717-718 MCO 60 Term - Abuse of billing 2 Numeric R Enrollment privileges Termination 61 Term - Action Taken by Code 1 Medicaid/CHIP 62 Term - Action Taken by Medicare 63 Term - Change of Ownership 64 Term - Failure to report a change of address/ownership 65 Term - False or misleading information 66 Term - Federal exclusion/ debarment, etc. 67 Term - Felony conviction 68 Term - Involuntary Termination 69 Term - License Expired 70 Term - License Revoked 71 Term - Loss of license or other State action 72 Term - Medicare/Medicaid Exclusion 73 Term - Medicaid Authority 74 Term - Medicare Termination 75 Term - Misuse of billing number 76 Term - No Claims Activity 77 Term - Non-Compliance 78 Term - Onsite review/ Provider is no longer operational 79 Term - Other 80 Term - Provider Deceased 81 Term - State exclusion/ debarment, etc. 82 Term - Unknown 83 Term - Voluntary Termination Blank if contract is still enforce 719-719 Delimiter Use the ^ character value 1 Character R 720-727 MCO Effective beginning date of 8 Date O Enrollment services which can be paid by Begin Date 2 MCO 728-728 Delimiter Use the ^ character value 1 Character R 729-736 MCO Effective ending date of services 8 Date O Enrollment End of which can be paid by MCO Date 2 20991231 if no ending date is available. 737-737 Delimiter Use the ^ character value 1 Character R
717-718 MCO Enrollment Termination Code 1 60 Term - Abuse of billing privileges 61 Term - Action Taken by Medicaid/CHIP 62 Term - Action Taken by Medicare 63 Term - Change of Ownership 64 Term - Failure to report a change of address/ownership 65 Term - False or misleading information 66 Term - Federal exclusion/ debarment, etc. 67 Term - Felony conviction 68 Term - Involuntary Termination 69 Term - License Expired 70 Term - License Revoked 71 Term - Loss of license or other State action 72 Term - Medicare/Medicaid Exclusion 73 Term - Medicaid Authority 74 Term - Medicare Termination 75 Term - Misuse of billing number 76 Term - No Claims Activity 77 Term - Non-Compliance 78 Term - Onsite review/ Provider is no longer operational 79 Term - Other 80 Term - Provider Deceased 81 Term - State exclusion/ debarment, etc. 82 Term - Unknown 83 Term - Voluntary Termination Blank if contract is still enforce 2 Numeric R 719-719 Delimiter Use the ^ character value 1 Character R 720-727 MCO Enrollment Begin Date 2 Effective beginning date of services which can be paid by MCO 8 Date O 728-728 Delimiter Use the ^ character value 1 Character R 729-736 MCO Enrollment End Date 2 Effective ending date of services of which can be paid by MCO 20991231 if no ending date is available. 8 Date O 737-737 Delimiter Use the ^ character value 1 Character R
PIHP_CSoC_SystemsCompanionGuide-Sept2018_V12.docx