Number should be the identifier used by the payer for internal identification purposes, and does not routinely change. MC121 National 2/1/2016 Text 20 National Provider ID for referring provider Provider ID – Referring Refer to Appendix A Provider Referring 2/1/2016 Text 40 Individual first name Provider First Name MC123 Referring 2/1/2016 Text 25 Individual middle name or initial Provider Middle Name Referring 2/1/2016 Text 60 Individual last name Provider Last Name MC125 Referring 2/1/2016 Text 10 Individual name suffix The referring provider suffix Provider Suffix shall be used to capture the generation of the individual clinician (e.g., Jr., Sr., III), if applicable, rather than the clinician’s degree (e.g., MD, LCSW). MC200 Principal 10/1/2014 Text 7 ICD-10-CM Do not code Diagnosis decimal point. Refer to Appendix A
Number should be the identifier used by the payer for internal identification purposes, and does not routinely change. MC121 National Provider ID – Referring Provider 2/1/2016 Text 20 National Provider ID for referring provider Refer to Appendix A Referring Provider First Name 2/1/2016 Text 40 Individual first name MC123 Referring Provider Middle Name 2/1/2016 Text 25 Individual middle name or initial Referring Provider Last Name 2/1/2016 Text 60 Individual last name MC125 Referring Provider Suffix 2/1/2016 Text 10 Individual name suffix The referring provider suffix shall be used to capture the generation of the individual clinician (e.g., Jr., Sr., III), if applicable, rather than the clinician’s degree (e.g., MD, LCSW). MC200 Principal Diagnosis 10/1/2014 Text 7 ICD-10-CM Do not code decimal point. Refer to Appendix A