TS2 |
Provider Supplemental Summary Information |
|
||||||
|
Ref |
Id |
Element Name |
Req |
Type |
Min/Max |
Usage |
|
TS201 |
782 |
Monetary Amount
|
O |
R |
1/18 |
Situational |
|
TS202 |
782 |
Monetary Amount
|
O |
R |
1/18 |
Situational |
|
TS203 |
782 |
Monetary Amount
|
O |
R |
1/18 |
Situational |
|
TS204 |
782 |
Monetary Amount
|
O |
R |
1/18 |
Situational |
|
TS205 |
782 |
Monetary Amount
|
O |
R |
1/18 |
Situational |
|
TS206 |
782 |
Monetary Amount
|
O |
R |
1/18 |
Situational |
|
TS207 |
380 |
Quantity
|
O |
R |
1/15 |
Situational |
|
TS208 |
782 |
Monetary Amount
|
O |
R |
1/18 |
Situational |
|
TS209 |
782 |
Monetary Amount
|
O |
R |
1/18 |
Situational |
|
TS210 |
380 |
Quantity
|
O |
R |
1/15 |
Situational |
|
TS211 |
380 |
Quantity
|
O |
R |
1/15 |
Situational |
|
TS212 |
380 |
Quantity
|
O |
R |
1/15 |
Situational |
|
TS213 |
380 |
Quantity
|
O |
R |
1/15 |
Situational |
|
TS214 |
380 |
Quantity
|
O |
R |
1/15 |
Situational |
|
TS215 |
782 |
Monetary Amount
|
O |
R |
1/18 |
Situational |
|
TS216 |
380 |
Quantity
|
O |
R |
1/15 |
Situational |
|
TS217 |
782 |
Monetary Amount
|
O |
R |
1/18 |
Situational |
|
TS218 |
782 |
Monetary Amount
|
O |
R |
1/18 |
Situational |
|
TS219 |
782 |
Monetary Amount
|
O |
R |
1/18 |
Situational |
1. |
TS201 is the total diagnosis related group (DRG) amount. |
2. |
TS202 is the total federal specific amount. |
3. |
TS203 is the total hospital specific amount. |
4. |
TS204 is the total disproportionate share amount. |
5. |
TS205 is the total capital amount. |
6. |
TS206 is the total indirect medical education amount. |
7. |
TS207 is the total number of outlier days. |
8. |
TS208 is the total day outlier amount. |
9. |
TS209 is the total cost outlier amount. |
10. |
TS210 is the diagnosis related group (DRG) average length of stay. |
11. |
TS211 is the total number of discharges. |
12. |
TS212 is the total number of cost report days. |
13. |
TS213 is the total number of covered days. |
14. |
TS214 is total number of non-covered days. |
15. |
TS215 is the total Medicare Secondary Payer (MSP) pass- through amount calculated for a non-Medicare payer. |
16. |
TS216 is the average diagnosis-related group (DRG) weight. |
17. |
TS217 is the total prospective payment system (PPS) capital, federal-specific portion, diagnosis-related group (DRG) amount. |
18. |
TS218 is the total prospective payment system (PPS) capital, hospital-specific portion, diagnosis-related group (DRG) amount. |
19. |
TS219 is the total prospective payment system (PPS) disproportionate share, hospital diagnosis-related group (DRG) amount. |
Notes: |
1. Use the TS2 segment only after a TS3 segment. This segment provides summary information specific to an iteration of the LX loop (Table 2). This segment is expected to be used only for Medicare Part A claims.
|
Example: |
TS2*59786*55375.77~ |