MCO - MassHealth Managed Care 4 Organization Enrollee 5 Supplemental Policy Enrollee ICO - Integrated Care Organization or 6 SCO Senior Care Option – 0 Unknown / Not Applicable Claim Lookup Line Paid Report the value that defines the element. DC 69 Line Paid 10/30/14 Table - int[1] Required 100% B Indicator EXAMPLE: 1 = Yes, Claim Line was paid. Flag Integer Value Description 1 Yes 2 No 3 Unknown 4 5 Not Applicable Report DC here. This validates the type of Record File Type DC 70 11/8/12 Text ID File char[2] file and the data contained within the file. All 100% A0 Type Identifier This must match HD004 TR Record Trailer Record Report here. Indicates the end of the 1 6/24/10 Text ID Record char[2] Mandatory 100% TM Type Identifier data file Trailer Submitter / Report the Unique Submitter ID as defined 2 Submitter 11/8/12 Integer ID Submitter varchar[6] Carrier ID by CHIA here. This must match the Mandatory 100% TM defined by Submitter ID reported in HD002 CHIA
4 MCO - MassHealth Managed Care Organization Enrollee 5 Supplemental Policy Enrollee 6 ICO - Integrated Care Organization or SCO – Senior Care Option 0 Unknown / Not Applicable DC 69 Claim Line Paid Flag 10/30/14 Lookup Table - Integer int[1] Line Paid Indicator Report the value that defines the element. EXAMPLE: 1 = Yes, Claim Line was paid. Required 100% B Value Description 1 Yes 2 No 3 Unknown 4 5 Not Applicable DC 70 Record Type 11/8/12 Text ID File char[2] File Type Identifier Report DC here. This validates the type of file and the data contained within the file. This must match HD004 All 100% A0 1 Record Type 6/24/10 Text ID Record char[2] Trailer Record Identifier Report TR here. Indicates the end of the data file Mandatory 100% TM 2 Submitter 11/8/12 Integer ID Submitter varchar[6] Trailer Submitter / Carrier ID defined by CHIA Report the Unique Submitter ID as defined by CHIA here. This must match the Submitter ID reported in HD002 Mandatory 100% TM