Report the code that applies to Required External External Code facility claims where Type of Bill = an when Admission Code Source 14 - Admission Source MC 22 11/8/12 char[1] inpatient setting. This code indicates = 002 and 98% A1 Source Source Admission Code how the patient was referred into an MC039 is 14 - Text Source inpatient setting at the facility. populated Report the Discharge Time in HHMM Format. Only applies to facility claims Required Type of Bill = an inpatient when Discharge Time Period setting. Time is expressed in military MC094 = MC 23 11/8/12 Numeric char[4] Discharge Time 5% C Hour Hour Minutes time. If only the hour is known, code 002 and the minutes as 00. 4 AM would be MC069 is reported as 0400; 4 PM would be populated reported as 1600. Required External External Code when Code Inpatient Report the appropriate Discharge Discharge Source 14 - MC094 = MC 24 11/8/12 Source char[2] Discharge Status Status Code of the patient as defined 98% A1 Status Discharge 002 and 14 - Code by External Code Source Status MC069 is Numeric populated Report the carrier / submitter assigned service provider number. This number should be the identifier Service Service Provider ID Link to used for internal identification MC 25 Provider 6/24/10 Text Identification All 99% A1 24 PV002 purposes, and does not routinely Number Number change. The value in this field must match a record in the provider file in PV002. Service Report the Federal Tax ID of the Provider Service Provider's MC 26 11/8/12 Numeric ID Tax char[9] Service Provider here. Do not use All 97% C Tax ID Tax ID number hyphen or alpha prefix. Number Report the Primary National Provider National External External Code National Provider ID (NPI) of the Service Provider in Provider Code Source 3 - Identification (NPI) MC 27 11/8/12 int[10] This ID should be found on the All 98% C ID - Source 3 National of the Service Provider File in the NPI Field Service - Integer Provider ID Provider (PV039)
MC 22 Admission Source 11/8/12 External Code Source 14 - Text External Code Source 14 - Admission Source char[1] Admission Source Code Report the code that applies to facility claims where Type of Bill = an inpatient setting. This code indicates how the patient was referred into an inpatient setting at the facility. Required when = 002 and MC039 is populated 98% A1 MC 23 Discharge Hour 11/8/12 Numeric Time Period Hour Minutes char[4] Discharge Time Report the Discharge Time in HHMM Format. Only applies to facility claims Type of Bill = an inpatient setting. Time is expressed in military time. If only the hour is known, code the minutes as 00. 4 AM would be reported as 0400; 4 PM would be reported as 1600. Required when MC094 = 002 and MC069 is populated 5% C MC 24 Discharge Status 11/8/12 External Code Source 14 - Numeric External Code Source 14 - Discharge Status char[2] Inpatient Discharge Status Code Report the appropriate Discharge Status Code of the patient as defined by External Code Source Required when MC094 = 002 and MC069 is populated 98% A1 MC 25 Service Provider Number 6/24/10 Text ID Link to PV002 Service Provider Identification Number Report the carrier / submitter assigned service provider number. This number should be the identifier used for internal identification purposes, and does not routinely change. The value in this field must match a record in the provider file in PV002. All 99% A1 MC 26 Service Provider Tax ID Number 11/8/12 Numeric ID Tax char[9] Service Provider's Tax ID number Report the Federal Tax ID of the Service Provider here. Do not use hyphen or alpha prefix. All 97% C MC 27 National Provider ID - Service 11/8/12 External Code Source 3 - Integer External Code Source 3 - National Provider ID int[10] National Provider Identification (NPI) of the Service Provider Report the Primary National Provider ID (NPI) of the Service Provider in This ID should be found on the Provider File in the NPI Field (PV039) All 98% C 24