Health data as reflected in a patient's Explanation of Benefits (EOB) statements, typically derived from claims and other administrative data.

Data Element

Information from the submission form

Diagnosis Code
Description

ICD-9-CM code describing the condition chiefly responsible for a patient's admission to a facility. It may be different from the principal diagnosis, which is the diagnosis assigned after evaluation. (UB04 Form Locator 69). Decimals will be included.
Facility: The member's principal condition treated during this service. (UB04 Form Locator 67). This may or may not be different from the admitting diagnosis. Decimals will be included.
Professional and Non-Physician: The member's principal condition treated during this service.
Additional diagnosis identified for this member. Decimals will be included.
ICD-10-CM code describing the condition chiefly responsible for a patient's admission to a facility. It may be different from the principal diagnosis, which is the diagnosis assigned after evaluation. Decimals will be included.
The member's principal condition treated during this service. This may or may not be different from the admitting diagnosis. Decimals will be included.
Additional diagnosis identified for this member. Decimals will be included.

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