Carrier Report the identifier the carrier / Specific submitter uses internally to uniquely ID Link to Member's Unique MC Unique 11/8/12 Text identify the member. Used to validate All 100% A0 ME107 ID Member Unique Member ID and link back to ID Member Eligibility (ME107). Report the code that defines the Lookup Claim Line Claim Line Activity claim line status in terms of MC 11/8/12 Table - char[1] All 98% A2 Type Type Code adjudication. EXAMPLE: O = Text Original Code Description O Original V Void R Replacement B Back Out A Amendment Report the Control Number (MC004) that was originally sent in a prior filing that this line corresponds Former to. When reported, this data cannot ID Claim Previous Claim MC Claim 12/1/10 Text equal its own MC004. Use of All 0% B Number Number Number Claim Number” to version “Former claims can only be used if approved by the MA APCD. Contact the MA APCD for conditions of use. MC Carrier Report the identifier the carrier / Specific submitter uses internally to uniquely ID Link to Subscriber's MC Unique 11/8/12 Text identify the subscriber. Used to All 100% A0 ME117 Unique ID Subscriber validate Unique Member ID and link ID back to Member Eligibility (ME117).
MC Carrier Specific Unique Member ID 11/8/12 Text ID Link to ME107 Member's Unique ID Report the identifier the carrier / submitter uses internally to uniquely identify the member. Used to validate Unique Member ID and link back to Member Eligibility (ME107). All 100% A0 MC Claim Line Type 11/8/12 Lookup Table - Text char[1] Claim Line Activity Type Code Report the code that defines the claim line status in terms of adjudication. EXAMPLE: O = Original All 98% A2 Code Description O Original V Void R Replacement B Back Out A Amendment MC Former Claim Number 12/1/10 Text ID Claim Number Previous Claim Number Report the Control Number (MC004) that was originally sent in a prior filing that this line corresponds to. When reported, this data cannot equal its own MC004. Use of “Former Claim Number” to version claims can only be used if approved by the MA APCD. Contact the MA APCD for conditions of use. All 0% B MC MC Carrier Specific Unique Subscriber ID 11/8/12 Text ID Link to ME117 Subscriber's Unique ID Report the identifier the carrier / submitter uses internally to uniquely identify the subscriber. Used to validate Unique Member ID and link back to Member Eligibility (ME117). All 100% A0