Description 1 Yes 2 No 3 Unknown 4 Other 5 Not Applicable External Code External Source 8 - Diagnosis Code ICD Diagnosis Report the ICD Diagnosis Code when PC 91 11/8/12 International varchar[7] All 1% B Code Source Code applicable Classification of 8 - Text Disease International Required Lookup Report the value that defines whether the ICD Classification of when PC 92 11/8/12 Table - tlkpICDIndicator int[1] diagnoses on claim are ICD9 or ICD10. 100% B Indicator Diseases PC114 is Integer EXAMPLE: 9 = ICD9 version populated Value Description 9 ICD-9 0 ICD-10 Required Lookup Report the value that defines the element. Denied Denied Claim when PC 93 11/8/12 - tlkpFlagIndicators int[1] EXAMPLE: 1 = Yes, Claim Line was 100% A0 Flag Line Indicator PC025 = Integer denied. 04 Value Description 1 Yes 2 No 3 Unknown 4 Other 5 Not Applicable Carrier Defined External Code - Source 16 - Report the code that defines the reason Required Denial OR - Reason Denial Reason for denial of the claim line. Carrier must PC 94 11/8/12 when 98% A2 Reason External -OR Code submit denial reason codes in separate – = 1 Code Carrier Defined table to the APCD. Source Table 16 Report the value that defines the Payment Lookup Payment contracted payment methodology for this PC 95 11/8/12 - char[2] Arrangement All 98% A0 claim line. 02 = Fee for EXAMPLE: Type Numeric Type Value Service
Description 1 Yes 2 No 3 Unknown 4 Other 5 Not Applicable PC 91 Diagnosis Code 11/8/12 External Code Source 8 - Text External Code Source 8 - International Classification of Disease varchar[7] ICD Diagnosis Code Report the ICD Diagnosis Code when applicable All 1% B PC 92 ICD Indicator 11/8/12 Lookup Table - Integer tlkpICDIndicator int[1] International Classification of Diseases version Report the value that defines whether the diagnoses on claim are ICD9 or ICD10. EXAMPLE: 9 = ICD9 Required when PC114 is populated 100% B Value Description 9 ICD-9 0 ICD-10 PC 93 Denied Flag 11/8/12 Lookup - Integer tlkpFlagIndicators int[1] Denied Claim Line Indicator Report the value that defines the element. EXAMPLE: 1 = Yes, Claim Line was denied. Required when PC025 = 04 100% A0 Value Description 1 Yes 2 No 3 Unknown 4 Other 5 Not Applicable PC 94 Denial Reason 11/8/12 Carrier Defined - OR - External Code Source 16 External Code Source 16 - Reason -OR – Carrier Defined Table Denial Reason Code Report the code that defines the reason for denial of the claim line. Carrier must submit denial reason codes in separate table to the APCD. Required when = 1 98% A2 PC 95 Payment Type 11/8/12 Lookup - Numeric char[2] Payment Arrangement Type Value Report the value that defines the contracted payment methodology for this claim line. EXAMPLE: 02 = Fee for Service All 98% A0