center Detail File”.
contain “Part A Procedure Code
File”.
contain “Part A Diagnosis Code
File”.
contain “Part B Physicians File”.
contain “Part B DME File”.
contain “Part D File”.
contain “Beneficiary Demographics
File”.
contain “BENE XREF File”.
For file CCLFA, this field will
contain “Part A BE and Demo
Codes File”.
For file CCLFB, this field will
contain “Part B BE and Demo
Codes File”.
5 Number of records Contains the 53 63 11 X(11) This field will be right-justified and
number of left-padded with spaces.
records in the
file
7 Length of record Contains the 65 69 5 X(5) This field will be right-justified and
length of the left-padded with spaces.
record in the
file.
8 Filler Filler 70 70 1 X(1) Blank

2021 CCLF File Data Elements Resource - V2 - 508

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Medicare Shared Savings Program

CLAIM AND CLAIM LINE FEED

Table 1. Part A Claims Header File (CCLF1)

Table 2. Part A Claims Revenue Center Detail File (CCLF2)

Table 3. Part A Procedure Code File (CCLF3)

Table 4. Part A Diagnosis Code File (CCLF4)

Table 5. Part B Physicians File (CCLF5)

Table 6. Part B DME File (CCLF6)

Table 7. Part D File (CCLF7)

Table 8. Beneficiary Demographics File (CCLF8)

Table 9. Beneficiary XREF File (CCLF9)

10 CLM_LINE_NGACO_CPTATN_S AIPBP Benefit 52 52 1 X(1) A single character code of “Y” or “N”

Table 12. Summary Statistics Header Record (CCLF0)

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