Report here. Indicates that the Defines the file data within this file is expected to be Type of - 4 11/8/12 Text ID File char[2] type and data MEDICAL CLAIM-based. This must Mandatory 100% HM File MC expected. match the File Type reported in TR004. Report the Year and Month of the reported submission period in Period Date Century Year CCYYMM format. This date period Header Period - 5 Beginning 11/8/12 Period Month int[6] must be repeated in HD006, TR005 Mandatory 100% HM Date MC Date Integer CCYYMM and TR006. This same date must be selected in the upload application for successful transfer. Report the Year and Month of the reporting submission period in Period Date Century Year Header Period CCYYMM format. This date period - 6 Ending 11/8/12 Period Month int[6] Mandatory 100% HM Ending Date must match the date period reported MC Date Integer CCYYMM in HD005 and be repeated in TR005 and TR006. Report the total number of records Record Header Record submitted within this file. Do not - 7 11/8/12 Integer Counter Mandatory 100% HM Count Count report leading zeros, space fill, MC decimals, or any special characters. May be used to document the Header Carrier submission by assigning a filename, - 8 11/8/12 Text Free Text Optional 0% HO Comments system source, compile identifier, MC etc. Report the version number as presented on the APCD Medical APCD Claim File Submission Guide in 0.0 Decimal Submission - 9 Version ID Version char[3] Format. Sets the intake control for Mandatory 100% HM 9 Numeric Version MC Number editing elements. Version must be accurate else file will drop. EXAMPLE: 3.0 = Version 3.0 Code Description Version; valid only for reporting 2.1 periods prior to October 2013 Version 3.0; required for reporting 3.0 periods as of October 2013; No Longer Valid as of May 2015
4 Type of File 11/8/12 Text ID File char[2] Defines the file type and data expected. Report MC here. Indicates that the data within this file is expected to be MEDICAL CLAIM-based. This must match the File Type reported in TR004. Mandatory 100% HM 5 Period Beginning Date 11/8/12 Date Period Integer Century Year Month CCYYMM int[6] Header Period Date Report the Year and Month of the reported submission period in CCYYMM format. This date period must be repeated in HD006, TR005 and TR006. This same date must be selected in the upload application for successful transfer. Mandatory 100% HM 6 Period Ending Date 11/8/12 Date Period - Integer Century Year Month - CCYYMM int[6] Header Period Ending Date Report the Year and Month of the reporting submission period in CCYYMM format. This date period must match the date period reported in HD005 and be repeated in TR005 and TR006. Mandatory 100% HM 7 Record Count 11/8/12 Integer Counter Header Record Count Report the total number of records submitted within this file. Do not report leading zeros, space fill, decimals, or any special characters. Mandatory 100% HM 8 11/8/12 Text Free Text Header Carrier Comments May be used to document the submission by assigning a filename, system source, compile identifier, etc. Optional 0% HO 9 APCD Version Number Decimal - Numeric ID Version char[3] Submission Version Report the version number as presented on the APCD Medical Claim File Submission Guide in 0.0 Format. Sets the intake control for editing elements. Version must be accurate else file will drop. EXAMPLE: 3.0 = Version 3.0 Mandatory 100% HM Code Description 2.1 Version; valid only for reporting periods prior to October 2013 3.0 Version 3.0; required for reporting periods as of October 2013; No Longer Valid as of May 2015 MC MC MC - MC MC 9 - -