Office of Workers' Compensation Programs (OWCP)
Division of Federal Employees' Compensation (DFEC)
Chargeback Data Dictionary
FIELD NAME |
LOCATION START END |
FIELD TYPE |
CBSUM-REC NAME |
DESCRIPTION |
DEFINITION OF LEGAL VALUES ESAFECS |
|
CB AGENCY KEY |
1 |
7 |
NUM/7 |
PREFIX |
Department indicator and accounting code |
|
ROLLUP CODE |
8 |
11 |
NUM/4 |
AGENCY-ROLLUP-CODE |
Chargeback agency rollup code |
|
CASE NUMBER |
12 |
20 |
NUM/9 |
CASE-NO |
Unique numeric identifier for each case |
|
RECORD TYPE |
21 |
21 |
NUM/1 |
REC TYPE |
Appropriate record type |
1 – SUMMARY 2 – DETAIL |
DISTRICT OFFICE |
22 |
23 |
NUM/2 |
LAST-PYMT-DIST |
Owning district office |
|
LAST PAYMENT DATE |
24 |
31 |
DATE/8 |
LAST-PYMT-DATE |
Date of the latest transaction |
YYYYMMDD
|
LAST SERVICE INDICATOR |
32 |
32 |
CHAR/1 |
SRCE-CP-OR-BP |
Latest transaction’s service type. |
B - MEDICAL C - COMPENSATION X – CANCELLED CHECK (COMPENSATION) |
LAST ROLL |
33 |
33 |
CHAR/1 |
SRCE-CP-LAST-ROLL |
Latest roll type for which the claimant was last paid |
S - SUPPLEMENTAL P – PERIODIC D – DEATH |
PAYMENT TYPE |
34 |
34 |
CHAR/1 |
SRCE-PYMT-TYPE |
Type of transaction for a case when it is a bill pay or compensation. This is dependent upon the last service indicator
|
If Last Service Indicator is ‘B’, then payment type could be either: B - NORMAL MEDICAL BILLS PAID BY THE SYSTEM C - CANCELLED CHECK D - CASH DEPOSIT M - MANUAL PAYMENT |
If Last Service Indicator is ‘C’, then payment type could be either: 0 = ADJUSTMENT 1 = DISABILITY 2 = LEAVE BUY BACK 3 = WEC 4 = DIRECT PAYMENT 5 = INCARCERATED 6 = DEATH EXPENSES 7 = DEATH 8 = MANUAL PAYMENT 9 = SCHEDULED AWARD A = DEATH LUMP SUM B = CASH RECEIPT C = FECS PAYMENTS ADJUSTMENT |
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SUMMARY RECORD |
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CASE NUMBER |
35 |
43 |
NUM/9 |
CBSUM-CASE-PTR |
Use the case type field to map the cases to the master case number.
By default, if no master case number exists, then this section shall be blank.
If the case type is ‘S’ or ‘M’, then this section shall indicate the master case number. |
|
CASE TYPE |
44 |
44 |
CHAR/1 |
CASE-PTR-TYPE |
Relationship between this case and any other cases in the file |
I = INDEPENDENT M = MASTER S = SUBSIDIARY |
CLAIMANT NAME |
45 |
87 |
CHAR/43 |
CLM-NAME |
Claimant’s full name |
LAST NAME 45 – 64 FIRST NAME 65 – 74 MIDDLE NAME 75 – 84 |
SOCIAL SECURITY |
88 |
96 |
NUM/9 |
SSAN |
Claimant’s social security number |
|
GENDER |
97 |
97 |
CHAR/1 |
SEX |
Claimant’s gender |
M – MALE F – FEMALE |
DATE OF BIRTH |
98 |
105 |
DATE/8 |
DOB |
Claimant’s date of birth |
YYYYMMDD |
CLAIMANT’S ADDRESS |
106 |
167 |
CHAR/50 |
CLM-ADDR |
Claimant’s full address |
CLM-ADDR-STREET 106 – 140 CLM-ADDR-CITY 141 – 160 CLM-ADDR-STATE 161 – 162 CLM-ADDR-ZIP 163 – 167 |
OCCUPATIONAL CODE |
168 |
172 |
CHAR/5 |
OCC-CODE |
Claimant’s job at the time of injury |
|
AGENCY CODE |
173 |
176 |
NUM/4 |
AGENCY-CODE |
Employing agency code |
|
BUILDING CODE |
177 |
178 |
NUM/2 |
AGENCY-BLDG |
Building location code |
INTERNAL TO OWCP |
GEOGRAPHIC LOCATION |
179 |
187 |
CHAR/9 |
GEO-LOC |
Geographic location where the injury or death took place |
|
DATE OF INJURY |
188 |
195 |
DATE/8 |
DOI |
Employee’s date of injury |
YYYYMMDD |
DATE OF DEATH |
196 |
203 |
DATE/8 |
DOD |
Employee’s date of death |
YYYYMMDD |
INJURY OF ZIP |
204 |
208 |
NUM/5 |
INJ-ZIP |
Zip code where the injury took place |
|
EXTENT OF INJURY |
209 |
209 |
CHAR/1 |
EXTENT-INJ |
Seriousness of the injury |
1 = NO TIME LOST 2 = FIRST AID 8 = INOCULATION X = NON-FATAL, LOST TIME 0 = FATAL |
STATUS OF INJURY |
210 |
210 |
NUM/1 |
STATUS-INJ |
Status of injury |
0 = NON-FATAL 1 = FATAL |
FATAL INDICATOR |
211 |
211 |
NUM/1 |
FATAL-IND |
Relationship between the employee’s death and the claimed injury |
BLANK = NO DEATH 0 = DEATH NOT WORK RELATED 1 = DEATH RELATED TO WORK 2 = DEATH RELATED TO WORK, INITIALLY NOT SEVERE |
ANATOMICAL LOCATION |
212 |
213 |
CHAR/2 |
ANAT-LOC |
Anatomical location of the injury |
|
NATURE OF INJURY |
214 |
215 |
CHAR/2 |
NATURE |
Nature of injury |
|
CAUSE OF INJURY |
216 |
217 |
NUM/2 |
CAUSE |
Cause of injury |
|
PREVIOUS OWNERS |
218 |
224 |
NUM/7 |
CURR-PREV-OWNERS |
NO LONGER USED |
BLANK |
DATE RECEIVED |
225 |
232 |
DATE/8 |
DATE-REC |
Date the initial claim form was received (date stamped) |
YYYYMMDD |
FORMS RECEIVED |
233 |
234 |
NUM/2 |
FORMS-RECVD |
Type of claim form used at the time the case was created |
1 = CA-1 2 = CA-2 5 = CA-5 |
DATE CASE CREATED |
235 |
242 |
DATE/8 |
DATE-CASE-CREATED |
Date the case was created in the district office |
YYYYMMDD |
ADJUDICATED STATUS |
243 |
244 |
CHAR/2 |
ADJUD-STATUS |
Case’s current adjudication status code |
00 = NO STATUS A0 = ACCEPTED - NO BENEFITS PAYABLE AC = ACCEPTED AS COMPENSABLE - COP ONLY, MED BENEFITS AUTHORIZED AD = ACCEPTED AS COMPENSABLE - DAILY ROLL & MED BENEFITS AUTHORIZED AF = ACCEPTED AS COMPENSABLE – FATAL, DEPENDENT ON PERIODIC ROLL, NO MED BENEFITS AL = ACCEPTED AS COMPENSABLE - LEAVE ELECTED MED BENEFITS AUTHORIZED AM = ACCEPTED AS COMPENSABLE - MED BENEFITS ONLY AUTHORIZED AP = ACCEPTED AS COMPENSABLE - PERIODIC ROLL AND MED. BENEFITS AUTHORIZED AR = ADMINISTRATIVE REVIEW AT = ACCEPTED AS WORK-RELATED - WAGE LOSS COMP DENIED, MED BENEFITS AUTHORIZED DO = DENIED; CASE ON APPEAL/RECON D1 = DENIED; UNTIMELY D2 = DENIED; NOT CIVIL SERVICE EMPLOYEE D3 = DENIED; NO FACT OF INJURY D4 = DENIED: NOT IN PERFORMANCE OF DUTY D5 = DENIED; NO CASUAL RELATIONSHIP D6 = DENIED; BURDEN OF PROOF (NO LONGER USED) D7 = DENIED: CASE ON APPEALS REMAND D8 = DENIED; CASE ON HEARING REMAND D9 = DENIED; CASE IN RECONSIDERATION SU = SUSPENDED UD = LEGACY CASES ONLY UN = UNADJUDICATED |
ADJUDICATED STATUS DATE |
245 |
252 |
DATE/8 |
ADJUD-STATUS-DATE |
Date of the most recent adjudication status. |
YYYYMMDD |
CURRENT CASE STATUS |
253 |
254 |
ALPHNUM/2 |
CURR-CASE-STATUS |
Current case pay status |
AR = ADMINISTRAVE REVIEWED C1= CLOSED, NO TIME LOST C2 = CLOSED, LEAVE ELECTED C3 = CLOSED, BENEFITS DENIED C4 = CLOSED, COP COVERED ALL TIME LOST C5 = CLOSED, OTHER - ALL BENEFITS PAID CL = CLOSED, ADMINISTRATIVE DE = DEATH ROLL DR = DAILY ROLL MC = MEDICAL PAYMENTS ONLY N = PERIODIC ROLL W NO RE-EMPLOYMENT POTENTIAL (NO LONGER USED) ON = OVERPAYMENT, NOT IN RECEIPT OF COMP OP = OVERPAYMENT, CASE ON COMP ROLL PI = CASE ON INTERMEDIATE ROLL (USE PR) (NO LONGER USED) PN = PERIODIC ROLL, NO WAGE EARNING CAPACITY PR = PERIODIC ROLL PS = SCHEDULE AWARD PW = PERIODIC ROLL, LWEC IN PLACE PV = PERIODIC ROLL; IN VOC REHAB (USE PR) (NO LONGER USED) RH = NO LONGER USED RO = REOPEN (LEGACY DATA) RT = CASE RETIRED OR AWAITING RETIREMENT UD = CLAIM UNDER DEVELOPMENT UN = CLAIM UNREVIEWED, PRIMARY XX = DESTROYED |
CURRENT CASE DATE |
255 |
262 |
DATE/8 |
CURR-STATUS-DATE |
Case’s current pay status date |
YYYYMMDD |
EARLY REFERENCE |
263 |
264 |
CHAR/2 |
EARLY-REF |
NO LONGER USED |
BLANK |
CMF CODE |
265 |
265 |
CHAR/1 |
CMF-CODE |
NO LONGER USED |
BLANK |
REP. ACCEPTANCE CONDITION |
266 |
300 |
CHAR/35 |
REP-ACCPT-COND |
NO LONGER USED |
BLANK |
SOURCE OF INJURY |
301 |
304 |
NUM/4 |
SOURCE-INJURY |
OSHA injury site |
|
CA1 SIGNATURE DATE |
305 |
312 |
DATE/8 |
CA1-2-SIG-DATE |
Date the submitted claim (CA1, CA2, or CA5) was signed |
YYYYMMDD |
ACCEPTED CONDITION FLAG |
313 |
313 |
CHAR/1 |
REP-ACCPT-COND-FLAG |
Whether the reported diagnosis was accepted as compensable |
N = NOT ACCEPTED AS COMPENSABLE Y = ACCEPTED AS COMPENSABLE |
THIRD PARTY INDICATOR |
314 |
314 |
CHAR/1 |
3RD-PARTY-IND |
Latest third party insurance, if present |
0 = NO 3RD PARTY INSURANCE 1 = NOT REFERRED TO SOL 2 = REFERRED TO SOL 4 = CLOSED; MINOR, NOT ECONOMICAL TO PURSUE 5 = CLOSED; OTHER 6 = SETTLED; NO REFUND DUE 7 = SETTLED; REFUND NOT RECEIVED 8 = SETTLED; REFUND RECEIVED, NO CREDIT DUE 9 = SETTLED; REFUND RECEIVED, CREDIT DUE AGAINST FUTURE COMPENSATION |
REHABILITATION INDICATOR |
315 |
315 |
CHAR/1 |
REHAB-IND |
Case’s vocational rehabilitation status |
1 = CLOSED ON REFERRAL 2 = CLOSED REHABILITATED 3 = CLOSED REHABILITATED, NEW EMPLOYER 4 = CLOSED REHABILITATED, PREV. REEMP 5 = CLOSED, NOT REHABILITATED, 6 = CLOSED WITH POST EMPLOYMENT SERVICES 7 = RETURNED TO WORK, NURSE INTERVENTION 8 = RETURNED TO WORK, W/OUT VR ASSISTANCE 9 = COP CLOSURE A = INITIAL INTERVIEW HELD B = NURSE INTERVENTION C = RETURNED TO CE D = PLAN DEVELOPMENT E = EXTENSION F = WORKING PART TIME OR TEMPORARY G = PLACEMENT ASST. REEMPLOYMENT H = EMPLOYED BY NURSE I = PLAN APPROVED K = NOT RTW, NI, WORK LIMITS ON FILE L = LIGHT DUTY N = PLACEMENT PREV. EMPLOYER O = NO RTW, NI, RETURNED TO CE P = PLACEMENT, NEW EMPLOYER Q = SCREENED R = REFERRED TO RS(DEFAULT ADD STATUS) S = SELF-EMPLOYED T = TRAINING U = CLOSED BY NURSE, NOT RTW V = EMPLOYED, ASST. REEMPLOYMENT W = PLACEMENT PREV. EMPLOYER W/OTHER SERV. X = SERVICES INTERRUPTED Y = NURSE INTERRUPT Z = POST EMPLOYMENT SERVICES |
REHABILITATION DATE |
316 |
323 |
DATE/8 |
REHAB-DATE |
Case’s current vocational rehabilitation status date |
YYYYMMDD |
PAY DISPOSITION |
324 |
324 |
CHAR/1 |
PYMT-DISP |
Whether the agency has reported to OWCP that pay has been terminated |
N = PAY NOT TERMINATED Y = PAY TERMINATED |
CONTINUATION OF PAY |
325 |
325 |
CHAR/1 |
COP-TYPE |
Whether the claimant used COP benefits |
N = COP BENEFIT NOT USED Y = COP BENEFIT USED |
CONTROVERSION IND, |
326 |
326 |
CHAR/1 |
CNTRVTD-IND |
If the claim was controverted |
N = NOT CONTROVERTED Y = CONTROVERTED |
COMP CLAIM IND. |
327 |
327 |
CHAR/1 |
CMP-CLM-IND |
Whether a CA-7 is on file |
Y = CA-7 FORM IS ON FILE N = CA-7 FORM IS NOT ON FILE |
COMP CLAIM DATE |
328 |
335 |
DATE/8 |
CMP-CLM-DATE |
Latest date when the compensation claim was received |
YYYYMMDD |
ACTIVITY CODE |
336 |
337 |
NUM/2 |
ACTIVITY-CODE |
Whether coverage was by FECA or the FRINGE ACTS |
01 = FEDERAL CIVILIAN 02 = RESERVISTS(NO MINS, NO CPI’S) 03 = CIVIL AIR PATROL 04 = RESERVE OFFICER TRAINING 05 = MARITIME WAR RISK 06 = EMERGENCY RELIEF WORKERS – FIRE HAZZARD 07 = WAR – CONNECTED 08 = CIVILIAN WAR BENEFITS 09 = TOTAL BENEFITS, WAR CLAIMS 10 = POVERTY PROGRAMS 11 = LAW ENFORCEMENT OFFICERS 12 = COAST GUARD AUX 13 = JOB CORPS 14 = NEIGHBORHOOD YOUTH ENROLLEES 15 = MILITARY RESERVISTS SURVIVORS 16 = MEMBERS OF THE WOMAN’S ARMY AUXILIARY CORPS 17 = PEACE CORP VOLUNTEERS LEADERS 99 = OTHER |
RESPONSIBLE EXAMINER |
338 |
340 |
CHAR/3 |
RESP-EXAM |
Claims Examiner responsible for the claim |
|
PRMS INDICATOR |
341 |
341 |
CHAR/1 |
PRMS-IND |
If a case is part of the Periodic Roll Management System (PRMS) |
N = DEFAULT VALUE AT CASE CREATE, NOT PART OF PRMS Y = PART OF THE PRMS UNIVERSE |
TYPE INJURY |
342 |
344 |
NUM/3 |
TYPE-INJURY |
The type of OSHA injury |
100 = STRUCK 110 = STRUCK BY 111 = STRUCK BY FALLING OBJECT 120 = STRUCK AGAINST 200 = FELL, SLIPPED, TRIPPED 210 = FELL, SAME LEVEL 220 = FELL, DIFFERENT LEVEL 230 = SLIPPED, TRIPPED, NO FALL 300 = CAUGHT 310 = CAUGHT ON 320 = CAUGHT IN 330 = CAUGHT BETWEEN 400 = PUNCTURED, LACERATED 410 = PUNCTURED BY 420 = CUT BY 430 = STUNG BY 440 = BITTEN BY 500 = CONTACT 510 = CONTACT WITH 520 = CONTACT BY 600 = EXERTION 610 = LIFTED, STRAINED BY 620 = STRESSED BY 700 = EXPOSURE 710 = INHALATION 720 = INGESTION 730 = ABSORPTION 800 = TRAVELING IN 999 = UNCLASSIFIED |
BILLABLE FLAG |
345 |
345 |
CHAR/1 |
BILLABLE-FLAG |
INTERNAL USE ONLY |
|
ERROR CODE COUNTER |
346 |
347 |
NUM/2 |
ERROR-CODE-CNTR |
INTERNAL USE ONLY |
|
ERROR CODES |
348 |
373 |
CHAR/26 |
ERRORS-CODES |
INTERNAL USE ONLY |
|
HBI OLI FLAG |
374 |
374 |
CHAR/1 |
HBI-OLI-FLAG |
INTERNAL USE ONLY |
|
CANCELLED CHECK FLAG |
375 |
375 |
CHAR/1 |
CANCEL-CK-FLAG |
Whether the compensation check has or will be cancelled |
Y = CANCELLATION ENTRY(LATER CHECK DATE) |
DUPLICATE FLAG |
376 |
376 |
CHAR/1 |
DUP-FLAG |
INTERNAL USE ONLY |
|
HBI/OLI ADJUSTMENTS |
377 |
378 |
NUM/2 |
HBI-OLI-ADJ-CNT |
INDICATES NUMBER OF HBI/OLI ADJUSTMENTS |
No longer valid |
CANCELLED CHECKS ADJUSTMENTS |
379 |
380 |
NUM/2 |
CANCEL-CK-ADJ-CNT |
Number of compensation cancelled check adjustments |
|
DUPLICATE ADJUSTMENTS |
381 |
382 |
NUM/2 |
DUP-ADJ-CNT |
INDICATES NUMBER OF DUPLICATE ADJUSTMENTS |
No longer valid |
HBI/OLI ADJUSTMENTS |
383 |
392 |
NUM/10 |
HBI-OLI-ADJ-AMT |
INDICATES AMOUNT OF HBI/OLI ADJUSTMENTS |
No longer valid |
CANCELLED CHECKS |
393 |
402 |
NUM/10 |
CANCEL-CK-ADJ-AMT |
This section shall indicate the amount of cancelled checks (Compensation only) |
|
DUPLICATE ADJUSTMENTS |
403 |
412 |
NUM/10 |
DUP-ADJ-AMT |
INDICATES AMOUNT OF DUPLICATE ADJUSTMENTS |
No longer valid |
TOTAL AMOUNT PAID |
413 |
421 |
NUM/9
|
TOTAL-AMT |
Total Chargeback amount paid for bill pay and compensation payments |
|
MEDICAL BILLS |
422 |
426 |
NUM/5 |
BPS-NO |
Total number of medical bills paid |
|
MEDICAL BILLS PAID |
427 |
435 |
NUM/9 |
BPS-AMT |
Total amount of medical bills paid |
|
COMPENSATION PAYMENTS |
436 |
440 |
NUM/5 |
CP-NO |
Total amount of compensation payments, fatal and non-fatal |
|
COMPENSATION PAYMENTS PAID |
441 |
449 |
NUM/9 |
CP-AMT |
Total amount of compensation paid, fatal and non-fatal |
|
COMPENSATION FLAG |
450 |
450 |
CHAR/1 |
CP-FLAG |
Whether the compensation payment was issued for a case |
Y = Compensation Payment Was Issued |
DETAIL RECORD |
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PAYING DISTRICT |
35 |
36 |
NUM/2 |
PAYING-DIST |
District office that made the payment |
|
PAYMENT DATE |
37 |
44 |
DATE/8 |
PYMT-DATE |
Payment date |
YYYYMMDD |
PAYMENT AMOUNT |
45 |
52 |
NUM/8 |
PYMT-AMT |
Chargeback amount paid |
|
PAYMENT FROM DATE |
53 |
60 |
DATE/8 |
PYMT-FROM-DATE |
Starting date of the payment |
YYYYMMDD |
PAYMENT TO DATE |
61 |
68 |
DATE/8 |
PYMT-TO-DATE |
Ending date of the payment |
YYYYMMDD |
SSN |
69 |
77 |
NUM/9 |
PAYEE-SSN-EIN |
Payee’s social security number or EIN number |
|
PAYEE NAME |
78 |
112 |
CHAR/35 |
PAYEE-NAME |
Payee’s name |
|
PAYEE ADDRESS |
113 |
245 |
CHAR/133 |
PAYEE-ADDR |
Payee’s address or the EFT/account routing number |
PAYEE ADDRESS LINE 1,2,3 = 113-218 PAYEE CITY = 219-238 PAYEE STATE = 239-240 PAYEE ZIP = 241-245 |
PAYMENT TYPE |
246 |
246 |
CHAR/1 |
CB-PAY-TYPE |
Type of transaction for a case when it is a bill pay or compensation
|
If Service Indicator is ‘B’, then payment type could be either: B - NORMAL MEDICAL BILLS PAID BY THE SYSTEM C - CANCELLED CHECK D - CASH DEPOSIT M - MANUAL PAYMENT
If Service Indicator is ‘C’, then payment type could be either: 0 = ADJUSTMENT 1 = DISABILITY 2 = LEAVE BUY BACK 3 = WEC 4 = DIRECT PAYMENT 5 = INCARCERATED 6 = BURIAL, TRANSPORTATION 7 = DEATH 8 = MANUAL PAYMENT 9 = SCHEDULED AWARD A = DEATH LUMP SUM B = CASH RECEIPT C = FECS PAYMENTS ADJUSTMENT |
BILL PAY REIMBURSEMENT CODE |
247 |
247 |
CHAR/1 |
BP-REIMB-CODE |
If payment has been made to the provider or claimant (Medical payments only) |
P = PROVIDER C = CLAIMANT |
ADJUSTMENT INDICATOR |
248 |
248 |
CHAR/1 |
ADJ-IND |
Whether the record is an adjustment record |
N = NO Y = YES |
TYPE INJURY |
249 |
251 |
NUM/3 |
TYPE-INJURY |
Type of injury |
100 = STRUCK 110 = STRUCK BY 111 = STRUCK BY FALLING OBJECT 120 = STRUCK AGAINST 200 = FELL, SLIPPED, TRIPPED 210 = FELL, SAME LEVEL 220 = FELL, DIFFERENT LEVEL 230 = SLIPPED, TRIPPED, NO FALL 300 = CAUGHT 310 = CAUGHT ON 320 = CAUGHT IN 330 = CAUGHT BETWEEN 400 = PUNCTURED, LACERATED 410 = PUNCTURED BY 420 = CUT BY 430 = STUNG BY 440 = BITTEN BY 500 = CONTACT 510 = CONTACT WITH 520 = CONTACT BY 600 = EXERTION 610 = LIFTED, STRAINED BY 620 = STRESSED BY 700 = EXPOSURE 710 = INHALATION 720 = INGESTION 730 = ABSORPTION 800 = TRAVELING IN 999 = UNCLASSIFIED |
SOURCE OF INJURY |
252 |
255 |
NUM/3 |
SOURCE-INJURY |
OSHA source of the injury |
|
OSHA SITE CODE |
256 |
264 |
CHAR/9 |
OSHA-SITE-CODE |
OSHA injury site |
|
PROCEDURE CODE |
265 |
272 |
CHAR/8 |
PROC-CODE |
Billed procedure code |
|
BILL NUMBER |
273 |
275 |
NUM/3 |
BILL-ID-NO |
Sequential number of the medical bill. |
|
BILL ITEM NUMBER |
276 |
279 |
NUM/4 |
BILL-LINE-ITEM-NO |
Sequential number of medical bill line item |
|
AGENCY CODE |
280 |
285 |
NUM/6 |
AGENCY-CODE |
Agency code |
|
FILLER |
286 |
451 |
CHAR/137 |
UNUSED-DATA-AREA |
|
|
|