Schedule F6- Data Feed-Hearing.xlsx

XLSX spreadsheet 31 KB Posted Sep 30, 2025

Attached to: Health Insurance Database Management System
Solicitation number: RFP-171-250000003097-2
Issued by: Michigan

About this file

Written by GovTribe AI · Oct 1, 2025

This is a detailed Excel file for Request for Proposal No. 250000002818 for a Health Insurance Database Management System issued by the Michigan Office of Retirement Services. The document provides an extensive data feed layout specification with 139 distinct data fields for healthcare claims processing, covering comprehensive details such as diagnosis codes, procedure codes, provider information, payment details, and patient demographics. The layout is designed for a fixed-record length format, specifying precise character and numeric field positions, lengths, and data type requirements.

The data specification covers an intricate range of healthcare claim-related information, including financial elements like allowed amounts, charges submitted, net payments, coinsurance, and copayments, as well as clinical details such as diagnosis codes, procedure codes, present on admission indicators, and provider taxonomy codes. The document includes specific formatting instructions for dates, numeric values, and character fields, with particular emphasis on unique identifiers like provider IDs, tax IDs, and national provider numbers. The layout appears to support detailed medical claims tracking and analysis, enabling precise documentation and processing of healthcare service encounters across various medical settings.

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Schedule F1- Data Feed-ORS.xls	XLS spreadsheet	Sep 30, 2025
250000003097 - Health Insurance Database Management System RFP.docx	DOCX document	Sep 30, 2025
Schedule F10- Data Feed- Vision.xlsx	XLSX spreadsheet	Sep 30, 2025
Schedule F3- Data Feed-Medicare Medical.csv	CSV file	Sep 30, 2025
Schedule F7- Data Feed- Non Medicare Pharmacy.xlsx	XLSX spreadsheet	Sep 30, 2025
Schedule F9- Data Feed-Dental.xls	XLS spreadsheet	Sep 30, 2025
Schedule H Quarterly Vendor Reconciliation Report.xlsx	XLSX spreadsheet	Sep 30, 2025
Schedule B - Healthcare Database.xlsx	XLSX spreadsheet	Sep 30, 2025
Schedule F2-Data Feed Non-Medicare Medical.csv	CSV file	Sep 30, 2025
Schedule F5- Data Feed-Medicare Lab.csv	CSV file	Sep 30, 2025
Schedule F8- Data Feed- Medicare Pharmacy.xls	XLS spreadsheet	Sep 30, 2025
Schedule J Software Table.xlsx	XLSX spreadsheet	Sep 30, 2025
RFP 250000003097 - Bidder Question and Answer Response.xlsx	XLSX spreadsheet	Sep 30, 2025
Schedule F4- Data Feed- Non-Medicare Lab.csv	CSV file	Sep 30, 2025
Schedule G Service Availability.xlsx	XLSX spreadsheet	Sep 30, 2025
Schedule I Sample Validation Report.xlsx	XLSX spreadsheet	Sep 30, 2025

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Detail Layout

Request for Proposal No. 250000002818
Health Insurance Database Management System for the Michigan Office of Retirement Services
Field Number	Field Name	Start	End	Length	Type	Data Element Description	Data Dictionary Needed	Data Supplier Instructions/Notes
Fixed-Record Length
0	ROW FOR CALCULATIONS ONLY	1	0	0
1	Adjustment Type Code	1	1	1	Character	Client-specific code for the claim adjustment type	Yes	Adjustment Type values will be identified in the Data Dictionary.
2	Allowed Amount	2	11	10	Numeric	The maximum amount allowed by the plan for payment.		Format 9(8)v99 (2 – digit, implied decimal)

On facility records, this field must be at the service/detail level as opposed to the header/claim level.

3	Bill Type Code UB	12	15	4	Character	The UB-04 standard code for the billing type, indicating type of facility, bill classification, and frequency of bill.	See Notes	Bill Type values will be identified in the Data Dictionary only if standard codes are not used.
4	Capitated Service Indicator	16	16	1	Character	An indicator that this service (encounter record) was capitated		Applicable field values are “Y” for Capitated services and “N” for non-cap services.
5	Charge Submitted	17	26	10	Numeric	The submitted or billed charge amount		Format 9(8)v99 (2 – digit, implied decimal)

On facility records, this field must be at the service/detail level as opposed to the header/claim level.

6	Claim ID	27	41	15	Character	The client-specific identifier of the claim.
7	Claim Type Code	42	43	2	Character	Client-specific code for the type of claim	Yes	Claim Type Codes will be identified in the Data Dictionary.
8	Coinsurance	44	53	10	Numeric	The coinsurance paid by the subscriber as specified in the plan provision.		Format 9(8)v99 (2 – digit, implied decimal)

On facility records, this field must be at the service/detail level as opposed to the header/claim level.

9	Copayment	54	63	10	Numeric	The copayment paid by the subscriber as specified by the plan provision.
10	Date of Birth	64	73	10	Date	Birth date of the person	MM/DD/CCYY format

The member’s birth date is part of the Person ID key and is, therefore, critical to tagging claims to eligibility.

The four-digit year is required for date of birth. The century cannot be accurately assigned based on a two-digit year.

11	Date of First Service	74	83	10	Date	The date of the first service reported on the claim or authorization record.	MM/DD/CCYY Format
12	Date of Last Service	84	93	10	Date	The date of the last service reported on the claim or authorization record.	MM/DD/CCYY Format
13	Date of Service Facility Detail	94	103	10	Date	The date of service for the facility detail record.	MM/DD/CCYY Format
14	Date Paid	104	113	10	Date	The date the claim or data record was paid.	MM/DD/CCYY format

This is the check date.

15	Days	114	119	6	Numeric	The number of inpatient days for the facility claim.
16	Deductible	120	129	10	Numeric	The amount paid by the subscriber through the deductible arrangement of the plan.	Format 9(8)v99 (2 – digit, implied decimal)

On facility records, this field must be at the service/detail level as opposed to the header/claim level.

17	Diagnosis Code Principal	130	137	8	Character	The first or principal diagnosis code for a service, claim or lab result. Length expanded from 5 to 8 for future use.	No decimal point.
18	Diagnosis Code 2	138	145	8	Character	A secondary diagnosis code for the claim. Length expanded from 5 to 8 for future use.	No decimal point.
19	Diagnosis Code 3	146	153	8	Character	A secondary diagnosis code for the claim. Length expanded from 5 to 8 for future use.	No decimal point.
20	Diagnosis Code 4	154	161	8	Character	A secondary diagnosis code for the claim. Length expanded from 5 to 8 for future use.	No decimal point.
21	Diagnosis Code 5	162	169	8	Character	A secondary diagnosis code for the claim. Length expanded from 5 to 8 for future use.	No decimal point.
22	Diagnosis Code 6	170	177	8	Character	A secondary diagnosis code for the claim. Length expanded from 5 to 8 for future use.	No decimal point.
23	Diagnosis Code 7	178	185	8	Character	A secondary diagnosis code for the claim. Length expanded from 5 to 8 for future use.	No decimal point.
24	Diagnosis Code 8	186	193	8	Character	A secondary diagnosis code for the claim. Length expanded from 5 to 8 for future use.	No decimal point.
25	Diagnosis Code 9	194	201	8	Character	A secondary diagnosis code for the claim. Length expanded from 5 to 8 for future use.	No decimal point.
26	Diagnosis Code 10	202	209	8	Character	A secondary diagnosis code for the claim. Length expanded from 5 to 8 for future use.	No decimal point.
27	Diagnosis Code 11	210	217	8	Character	A secondary diagnosis code for the claim. Length expanded from 5 to 8 for future use.	No decimal point.
28	Diagnosis Code 12	218	225	8	Character	A secondary diagnosis code for the claim. Length expanded from 5 to 8 for future use.	No decimal point.
29	Diagnosis Code 13	226	233	8	Character	A secondary diagnosis code for the claim. Length expanded from 5 to 8 for future use.	No decimal point.
30	Diagnosis Code 14	234	241	8	Character	A secondary diagnosis code for the claim. Length expanded from 5 to 8 for future use.	No decimal point.
31	Diagnosis Code 15	242	249	8	Character	A secondary diagnosis code for the claim. Length expanded from 5 to 8 for future use.	No decimal point.
32	Diagnosis Code 16	250	257	8	Character	A secondary diagnosis code for the claim. Length expanded from 5 to 8 for future use.	No decimal point.
33	Diagnosis Code 17	258	265	8	Character	A secondary diagnosis code for the claim. Length expanded from 5 to 8 for future use.	No decimal point.
34	Diagnosis Code 18	266	273	8	Character	A secondary diagnosis code for the claim. Length expanded from 5 to 8 for future use.	No decimal point.
35	Diagnosis Code 19	274	281	8	Character	A secondary diagnosis code for the claim. Length expanded from 5 to 8 for future use.	No decimal point.
36	Diagnosis Code 20	282	289	8	Character	A secondary diagnosis code for the claim. Length expanded from 5 to 8 for future use.	No decimal point.
37	Diagnosis Code 21	290	297	8	Character	A secondary diagnosis code for the claim. Length expanded from 5 to 8 for future use.	No decimal point.
38	Diagnosis Code 22	298	305	8	Character	A secondary diagnosis code for the claim. Length expanded from 5 to 8 for future use.	No decimal point.
39	Diagnosis Code 23	306	313	8	Character	A secondary diagnosis code for the claim. Length expanded from 5 to 8 for future use.	No decimal point.
40	Diagnosis Code 24	314	321	8	Character	A secondary diagnosis code for the claim. Length expanded from 5 to 8 for future use.	No decimal point.
41	Diagnosis Code 25	322	329	8	Character	A secondary diagnosis code for the claim. Length expanded from 5 to 8 for future use.	No decimal point.
42	Discharge Status Code UB	330	331	2	Numeric	The UB-04 standard patient status code, indicating disposition at the time of billing.
43	Discount	332	341	10	Numeric	The discount amount of the claim, applied to charges for any plan pricing reductions.	Format 9(8)v99 (2 – digit, implied decimal)

On facility records, this field must be at the service/detail level as opposed to the header/claim level.

44	Family ID/Employee SSN	342	350	9	Character	The unique identifier (Social Security Number) for the subscriber (contract holder, employee) and their associated dependents.	This will be the Account Holder MemberID for TruHearing Data
45	Gender	351	351	1	Character	Gender of the person.	M or F

The member’s gender is part of the Person ID key and is, therefore, critical to tagging claims to eligibility

46	Line Number	352	353	2	Numeric	The detail line number for the service on the claim
47	Net Payment	354	363	10	Numeric	The actual check amount for the record		Format 9(8)v99 (2 - digit, implied decimal)
48	Network Paid Indicator	364	364	1	Character	An indicator of whether the claim was paid at in-network or out-of-network level		On facility records, this field must be at the service/detail level as opposed to the header/claim level.
49	Network Provider Indicator	365	365	1	Character	Indicates if the servicing provider participates in the network to which the patient belongs		Y or "N"
50	Ordering Provider ID	366	378	13	Character	The ID number of the provider who referred the patient or ordered the test or procedure.
51	Ordering Provider Name	379	408	30	Character	The Name of the provider who referred the patient or ordered the test or procedure.
52	Ordering Provider Zip Code	409	413	5	Character	The zip code of the provider who referred the patient or ordered the test or procedure.
53	PCP Responsibility Indicator	414	414	1	Character	An indicator signifying that the PCP is the physician considered responsible or accountable for this claim.
54	Place of Service Code	415	416	2	Character	Client-specific code for the place of service.	See Notes	Truven prefers the CMS place of service values. Place of Service values will be identified in the Data Dictionary only if non-standard values are used.
55	Procedure Code	417	423	7	Character	The procedure code for the service record. Length expanded from 5 to 7 for future use.		CPT/HCPCS codes.
56	Procedure Code UB Surg 1	424	430	7	Character	The primary surgical procedure code (1) on the facility claim. Length expanded from 5 to 7 for future use.		ICD-9 or 10 Surgical procedure codes.
57	Procedure Code UB Surg 2	431	437	7	Character	The secondary surgical procedure code on the facility claim. Length expanded from 5 to 7 for future use.		ICD-9 or 10 Surgical procedure codes.
58	Procedure Code UB Surg 3	438	444	7	Character	The secondary surgical procedure code on the facility claim. Length expanded from 5 to 7 for future use.		ICD-9 or 10 Surgical procedure codes.
59	Procedure Code UB Surg 4	445	451	7	Character	The secondary surgical procedure code on the facility claim. Length expanded from 5 to 7 for future use.		ICD-9 or 10 Surgical procedure codes.
60	Procedure Code UB Surg 5	452	458	7	Character	The secondary surgical procedure code on the facility claim. Length expanded from 5 to 7 for future use.		ICD-9 or 10 Surgical procedure codes.
61	Procedure Code UB Surg 6	459	465	7	Character	The secondary surgical procedure code on the facility claim. Length expanded from 5 to 7 for future use.		ICD-9 or 10 Surgical procedure codes.
62	Procedure Code UB Surg 7	466	472	7	Character	The secondary surgical procedure code on the facility claim. Length expanded from 5 to 7 for future use.		ICD-9 or 10 Surgical procedure codes.
63	Procedure Code UB Surg 8	473	479	7	Character	The secondary surgical procedure code on the facility claim. Length expanded from 5 to 7 for future use.		ICD-9 or 10 Surgical procedure codes.
64	Procedure Code UB Surg 9	480	486	7	Character	The secondary surgical procedure code on the facility claim. Length expanded from 5 to 7 for future use.		ICD-9 or 10 Surgical procedure codes.
65	Procedure Code UB Surg 10	487	493	7	Character	The secondary surgical procedure code on the facility claim. Length expanded from 5 to 7 for future use.		ICD-9 or 10 Surgical procedure codes.
66	Procedure Code UB Surg 11	494	500	7	Character	The secondary surgical procedure code on the facility claim. Length expanded from 5 to 7 for future use.		ICD-9 or 10 Surgical procedure codes.
67	Procedure Code UB Surg 12	501	507	7	Character	The secondary surgical procedure code on the facility claim. Length expanded from 5 to 7 for future use.		ICD-9 or 10 Surgical procedure codes.
68	Procedure Code UB Surg 13	508	514	7	Character	The secondary surgical procedure code on the facility claim. Length expanded from 5 to 7 for future use.		ICD-9 or 10 Surgical procedure codes.
69	Procedure Code UB Surg 14	515	521	7	Character	The secondary surgical procedure code on the facility claim. Length expanded from 5 to 7 for future use.		ICD-9 or 10 Surgical procedure codes.
70	Procedure Code UB Surg 15	522	528	7	Character	The secondary surgical procedure code on the facility claim. Length expanded from 5 to 7 for future use.		ICD-9 or 10 Surgical procedure codes.
71	Procedure Code UB Surg 16	529	535	7	Character	The secondary surgical procedure code on the facility claim. Length expanded from 5 to 7 for future use.		ICD-9 or 10 Surgical procedure codes.
72	Procedure Code UB Surg 17	536	542	7	Character	The secondary surgical procedure code on the facility claim. Length expanded from 5 to 7 for future use.		ICD-9 or 10 Surgical procedure codes.
73	Procedure Code UB Surg 18	543	549	7	Character	The secondary surgical procedure code on the facility claim. Length expanded from 5 to 7 for future use.		ICD-9 or 10 Surgical procedure codes.
74	Procedure Code UB Surg 19	550	556	7	Character	The secondary surgical procedure code on the facility claim. Length expanded from 5 to 7 for future use.		ICD-9 or 10 Surgical procedure codes.
75	Procedure Code UB Surg 20	557	563	7	Character	The secondary surgical procedure code on the facility claim. Length expanded from 5 to 7 for future use.		ICD-9 or 10 Surgical procedure codes.
76	Procedure Code UB Surg 21	564	570	7	Character	The secondary surgical procedure code on the facility claim. Length expanded from 5 to 7 for future use.		ICD-9 or 10 Surgical procedure codes.
77	Procedure Code UB Surg 22	571	577	7	Character	The secondary surgical procedure code on the facility claim. Length expanded from 5 to 7 for future use.		ICD-9 or 10 Surgical procedure codes.
78	Procedure Code UB Surg 23	578	584	7	Character	The secondary surgical procedure code on the facility claim. Length expanded from 5 to 7 for future use.		ICD-9 or 10 Surgical procedure codes.
79	Procedure Code UB Surg 24	585	591	7	Character	The secondary surgical procedure code on the facility claim. Length expanded from 5 to 7 for future use.		ICD-9 or 10 Surgical procedure codes.
80	Procedure Code UB Surg 25	592	598	7	Character	The secondary surgical procedure code on the facility claim. Length expanded from 5 to 7 for future use.		ICD-9 or 10 Surgical procedure codes.
81	Procedure Modifier Code 1	599	600	2	Character	The 2-character code of the first procedure code modifier on the professional claim
82	Provider ID	601	613	13	Character	The unique identifier for the provider of service.		This must be the federal tax ID in order to use the standard hospital identifier lookup (Standard Facility).
83	TIN	614	622	9	Character	The federal tax ID of the provider.		Only needed if Provider ID is not the federal tax ID.
84	Provider Qualifier	623	632	10	Character	A qualifier to make Provider ID unique.		Only required if Provider ID is not unique.
85	Provider Type Code Claim	633	635	3	Character	Client-specific code for the provider type on the claim record	Yes	Provider Type codes are further defined in the Data Dictionary
86	Provider Taxonomy Code	636	645	10	Character	The Healthcare Provider Taxonomy code specific to the professional servicing provider associated with the claim. (Note: This is not a standard field in Advantage Suite. Truven asks for this field to aid in the mapping of Provider Type Code Code Claim to Truven's standard values.)		The National Uniform Claim Committee standard taxonomy code for the provider.
87	Provider Zip Code	646	650	5	Numeric	The 5-digit zip code corresponding to the Provider ID		Provider Location zip code
88	Revenue Code UB	651	654	4	Character	The CMS standard revenue code from the facility claim		This field must be at the service/detail level.
89	Third Party Amount	655	664	10	Numeric	The amount saved due to integration of third party liability (Coordination of Benefits) by all third party payers (including Medicare).		Format 9(8)v99 (2 - digit, implied decimal)

On facility records, this field must be at the service/detail level as opposed to the header/claim level.

90	Units of Service	665	668	4	Numeric	Client-specific quantity of services or units
91	Provider Name	669	698	30	Character	The description or name corresponding to the Provider ID.	The Provider Name should be specific to the provider and not a group name.
92	Funding Type Code	699	699	1	Character	Specifies whether the claim was paid under a fully or self-funded arrangement	“S” = Self-funded

“F” = Fully-funded

93	Account Structure	700	707	8	Character	Client-specific code for the account structure of the plan that the member is enrolled in. This is usually a group number.	Additional fields may be added to the layout if there is more than one component of the account structure.
94	Provider NPI Number	708	717	10	Character	The National Provider ID number for the provider.
95	Provider Address 1	718	767	50	Character	The current street address1 of the provider of service.	If the provider has multiple addresses, the primary address is preferred.
96	Provider Address 2	768	817	50	Character	The current street address2 of the provider of service.	If the provider has multiple addresses, the primary address is preferred.
97	HRA Amount	818	827	10	Numeric	The amount paid from the HRA as a result of this claim.	Format 9(8)v99 (2 - digit, implied decimal)

On facility records, this field must be at the service/detail level as opposed to the header/claim level.

98 HSA Amount 828 837 10 Numeric The amount paid from the HSA as a result of this claim. Format 9(8)v99 (2 - digit, implied decimal) On facility records, this field must be at the service/detail level as opposed to the header/claim level.

99 Present on Admission Principal 838 838 1 Character The principal POA code for the facility claim. Indicates whether the principal diagnosis was present on admission. Standard Values:

1 – Unreported/Not Used N – No, not present at admission U – Unknown W – Clinically Undetermined Y – Yes, present at admission

See Notes	If standard values are not used, define in the Data Dictionary.
100	Present on Admission 02	839	839	1	Character	A secondary POA code for the facility claim. Indicates whether the secondary diagnosis was present on admission. Standard Values listed in principal field.	See Notes	If standard values are not used, define in the Data Dictionary.
101	Present on Admission 03	840	840	1	Character	A secondary POA code for the facility claim. Indicates whether the secondary diagnosis was present on admission. Standard Values listed in principal field.	See Notes	If standard values are not used, define in the Data Dictionary.
102	Present on Admission 04	841	841	1	Character	A secondary POA code for the facility claim. Indicates whether the secondary diagnosis was present on admission. Standard Values listed in principal field.	See Notes	If standard values are not used, define in the Data Dictionary.
103	Present on Admission 05	842	842	1	Character	A secondary POA code for the facility claim. Indicates whether the secondary diagnosis was present on admission. Standard Values listed in principal field.	See Notes	If standard values are not used, define in the Data Dictionary.
104	Present on Admission 06	843	843	1	Character	A secondary POA code for the facility claim. Indicates whether the secondary diagnosis was present on admission. Standard Values listed in principal field.	See Notes	If standard values are not used, define in the Data Dictionary.
105	Present on Admission 07	844	844	1	Character	A secondary POA code for the facility claim. Indicates whether the secondary diagnosis was present on admission. Standard Values listed in principal field.	See Notes	If standard values are not used, define in the Data Dictionary.
106	Present on Admission 08	845	845	1	Character	A secondary POA code for the facility claim. Indicates whether the secondary diagnosis was present on admission. Standard Values listed in principal field.	See Notes	If standard values are not used, define in the Data Dictionary.
107	Present on Admission 09	846	846	1	Character	A secondary POA code for the facility claim. Indicates whether the secondary diagnosis was present on admission. Standard Values listed in principal field.	See Notes	If standard values are not used, define in the Data Dictionary.
108	Present on Admission 10	847	847	1	Character	A secondary POA code for the facility claim. Indicates whether the secondary diagnosis was present on admission. Standard Values listed in principal field.	See Notes	If standard values are not used, define in the Data Dictionary.
109	Present on Admission 11	848	848	1	Character	A secondary POA code for the facility claim. Indicates whether the secondary diagnosis was present on admission. Standard Values listed in principal field.	See Notes	If standard values are not used, define in the Data Dictionary.
110	Present on Admission 12	849	849	1	Character	A secondary POA code for the facility claim. Indicates whether the secondary diagnosis was present on admission. Standard Values listed in principal field.	See Notes	If standard values are not used, define in the Data Dictionary.
111	Present on Admission 13	850	850	1	Character	A secondary POA code for the facility claim. Indicates whether the secondary diagnosis was present on admission. Standard Values listed in principal field.	See Notes	If standard values are not used, define in the Data Dictionary.
112	Present on Admission 14	851	851	1	Character	A secondary POA code for the facility claim. Indicates whether the secondary diagnosis was present on admission. Standard Values listed in principal field.	See Notes	If standard values are not used, define in the Data Dictionary.
113	Present on Admission 15	852	852	1	Character	A secondary POA code for the facility claim. Indicates whether the secondary diagnosis was present on admission. Standard Values listed in principal field.	See Notes	If standard values are not used, define in the Data Dictionary.
114	Present on Admission 16	853	853	1	Character	A secondary POA code for the facility claim. Indicates whether the secondary diagnosis was present on admission. Standard Values listed in principal field.	See Notes	If standard values are not used, define in the Data Dictionary.
115	Present on Admission 17	854	854	1	Character	A secondary POA code for the facility claim. Indicates whether the secondary diagnosis was present on admission. Standard Values listed in principal field.	See Notes	If standard values are not used, define in the Data Dictionary.
116	Present on Admission 18	855	855	1	Character	A secondary POA code for the facility claim. Indicates whether the secondary diagnosis was present on admission. Standard Values listed in principal field.	See Notes	If standard values are not used, define in the Data Dictionary.
117	Present on Admission 19	856	856	1	Character	A secondary POA code for the facility claim. Indicates whether the secondary diagnosis was present on admission. Standard Values listed in principal field.	See Notes	If standard values are not used, define in the Data Dictionary.
118	Present on Admission 20	857	857	1	Character	A secondary POA code for the facility claim. Indicates whether the secondary diagnosis was present on admission. Standard Values listed in principal field.	See Notes	If standard values are not used, define in the Data Dictionary.
119	Present on Admission 21	858	858	1	Character	A secondary POA code for the facility claim. Indicates whether the secondary diagnosis was present on admission. Standard Values listed in principal field.	See Notes	If standard values are not used, define in the Data Dictionary.
120	Present on Admission 22	859	859	1	Character	A secondary POA code for the facility claim. Indicates whether the secondary diagnosis was present on admission. Standard Values listed in principal field.	See Notes	If standard values are not used, define in the Data Dictionary.
121	Present on Admission 23	860	860	1	Character	A secondary POA code for the facility claim. Indicates whether the secondary diagnosis was present on admission. Standard Values listed in principal field.	See Notes	If standard values are not used, define in the Data Dictionary.
122	Present on Admission 24	861	861	1	Character	A secondary POA code for the facility claim. Indicates whether the secondary diagnosis was present on admission. Standard Values listed in principal field.	See Notes	If standard values are not used, define in the Data Dictionary.
123	Present on Admission 25	862	862	1	Character	A secondary POA code for the facility claim. Indicates whether the secondary diagnosis was present on admission. Standard Values listed in principal field.	See Notes	If standard values are not used, define in the Data Dictionary.
124	DRG MS Payment Code	863	865	3	Numeric	The Diagnosis Related Group (MS-DRG) code under which the claim was paid.
125	ICD Version	866	866	1	Character	The ICD version or qualifier code that identifies either ICD-9 (9) or ICD-10 (0) diagnosis and procedure codes on the facility claim.	See Notes	If 0 and 9 not used, values defined in the Data Dictionary.
126	Tax Amount	867	876	10	Numeric	The amount charged by some states per medical claim.		Format 9(8)v99 (2 – digit, implied decimal)

127	Tax Type Code	877	877	1	Character	Data Supplier specific code identifying the state and/or type of tax.	Yes	Tax Type Codes will be identified in the Data Dictionary.
128	NDC Number Code	878	888	11	Character	The FDA (Food and Drug Administration) registered number for the drug. Please include for any drugs dispensed in the medical setting if available.
129	Billing Prov ID	889	908	20	Character
130	Billing Tax ID	909	928	20	Character
131	Billing Provider First Name	929	963	35	Character
132	Billing Provider Last Name	964	998	35	Character
133	Bill Provider Address 1	999	1048	50	Character
134	Bill Provider Address 2	1049	1098	50	Character
135	Bill Prov City	1099	1118	20	Character
136	Bill Provider State	1119	1138	20	Character
137	Billing Provider Zip Code	1139	1147	9	Character
138	Filler	1148	1148	1	Character	Filler Space		Blanks
139	Record Type	1149	1149	1	Character	Record type identifier		Hard Code to "D"

Trailer Layout

Request for Proposal No. 250000003097

Health Insurance Database Management System for the Michigan Office of Retirement Services

Field Number	Field Name	Start	End	Length	Type	Data Element Description	Data Supplier Instructions/Notes
Fixed-Record Length
0	ROW USED FOR CALCULATIONS	1	0	0
1	Data Start Date	1	10	10	Date	Data Start Date	MM/DD/CCYY format – i.e. 09/01/2014

This will represent the 1st day of the month for which data is provided.

2 Data End Date 11 20 10 Date Data End Date MM/DD/CCYY format – i.e. 09/30/2014

This will represent the last day of the month for which data is provided.

3	Record Count	21	30	10	Numeric	Number of Records on File	The count of records provided in the data including the Trailer Record.
4	Total Net Payments	31	44	14	Numeric	Total net payments on the file	The sum of net payments provided in the file
5	Filler	45	1148	1104	Character	Reserved for future use	Fill with Blanks
6	Record Type	1149	1149	1	Character	Record Type Identifier	Hard Code ‘T’

File details come from the government source that posted it. Updated Oct 1, 2025.