2 II. 3 III. 4 Jr. 5 Sr. 0 Unknown / Not Applicable Report the standard code that defines this provider for this line of External Service External Code service. Taxonomy values allow for Code MC 33 Provider 11/8/12 Source 5 - Taxonomy Code the reporting of nurses, assistants All 98% A2 Source 5 Taxonomy Taxonomy and laboratory technicians, where - Text applicable, as well as Physicians, Medical Groups, Facilities, etc. Service Report the city name of provider - Address City City Name of the MC 34 Provider 6/24/10 Text preferably practice location. Do not All 98% B Provider Provider City Name report any value if not available. External Address State Report the of the service Service Code External Code State of the providers as defined by the US MC 35 Provider 11/8/12 char[2] All 98% B Source 2 Source 2 - Service Provider Postal Service. Do not report any State - Text States value if not available. External Address Zip Report the 5 or 9 digit Zip Code as Service Code External Code Zip Code of the defined by the United States Postal MC 36 Provider 11/8/12 varchar[9] All 98% B Source 2 Source 2 - Zip Service Provider Service. When submitting the 9-digit ZIP Code - Text Codes Zip Code do not include hyphen. External Type of Required Code External Code Report the value that defines Bill - on when MC 37 11/8/12 Source Source 14 - int[2] Type of Bill the Type of Bill on an institutional 98% A0 Facility MC094 = 14 - Type of Bill claim. Do not report leading zero. Claims 002 Integer Site of External Service - Required Code External Code Report the two-digit value that on Place of Service when MC 38 11/8/12 Source Source 13 - char[2] defines the Place of Service on 100% A0 NSF/CMS Code MC094 = 13 - Place of Service professional claim. 1500 001 Numeric Claims Lookup Claim Report the value that defines the MC 39 11/8/12 - tlkpClaimStatus varchar[2] Claim Line Status All 98% A0 Status payment status of this claim line. Numeric
2 II. 3 III. 4 Jr. 5 Sr. 0 Unknown / Not Applicable MC 33 Service Provider Taxonomy 11/8/12 External Code Source 5 - Text External Code Source 5 - Taxonomy Taxonomy Code Report the standard code that defines this provider for this line of service. Taxonomy values allow for the reporting of nurses, assistants and laboratory technicians, where applicable, as well as Physicians, Medical Groups, Facilities, etc. All 98% A2 MC 34 Service Provider City Name 6/24/10 Text Address City Provider City Name of the Provider Report the city name of provider - preferably practice location. Do not report any value if not available. All 98% B MC 35 Service Provider State 11/8/12 External Code Source 2 - Text Address State External Code Source 2 - States char[2] State of the Service Provider Report the of the service providers as defined by the US Postal Service. Do not report any value if not available. All 98% B MC 36 Service Provider ZIP Code 11/8/12 External Code Source 2 - Text Address Zip External Code Source 2 - Zip Codes varchar[9] Zip Code of the Service Provider Report the 5 or 9 digit Zip Code as defined by the United States Postal Service. When submitting the 9-digit Zip Code do not include hyphen. All 98% B MC 37 Type of Bill - on Facility Claims 11/8/12 External Code Source 14 - Integer External Code Source 14 - Type of Bill int[2] Type of Bill Report the value that defines the Type of Bill on an institutional claim. Do not report leading zero. Required when MC094 = 002 98% A0 MC 38 Site of Service - on NSF/CMS 1500 Claims 11/8/12 External Code Source 13 - Numeric External Code Source 13 - Place of Service char[2] Place of Service Code Report the two-digit value that defines the Place of Service on professional claim. Required when MC094 = 001 100% A0 MC 39 Claim Status 11/8/12 Lookup - Numeric tlkpClaimStatus varchar[2] Claim Line Status Report the value that defines the payment status of this claim line. All 98% A0