Required when MC094 = 002 and Report the code that applies to MC036 = External External Code facility claims where Type of Bill = an 11, 18, 21, Admission Code Source 14 - Admission Source MC 22 11/8/12 char[1] inpatient setting. This code indicates 28, 41, 65, 98% A1 Source Source Admission Code how the patient was referred into an 66, 84, 86 14 - Text Source inpatient setting at the facility. or 89 (type of bill indicates an inpatient visit) The MA APCD reserves this field for MC 23 Filler 10/30/14 Filler Filler char[4] Filler future use. Do not populate with any All 0% Z data. Required External External Code when Code Inpatient Report the appropriate Discharge Discharge Source 14 - MC094 = MC 24 11/8/12 Source char[2] Discharge Status Status Code of the patient as defined 98% A1 Status Discharge 002 and 14 - Code by External Code Source Status MC069 is Numeric populated Report the carrier / submitter assigned service provider number. This number should be the identifier Service Service Provider ID Link to used for internal identification MC 25 Provider 6/24/10 Text Identification All 99% A1 24 PV002 purposes, and does not routinely Number Number change. The value in this field must match a record in the provider file in PV002. Service Report the Federal Tax ID of the Provider Service Provider's MC 26 11/8/12 Numeric ID Tax char[9] Service Provider here. Do not use All 97% C Tax ID Tax ID number hyphen or alpha prefix. Number
MC 22 Admission Source 11/8/12 External Code Source 14 - Text External Code Source 14 - Admission Source char[1] Admission Source Code Report the code that applies to facility claims where Type of Bill = an inpatient setting. This code indicates how the patient was referred into an inpatient setting at the facility. Required when MC094 = 002 and MC036 = 11, 18, 21, 28, 41, 65, 66, 84, 86 or 89 (type of bill indicates an inpatient visit) 98% A1 MC 23 Filler 10/30/14 Filler Filler char[4] Filler The MA APCD reserves this field for future use. Do not populate with any data. All 0% Z MC 24 Discharge Status 11/8/12 External Code Source 14 - Numeric External Code Source 14 - Discharge Status char[2] Inpatient Discharge Status Code Report the appropriate Discharge Status Code of the patient as defined by External Code Source Required when MC094 = 002 and MC069 is populated 98% A1 MC 25 Service Provider Number 6/24/10 Text ID Link to PV002 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 field must match a record in the provider file in PV002. All 99% A1 MC 26 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 alpha prefix. All 97% C 24