Patient 1/1/2003 Text 2 Required for all inpatient claims Discharge Refer to Appendix A Status MC024 Rendering 1/1/2003 Text 30 Payer assigned rendering Provider provider number Number MC025 Rendering 1/1/2003 Text 10 Federal taxpayer’s identification Provider Tax ID number Number MC026 National 4/1/2004 Text 20 National Provider ID for Provider ID Rendering Provider – Rendering This data element pertains to Provider the entity or individual directly providing the service. Refer to Appendix A MC027 Rendering 4/1/2004 Number 1 HIPAA provider taxonomy Provider Entity classifies provider groups Type Qualifier (clinicians who bill as a group practice or under a corporate name, even if that group is composed of one provider) as a and these shall be “person”, coded as a person. to Appendix A MC028 Rendering 1/1/2003 Text 40 Individual first name Provider First Leave blank if provider is a Name facility or organization. MC029 Rendering 1/1/2003 Text 25 Individual middle name or initial
Patient Discharge Status 1/1/2003 Text 2 Required for all inpatient claims Refer to Appendix A MC024 Rendering Provider Number 1/1/2003 Text 30 Payer assigned rendering provider number MC025 Rendering Provider Tax ID Number 1/1/2003 Text 10 Federal taxpayer’s identification number MC026 National Provider ID – Rendering Provider 4/1/2004 Text 20 National Provider ID for Rendering Provider This data element pertains to the entity or individual directly providing the service. Refer to Appendix A MC027 Rendering Provider Entity Type Qualifier 4/1/2004 Number 1 HIPAA provider taxonomy classifies provider groups (clinicians who bill as a group practice or under a corporate name, even if that group is composed of one provider) as a “person”, and these shall be coded as a person. to Appendix A MC028 Rendering Provider First Name 1/1/2003 Text 40 Individual first name Leave blank if provider is a facility or organization. MC029 Rendering 1/1/2003 Text 25 Individual middle name or initial