OF Other Federal Program TF HSN Trust Fund TV Title V VA Veterans Administration Plan WC Workers' Compensation ZZ Other Payer Payer Claim Report the Unique identifier within the Claim ID Claim DC 4 6/24/10 Text varchar[35] Control payer's system that applies to the entire All 100% A0 Control Number Identification claim. Number Report the line number for this service Line Incremental within the Start with 1 and increment DC 5 11/8/12 Integer ID Count varchar[4] All 100% A0 Counter Line Counter by 1 for each additional line. Do not start with 0, include alphas or special characters. Report the version number of this Claim Service service line. The version number begins Version DC 6 7/6/10 Integer Counter varchar[4] Line Version with 0 and is incremented by 1 for each All 100% A0 Number Number subsequent version of that service line. No alpha or special characters. Insured Report the number that defines the insured Group or Group / Policy group or policy. Do not report the number DC 7 11/8/12 Text ID Group varchar[30] All 98% C Policy Number that uniquely identifies the subscriber or Number member. Report the Subscriber's SSN here; used to Subscriber's validate Unique Member ID; will not be DC 8 11/8/12 Numeric ID Tax char[9] Social Security passed into analytic file. Do not use All 70% B SSN Number hyphen. If not available do not report any value here. Report the Plan assigned contract number. Plan Do not include values in this element that Specific Contract will distinguish one member of the family DC 9 6/24/10 Text ID Contract varchar[30] All 70% C Contract Number from another. This should be the contract Number or certificate number for the subscriber and all of the dependents.
OF Other Federal Program TF HSN Trust Fund TV Title V VA Veterans Administration Plan WC Workers' Compensation ZZ Other DC 4 Payer Claim Control Number 6/24/10 Text ID Claim Number varchar[35] Payer Claim Control Identification Report the Unique identifier within the payer's system that applies to the entire claim. All 100% A0 DC 5 Line Counter 11/8/12 Integer ID Count varchar[4] Incremental Line Counter Report the line number for this service within the Start with 1 and increment by 1 for each additional line. Do not start with 0, include alphas or special characters. All 100% A0 DC 6 Version Number 7/6/10 Integer Counter varchar[4] Claim Service Line Version Number Report the version number of this service line. The version number begins with 0 and is incremented by 1 for each subsequent version of that service line. No alpha or special characters. All 100% A0 DC 7 Insured Group or Policy Number 11/8/12 Text ID Group varchar[30] Group / Policy Number Report the number that defines the insured group or policy. Do not report the number that uniquely identifies the subscriber or member. All 98% C DC 8 SSN 11/8/12 Numeric ID Tax char[9] Subscriber's Social Security Number Report the Subscriber's SSN here; used to validate Unique Member ID; will not be passed into analytic file. Do not use hyphen. If not available do not report any value here. All 70% B DC 9 Plan Specific Contract Number 6/24/10 Text ID Contract varchar[30] Contract Number Report the Plan assigned contract number. Do not include values in this element that will distinguish one member of the family from another. This should be the contract or certificate number for the subscriber and all of the dependents. All 70% C
v3-1-apcd-dental-claim-file-submission-guide-2013-06.docx