C-A D8 Title XIX Facility Alert
ST: XX FO: XXX RDT: XXXXXX
HUN: XXX-XX-XXXX SSN: XXX-XX-XXXX
NAME: XXXXXXXXXXXXXXXXXXXX, XXXXXXXXXX, X
DOE: MM/DD/YYYY DD: MM/DD/YYYY
RD: MM/DD/YYYY AED: MM/DD/YYYY
CPS: x ELS: x
MDS Facility ID No.: xxxxxxxxxxxxxxxx
FAD:XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
XXXXXXXXXXXXXXXXXXXXXXXXXXXX XX
FTEL: XXX-XXX-XXXX
The following represent the data elements in the alert:
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ST: State code of residence on the SSR when the system created the record selection
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RDT: The run date of the match
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HUN: The housed-under number for the record alerted
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SSN: The Social Security Number (SSN) of the matched individual
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NAME: Last, First, Middle Initial of the matched individual on the title XIX record
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DOE: Admission date to the facility
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DD: Discharge date from the facility
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RD: Reentry date to the facility
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AED: Assessment Effective Date; i.e., the date the facility recorded the information
in the alert.
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CPS: Current payment source. It is possible for a person’s cost-of-care to come from
more than one source. If so, the first source in the list appears on the alert, as
follows:
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c: Medicare ancillary part A;
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d: Medicare ancillary part B;
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f: Veterans Affairs (VA) per diem;
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g: Self or family pays for full per diem;
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h: Medicaid resident liability or Medicare co-payment;
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i: Private insurance per diem (including co-payment); and
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ELS: Expected length of stay:
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O: Expected Discharge more than 90 days after the AED
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1: Expected Discharge within 30 days of the AED
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2: Expected Discharge within 31-90 days of the AED
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3: Expected Discharge status uncertain
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MDS Facility ID No.: Identification number of the title XIX provider. The CMS or the
State providing Medicaid coverage may assign this ID number.
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FAD: Facility name
Street address
City and State
Zip
Code
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FTEL: Facility telephone number