1. National Drug Codes - identifies vendor - product - and package size - recognized by FDA - maintained by HHS

2. The policy and/or group number of the Medigap insured preceded by MEDIGAP - MG or MGAP

3. The claims processing address of the Medigap insurer. Left blank if 9d is completed

4. Diagnosis codes - maintained by National Center for Health Statistics - Centers for Disease Control

5. HCPCS; CPT; ICD-10-CM; NDC; CDT; Place of Service Codes

6. Two-digit codes that denote the setting in which the service was provided - maintained by CMS

7. Services not covered by CPT - established by CMS

8. Describe medical procedures and physician services - maintained by AMA

9. Claims & encounter information; Payment & remittance advice; Claim status; Eligibility; Enrollment & disenrollment; Referrals & authorizations; Coordination of benefits; and Premium payments

10. The Coordination of Benefits Agreement (COBA) Medigap claim-based Identifier (ID)

11. Inpatient hospital services - maintained by CMS

12. Comprehensive health & developmental history; Comprehensive unclothed physical exam; Immunizations according to the Advisory Committee on Immunization Practices; Lab tests - including toxicity screening; Health education w/anticipator guidance including child development - health lifestyles and accident & disease prevention; Vision; Dental; Hearing; Other necessary healthcare (state); Diagnostic; Treatment

13. Full Name; DOB; HICN; Gender

14. Current Dental Terminology - dental services - maintained by ADA (American Dental Association)

15. The medigap insured's 8-digit date of birth (mm/dd/yyyy) and sex

16. The health plan of the member whose birthday comes first in the calendar year (year of birth is not a factor)