Transaction Details

This transaction records outpatient community mental health services provided to consumers.

Transaction ID	Transaction Description	Status	Status Date
120.03	Outpatient Services	Final	4/1/2010

Key	Field ID	Field Code	Field Name	Field Description	Actions Allowed	Char Length
	101073	CV01	RCODE	Transaction ID	NN	6
	030010	CV02	RACTION	Action Code	NA	1
	030760	CV03	RSNID	RSN Report Unit	NN	3
K	030020	CV04	RORG	Agency Reporting Unit ID	NN	5
K	030001	CV05	RLGUID	Unique Identifier	NN	30
	030620	CV06	PN	Master Client Number	NN	11
	101067	RV01	sdate	Service Date	NA	8
	200126	RV02	pos	Health Care Service Location	NA	2
	200257	RV03	cpt	CPT Code	NA	5
	101063	RV04	min	Minutes of Service	NA	4
	030520	RV05	eflag	EPSDT Indicator	LA	1
	101018	RV06	pic	PIC	LA	11
	030470	RV07	epis	Episode ID	NA	5
	030490	RV08	epistype	Episode Type	NA	5
	030710	RV09	diag	Principal Diagnosis	NA	6
	030310	RV11	diag2	Diagnosis 2	LA	6
	030320	RV12	diag3	Diagnosis 3	LA	6
	030330	RV13	diag4	Diagnosis 4	LA	6
	030340	RV14	diag5	Diagnosis 5	LN	6
	030350	RV15	diag6	Diagnosis 6	LN	6
	030360	RV16	diag7	Diagnosis 7	LN	6
	030370	RV17	diag8	Diagnosis 8	LN	6
	030750	RV18	roicd	ROI Code	NA	1
	030640	RV19	psigsrc	Patient Signature Source Code	LA	1
	030210	RV20	cmpdxpt1	Composite Diagnosis Code Pointer 1	NA	2
	030220	RV21	cmpdxpt2	Composite Diagnosis Code Pointer 2	LA	2
	030230	RV22	cmpdxpt3	Composite Diagnosis Code Pointer 3	LA	2
	030240	RV23	cmpdxpt4	Composite Diagnosis Code Pointer 4	LA	2
	030720	RV24	refid	Reference Identification	NA	30
	030910	RV25	prvtp	Provider Type	NA	2
	200272	RV26	faccd	Facility Code	NA	5
	200709	RV27	prior	Prior Authorization or Referral Number	LA	8
	200705	RV28	mod1	Procedure Modifier 1	LA	2
	200706	RV29	mod2	Procedure Modifier 2	LA	2
	200707	RV30	mod3	Procedure Modifier 3	LA	2
	200708	RV31	mod4	Procedure Modifier 4	LA	2
	200701	RV32	ids	Co-Occurring Disorder IDS Screening Score	LN	1
	200702	RV33	eds	Co-Occurring Disorder EDS Screening Score	LN	1
	200703	RV34	sds	Co-Occurring Disorder SDS Screening Score	LN	1
	200704	RV35	aquadval	Co-Occurring Disorder Assessment Quadrant Value	LN	1
	200650	RV36	orgnpi	Agency National Provider Identifier	NA	80
	200657	RV37	staffnpi	Clinician National Provider Identifier	NA	80
	200968	RV38	svcaddr1	Service Street Address	NA	55
	200969	RV39	svcaddr2	Service Street Address 2	LA	55
	200970	RV40	svccity	Service City	NA	30
	200971	RV41	svczip	Service ZIP	NA	15
	200982	RV42	units	Service Units	NA	5

Field ID	Validation	CodeTable
030001	001 - Value Cannot Be Null
030001	003 - Length Invalid
030010	001 - Value Cannot Be Null
030010	002 - Code Invalid	ACODE
030020	001 - Value Cannot Be Null
030020	002 - Code Invalid	ORG
030210	001 - Value Cannot Be Null
030310	002 - Code Invalid	DIAG
030310	024 - DOS Out of Diagnosis Code Date Range
030320	002 - Code Invalid	DIAG
030320	024 - DOS Out of Diagnosis Code Date Range
030330	002 - Code Invalid	DIAG
030330	024 - DOS Out of Diagnosis Code Date Range
030470	001 - Value Cannot Be Null
030490	001 - Value Cannot Be Null
030490	002 - Code Invalid	EPIS
030620	001 - Value Cannot Be Null
030620	003 - Length Invalid
030640	001 - Value Cannot Be Null
030640	002 - Code Invalid	PSIG
030710	001 - Value Cannot Be Null
030710	002 - Code Invalid	DIAG
030710	024 - DOS Out of Diagnosis Code Date Range
030720	001 - Value Cannot Be Null
030750	001 - Value Cannot Be Null
030750	002 - Code Invalid	ROI
030760	001 - Value Cannot Be Null
030910	001 - Value Cannot Be Null
030910	002 - Code Invalid	PRVMO
030910	002 - Code Invalid	PRVTP
030910	026 - CPT Does not correspond to Provider Modality
101018	003 - Length Invalid
101063	001 - Value Cannot Be Null
101063	019 - Number of minutes must be between 0 and 1440.
101067	001 - Value Cannot Be Null
101067	020 - Date may not be in the future.
101073	001 - Value Cannot Be Null
200126	001 - Value Cannot Be Null
200126	002 - Code Invalid	POS
200257	001 - Value Cannot Be Null
200257	002 - Code Invalid	CPTMO
200257	002 - Code Invalid	CPT
200272	001 - Value Cannot Be Null
200272	002 - Code Invalid	FACCD
200650	001 - Value Cannot Be Null
200657	001 - Value Cannot Be Null
200701	002 - Code Invalid	CODSC
200702	002 - Code Invalid	CODSC
200703	002 - Code Invalid	CODSC
200704	002 - Code Invalid	CODAS
200705	002 - Code Invalid	CPTMO
200705	027 - Invalid Modifers per CPT
200706	002 - Code Invalid	CPTMO
200706	027 - Invalid Modifers per CPT
200707	002 - Code Invalid	CPTMO
200707	027 - Invalid Modifers per CPT
200708	002 - Code Invalid	CPTMO
200708	027 - Invalid Modifers per CPT
200968	001 - Value Cannot Be Null
200970	001 - Value Cannot Be Null
200971	001 - Value Cannot Be Null

Note_Date	Note
	Feeds from 837P.
	Reference Identification is the Line Item Control Number in HIPAA. In the Provider to RSN 837P transaction, this will echo the _rlguid^.
	Diagnoses 2-8 (diag2 - diag8) and Composite Diagnosis Code Pointer 2-4 will typically always be blank in the 837P transaction from the Providers.
	There is no 'RV10' - diag1. Previous documentation included this field in error.
4/18/2005	Added RV26 - Facility Code
3/22/2006	Actions Allowed for Service Date changed from 'NN' to 'NA'.
12/11/2006	For sdate>=20070101, RV03-CPT will be validated against code table 'CPTMO' and RV25-Provider Type will be validated against 'PRVMO'. For sdate<20070101, RV03-CPT will be validated against code table 'CPT' and RV25-Provider Type will be validated against PRVTP.
1/4/2007	Corrected table order for RV27-RV35
4/11/2007	Removed Validations for diag5-diag8. Changed actions allowed for diag5-diag8 from 'LA' to 'LN'.
7/9/2009	Actions Allowed for ids, eds, sds, aquadval changed from 'LA' to 'LN'.
7/9/2009	Added the following fields: orgnpi, staffnpi, svcaddr1, svcaddr2, svccity, svczip
7/16/2009	For Per Diem services, the staffnpi will = orgnpi.
7/17/2009	Starting with the implementation of ProviderOne, use the client's ProviderOne Client ID in field 'PIC' (101018) when, at the time of the service, the client has a valid Medicaid mental health benefit. If the client does not have a valid Medicaid mental health benefit at the time of the service, use the client's PN in field 'PIC'. PIC codes will no longer be accepted in this field. Once ProviderOne is implemented, NSMHA will reject all auth requests submitted with a legacy PIC.
7/17/2009	Changed the Character Length of 'PIC' (101018) from 14 to 11.
5/30/2012	Changed Actions Allowed for PSIGSRC - Patient Signature Source from 'NA' to 'LA' to coincide with HIPAA 5010.

North Sound
Mental Health Administration

NSMHA-CIS Data Dictionary

Outpatient Services

Transaction

Transaction Details

Validations

Transaction Notes

North Sound Mental Health Administration

NSMHA-CIS Data Dictionary

Outpatient Services

Transaction

Transaction Details

Validations

Transaction Notes

North Sound
Mental Health Administration