Report the version number of this claim service line. The version Claim Service Version number begins with 0 and is MC 6 6/24/10 Integer Counter varchar[4] Line Version All 100% A0 Number incremented by 1 for each Number subsequent version of that service line. No alpha or special characters. Insured Report the number that defines the or Group / Policy insured or policy. Do not report MC 7 6/24/10 Text ID Group All 98% A2 06 Policy Number the number that uniquely identifies Number the subscriber or member. Do not populate with any data. MC 8 Filler 2/2017 text Filler char[0] Filler All 100% A0 07 Required to be NULL. Report the Plan assigned contract number. Do not include values in Plan this field that will distinguish one Specific MC 9 6/24/10 Text ID Contract Contract Number member of the family from another. All 98% A2 08 Contract This should be the contract or Number certificate number for the subscriber and all of the dependents. Member Member/Patient's Report the unique number / identifier Suffix or Contract MC 10 6/24/10 Text ID Sequence of the member / patient within the All 98% A2 Sequence Sequence contract. Number Number Do not populate with any data. MC 11 Filler 2/2017 text Filler char[0] Filler All 100% A0 Required to be NULL. Report the value that defines the Individual Lookup Patient to Patient's relationship to the MC 12 6/24/10 Table char[2] Subscriber All 98% B Subscriber. EXAMPLE: 20 = Self / Code Text Relationship Code Employee Value Description Spouse Grandfather or Grandmother Grandson or Granddaughter Nephew or Niece
MC 6 Version Number 6/24/10 Integer Counter varchar[4] Claim Service Line Version Number Report the version number of this claim service line. The version number begins with 0 and is incremented by 1 for each subsequent version of that service line. No alpha or special characters. All 100% A0 MC 7 Insured or Policy Number 6/24/10 Text ID Group Group / Policy Number Report the number that defines the insured or policy. Do not report the number that uniquely identifies the subscriber or member. All 98% A2 MC 8 Filler 2/2017 text Filler char[0] Filler Do not populate with any data. Required to be NULL. All 100% A0 MC 9 Plan Specific Contract Number 6/24/10 Text ID Contract Contract Number Report the Plan assigned contract number. Do not include values in this field that will distinguish one member of the family from another. This should be the contract or certificate number for the subscriber and all of the dependents. All 98% A2 MC 10 Member Suffix or Sequence Number 6/24/10 Text ID Sequence Member/Patient's Contract Sequence Number Report the unique number / identifier of the member / patient within the contract. All 98% A2 MC 11 Filler 2/2017 text Filler char[0] Filler Do not populate with any data. Required to be NULL. All 100% A0 MC 12 Individual Code 6/24/10 Lookup Table Text char[2] Patient to Subscriber Relationship Code Report the value that defines the Patient's relationship to the Subscriber. EXAMPLE: 20 = Self / Employee All 98% B Value Description Spouse Grandfather or Grandmother Grandson or Granddaughter 07 Nephew or Niece 06 08