Sample of other form locator data elements


TOB	facility type	Bill Classification	Bill frequency
110	Hospital 	Inpatient	Nonpayment/Zero Claim
111	Hospital 	Inpatient	Admit-Through-Discharge Claim
112	Hospital 	Inpatient	Interim--First Claim
113	Hospital 	Inpatient	Interim--Continuing Claim
114	Hospital 	Inpatient	Interim--Last Claim
116	Hospital 	Inpatient	Adjustment Of Prior Claim
117	Hospital 	Inpatient	Replacement Of Prior Claim
118	Hospital 	Inpatient	Void/Cancel Of A Prior Claim
120	Hospital 	Inpatient Medicare Part B Only	Nonpayment/Zero Claim
121	Hospital 	Inpatient Medicare Part B Only	Admit-Through-Discharge Claim
122	Hospital 	Inpatient Medicare Part B Only	Interim--First Claim
123	Hospital 	Inpatient Medicare Part B Only	Interim--Continuing Claim
124	Hospital 	Inpatient Medicare Part B Only	Interim--Last Claim
126	Hospital 	Inpatient Medicare Part B Only	Adjustment Of Prior Claim
127	Hospital 	Inpatient Medicare Part B Only	Replacement Of Prior Claim
128	Hospital 	Inpatient Medicare Part B Only	Void/Cancel Of A Prior Claim
130	Hospital 	Outpatient	Nonpayment/Zero Claim
131	Hospital 	Outpatient	Admit-Through-Discharge Claim
132	Hospital 	Outpatient	Interim--First Claim
133	Hospital 	Outpatient	Interim--Continuing Claim
134	Hospital 	Outpatient	Interim--Last Claim
136	Hospital 	Outpatient	Adjustment Of Prior Claim
137	Hospital 	Outpatient	Replacement Of Prior Claim
138	Hospital 	Outpatient	Void/Cancel Of A Prior Claim
140	Hospital 	Other	Nonpayment/Zero Claim
141	Hospital 	Other	Admit-Through-Discharge Claim
142	Hospital 	Other	Interim--First Claim
143	Hospital 	Other	Interim--Continuing Claim
144	Hospital 	Other	Interim--Last Claim
146	Hospital 	Other	Adjustment Of Prior Claim
147	Hospital 	Other	Replacement Of Prior Claim
148	Hospital 	Other	Void/Cancel Of A Prior Claim
180	Hospital 	Swing Beds	Nonpayment/Zero Claim
181	Hospital 	Swing Beds	Admit-Through-Discharge Claim
182	Hospital 	Swing Beds	Interim--First Claim
183	Hospital 	Swing Beds	Interim--Continuing Claim
184	Hospital 	Swing Beds	Interim--Last Claim
186	Hospital 	Swing Beds	Adjustment Of Prior Claim
187	Hospital 	Swing Beds	Replacement Of Prior Claim
188	Hospital 	Swing Beds	Void/Cancel Of A Prior Claim
...			
no details in remainder in this sample			
21X	SNF	Inpatient	
22X	SNF	Inpatient Part B	
23X	SNF	Outpatient	
24X	SNF	Outpatient (other than Part B)	
28X	SNF	Swing Beds	
32X	Home health	Home health Part B
33X	Home health	Home health
34X	Home health	Home health (other)
41X	Religious nonmedical health care institution	Inpatient
51X	Religious nonmedical health care institution	Posthospital extended services
65X	Intermediate care	Level I
66X	Intermediate care	Level II
67X	Intermediate care	Subacute inpatient
71X	Clinic	Rural health
72X	Clinic	ESRD
73X	Clinic	Freestanding (FQHC)
74X	Clinic	ORF
75X	Clinic	CORF
76X	Clinic	CMHC
77X	Reserved	
78X	Reserved	
79X	Clinic	Other
81X	Special facility	Non-hospital hospice
82X	Special facility	Hospital-based hospice
83X	Special facility	Ambulatory Surgical Center
84X	Special facility	Freestanding Birthing Center
85X	Special facility	Critical Access Hospital
86X	Special facility	Residential Facility
87X	Reserved	
88X	Reserved	
89X	Special facility	Other
9XX	Reserved for national assignment