DC 16 External Address Zip Zip Code of Member Code External Code Report the 5 digit Zip Code as defined by DC 17 varchar[] the Member / All 99% ZIP Code Source Source 2 - Zip the United States Postal Service. Patient 2 - Text Codes Report the date that the payer approved this Date claim line for payment in CCYYMMDD Service Full Century Year Date Service Format. This element was designed to DC 18 Approved 6/24/10 Date - Month Day - int[8] Approved by capture date other than the Paid date. If All 98% C (AP Integer CCYYMMDD Payer Approved Date and Paid Date are the Date) same, then the date here should match Paid Date. Report the carrier / submitter assigned service provider number. This number Service Service should be the identifier used for internal ID Link to Provider DC 19 Provider 6/24/10 Text varchar[30] identification purposes, and does not All 100% A1 PV002 Identification Number routinely change. The value in this element Number must match a record in the provider file in PV002. Service Service Report the Federal Tax ID of the Service Provider DC 20 11/8/12 Numeric ID Tax char[9] Provider's Tax Provider here. Do not use hyphen or All 99% C Tax ID ID number prefix. Number National External National External Code Provider Code Report the Primary National Provider ID Provider Source 3 - Identification DC 21 10/30/14 Source int[10] (NPI) here. This ID should be found on the All 98% A2 ID - National (NPI) of the 3 - Provider File in the NPI element (PV039) Service Provider ID Service Integer Provider Service Report the that defines the provider Provider Lookup Service entity type. Only individuals should be DC 22 Entity 11/8/12 Table - int[1] Provider Entity identified with a 1. Facilities, professional All 98% A0 Type integer Identifier Code groups and clinic sites should all be Qualifier identified with a 2. 1 = Person EXAMPLE: Value Description
DC 16 DC 17 Member ZIP Code External Code Source 2 - Text Address Zip External Code Source 2 - Zip Codes varchar[] Zip Code of the Member / Patient Report the 5 digit Zip Code as defined by the United States Postal Service. All 99% DC 18 Date Service Approved (AP Date) 6/24/10 Full Date - Integer Century Year Month Day - CCYYMMDD int[8] Date Service Approved by Payer Report the date that the payer approved this claim line for payment in CCYYMMDD Format. This element was designed to capture date other than the Paid date. If Approved Date and Paid Date are the same, then the date here should match Paid Date. All 98% C DC 19 Service Provider Number 6/24/10 Text ID Link to PV002 varchar[30] Service Provider Identification Number Report the carrier / submitter assigned service provider number. This number should be the identifier used for internal identification purposes, and does not routinely change. The value in this element must match a record in the provider file in PV002. All 100% A1 DC 20 Service Provider Tax ID Number 11/8/12 Numeric ID Tax char[9] Service Provider's Tax ID number Report the Federal Tax ID of the Service Provider here. Do not use hyphen or prefix. All 99% C DC 21 National Provider ID - Service 10/30/14 External Code Source 3 - Integer External Code Source 3 - National Provider ID int[10] National Provider Identification (NPI) of the Service Provider Report the Primary National Provider ID (NPI) here. This ID should be found on the Provider File in the NPI element (PV039) All 98% A2 DC 22 Service Provider Entity Type Qualifier 11/8/12 Lookup Table - integer int[1] Service Provider Entity Identifier Code Report the that defines the provider entity type. Only individuals should be identified with a 1. Facilities, professional groups and clinic sites should all be identified with a 2. EXAMPLE: 1 = Person All 98% A0 Value Description