Report the amount that a prior payer has paid for this claim line. Indicates the submitting Payer is 'secondary' to the prior payer. Only report 0 if the Required Other Prior Payer paid 0 towards this claim when Insurance Amount paid by a MC 97 11/8/12 Integer Currency line, else do not report any value MC038 = 98% A2 Paid Primary Carrier here. Do not code decimal or round 2, 3, 20, or Amount up / down to whole dollars, code zero 21 cents (00) when applicable. 150.00 is reported as EXAMPLE: 15000; 150.70 is reported as 15070 Report the amount Medicare paid towards this claim line. Only report 0 here if Medicare paid 0. If Medicare did not pay towards this claim line do Medicare Required Amount Medicare not report any value here. Do not MC 98 Paid 11/8/12 Integer Currency when 98% A2 paid on claim code decimal or round up / down to Amount MC115 = 1 whole dollars, code zero cents (00) when applicable. EXAMPLE: 150.00 is reported as 15000; 150.70 is reported as 15070 Report the maximum amount contractually allowed, and that a carrier will pay to a provider for a particular procedure or service. This will vary by provider contract and most often it is less than or equal to Required Allowed the fee charged by the provider. when MC 99 11/8/12 Integer Currency Allowed Amount 99% A2 amount Report 0 when the claim line is does not = denied. Do not code decimal or 4, 22, or 23 round up / down to whole dollars, code zero cents (00) when applicable. EXAMPLE: 150.00 is reported as 15000; 150.70 is reported as 15070
MC 97 Other Insurance Paid Amount 11/8/12 Integer Currency Amount paid by a Primary Carrier Report the amount that a prior payer has paid for this claim line. Indicates the submitting Payer is 'secondary' to the prior payer. Only report 0 if the Prior Payer paid 0 towards this claim line, else do not report any value here. Do not code decimal or round up / down to whole dollars, code zero cents (00) when applicable. EXAMPLE: 150.00 is reported as 15000; 150.70 is reported as 15070 Required when MC038 = 2, 3, 20, or 21 98% A2 MC 98 Medicare Paid Amount 11/8/12 Integer Currency Amount Medicare paid on claim Report the amount Medicare paid towards this claim line. Only report 0 here if Medicare paid 0. If Medicare did not pay towards this claim line do not report any value here. Do not code decimal or round up / down to whole dollars, code zero cents (00) when applicable. EXAMPLE: 150.00 is reported as 15000; 150.70 is reported as 15070 Required when MC115 = 1 98% A2 MC 99 Allowed amount 11/8/12 Integer Currency Allowed Amount Report the maximum amount contractually allowed, and that a carrier will pay to a provider for a particular procedure or service. This will vary by provider contract and most often it is less than or equal to the fee charged by the provider. Report 0 when the claim line is denied. Do not code decimal or round up / down to whole dollars, code zero cents (00) when applicable. EXAMPLE: 150.00 is reported as 15000; 150.70 is reported as 15070 Required when does not = 4, 22, or 23 99% A2
v5-apcd-medical-claim-file-submission-guide-REDLINE.docx