Required when MC094 = 002 and MC036 = Report the provider assigned Patient 11, 18, 21, ID Claim Patient Control Encounter / Visit number to identify MC 69 Control 10/30/14 Text 28, 41, 65, 98% A2 Number Number patient treatment. Also known as the Number 66, 84, 86 Patient Account Number. or 89 (type of bill indicates an inpatient visit) Report the date the member was Required discharged from the facility in when Century Year Discharge Full Date CCYYMMDD Format. If patient is MC094 = MC 70 11/8/12 Day - int[8] Discharge Date 98% A2 Date - Integer still in-house and claim represents 002 and CCYYMMDD interim billing for interim payment, MC039 is report the interim through date. populated Address Service External Country Country name of Report the three-character country Provider Code MC 71 12/1/10 External Code char[3] the Service code as defined by ISO 3166-1, All 98% C Country Source 1 Source 1 - Provider Alpha 3. Code - Text Countries Report the DRG number applied to this claim on every line to which it’s applicable. Insurers and health care claims processors shall code using the CMS methodology when Required External available. When the CMS when External Code Diagnostic Code methodology for DRGs is not MC094 = MC 72 DRG 11/8/12 Source 15 - varchar[7] Related Group 98% B Source available, but the All Payer DRG 002 and DRG Code 15 - Text system is used, the insurer shall MC069 is format the DRG and the complexity populated level within the same element with the prefix of "A" and with a hyphen separating the AP DRG from the complexity level (e.g. AXXX-XX)
MC 69 Patient Control Number 10/30/14 Text ID Claim Number Patient Control Number Report the provider assigned Encounter / Visit number to identify patient treatment. Also known as the Patient Account Number. 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% A2 MC 70 Discharge Date 11/8/12 Full Date - Integer Century Year Day - CCYYMMDD int[8] Discharge Date Report the date the member was discharged from the facility in CCYYMMDD Format. If patient is still in-house and claim represents interim billing for interim payment, report the interim through date. Required when MC094 = 002 and MC039 is populated 98% A2 MC 71 Service Provider Country Code 12/1/10 External Code Source 1 - Text Address Country External Code Source 1 - Countries char[3] Country name of the Service Provider Report the three-character country code as defined by ISO 3166-1, Alpha 3. All 98% C MC 72 DRG 11/8/12 External Code Source 15 - Text External Code Source 15 - DRG varchar[7] Diagnostic Related Group Code Report the DRG number applied to this claim on every line to which it’s applicable. Insurers and health care claims processors shall code using the CMS methodology when available. When the CMS methodology for DRGs is not available, but the All Payer DRG system is used, the insurer shall format the DRG and the complexity level within the same element with the prefix of "A" and with a hyphen separating the AP DRG from the complexity level (e.g. AXXX-XX) Required when MC094 = 002 and MC069 is populated 98% B